Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Questions and Answers, Exams of Nursing

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Pharmacotherapeutics for Advanced

Practice Nurse Prescribers questions

with correct answers

Nurse practitioner prescriptive authority is regulated by who? - ** VERIFIED ANSWERS ** ✔✔ The State Board of Nursing for Each State What is the benefits of having an APRN prescriber? - ** VERIFIED ANSWERS ** ✔✔ APRN's care for patients more holistically and include patients in making decisions regarding their care What does clinical judgement in prescribing include? - ** VERIFIED ANSWERS ** ✔✔ Factoring in the cost of the particular What is included in the criteria for choosing and effective drug for a disorder? - ** VERIFIED ANSWERS ** ✔✔ Consulting nationally recognized guidelines for disease management NP's thrive under the new health-care reform because of what? - ** VERIFIED ANSWERS ** ✔✔ NP's have the ability to control care cost and improve patient outcome Nutritional intake and lab results reflect hypoalbuminemia; why is this important for prescribers? - ** VERIFIED ANSWERS ** ✔✔ The Distribution of drugs to target tissues may be affected Drugs that have an significant first-pass effect what? - ** VERIFIED ANSWERS ** ✔✔ they are rapidly metabolized by the liver and may have little if any desired action The route of excretion of a volatile drug will likely be? - ** VERIFIED ANSWERS ** ✔✔ Lungs

Medroxyprogesterone (Depo Provera) is prescribed IM to create storage reservoir of the drug. What are storage reserviors> - ** VERIFIED ANSWERS ** ✔✔ Increased the length of time a drug is available and active Why is Cephalexin given every 8 hours? What knowledge of the drug does the NP know? - ** VERIFIED ANSWERS ** ✔✔ Half Life Azithromycin doing requires that the first day's doing be twice those of the other four day; This is considered a loading does. What is a loading dose? - ** VERIFIED ANSWERS ** ✔✔ Rapidly actives drug levels in the therapeutic range The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - ** VERIFIED ANSWERS ** ✔✔ Onset of action Phenytoin required that a trough level be drawn. When and why are peak and trough levels are done - ** VERIFIED ANSWERS ** ✔✔ To determine if a d rug is in the therapeutic range Drugs that are receptor agonists may demonstrate what property? - ** VERIFIED ANSWERS ** ✔✔ Concentrations will produce an adverse effect Factors that affect gastric drug absorption include - ** VERIFIED ANSWERS ** ✔✔ Lipid solubility of the drug Drugs that are receptors antagonists, such as beta-blockers, may cause what? - ** VERIFIED ANSWERS ** ✔✔ An exaggerated response if abrupt discontinues Drug administration via IV:

1. need to be lipid soluble in order to absorb easily
2. Begin distribution in the body immediately
3. Are easily absorbed if they are nonionized

parent drug and they are totally deactivated so they are excreted without and effect; it depends on the medication being given What causes the body to increased the excretion of a drug through the renal system - ** VERIFIED ANSWERS ** ✔✔ Unbinding a nonvolatile drug from plasma proteins. What is "steady state"? - ** VERIFIED ANSWERS ** ✔✔ When the amount of the drug in the body remains constant When two pain medications are given together to treat pain, what kind of drug-to- drug interaction occurs? - ** VERIFIED ANSWERS ** ✔✔ Additive Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:

1. Reducing the dosage of one of the drugs
2. Scheduling their administration at different times
3. Prescribing a third drug to counteract the adverse reaction of the combination
4. Reducing the dosage of both drugs - ** VERIFIED ANSWERS ** ✔✔ Prescribing a third drug to counteract the adverse reaction of the combination What reduces the inhibition properties of Phase 1 Oxidative reductive process of drug metabolism? - ** VERIFIED ANSWERS ** ✔✔ What is the period of time called that it takes for a drug too decreased by 50% in the body? - ** VERIFIED ANSWERS ** ✔✔ Half Life Drug antagonism is best defined as an effect of a drug that:

1. Leads to major physiological and psychological dependence
2. Is modified by the concurrent administration of another drug
3. Cannot be metabolized before another dose is administered

4. Leads to a decreased physiological response when combined with another drug - ** VERIFIED ANSWERS ** ✔✔ Is modified by the concurrent administration of another drug What happens when a drug antagonist is given regularly? - ** VERIFIED ANSWERS ** ✔✔ Down regulated the number of specific receptors What should be included in the education fo those who are prescribed oral enteric coated tables - ** VERIFIED ANSWERS ** ✔✔ To achieve best effect, take the tablet with at least 8 oz of fluids What is the main reason for not crushing a sustained-released. capsule? - ** VERIFIED ANSWERS ** ✔✔ It can cause toxicity What medication in the follow is mostly absorbed in the intestines rather than the stomach?

1. Sodium bicarb
2. ascorbic acid
3. salicylic acid
4. glucose - ** VERIFIED ANSWERS ** ✔✔ Sodium Bicarb Which of the following variables is a factor in drug absorption?
5. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
6. A rich blood supply to the area of absorption leads to better absorption.
7. The less soluble the drug, the more easily it is absorbed.
8. Ionized drugs are easily absorbed across the cell membrane. - ** VERIFIED ANSWERS ** ✔✔ A rich blood supply of the are of absorption leads to better absorption What is an advantage of prescribing a sublingual medication? - ** VERIFIED ANSWERS ** ✔✔ Absorbed rapidly

When determining drug treatment, what should an NP always do? - ** VERIFIED ANSWERS ** ✔✔ Individualize the drug choice for the specific patient What should patient education include when prescribing a medication? - ** VERIFIED ANSWERS ** ✔✔ Discussion on adverse effects of the medication Passive monitoring of drug effectiveness includes:

1. Therapeutic drug levels
2. Adding or subtracting medications from the treatment regimen
3. Ongoing provider visits
4. Instructing the patient to report if the drug is not effective - ** VERIFIED ANSWERS ** ✔✔ Instructing the patient to report if the drug is not effective Pharmacokinetic factors that affect prescribing include - ** VERIFIED ANSWERS ** ✔✔ Bioavailability What recommendations bu the Institute of Medicine were made to address the impact of pharmaceutical promotion - ** VERIFIED ANSWERS ** ✔✔ Conflicts of interest and financial relationships should be disclosed by those providing education Under new U.S. FDA labeling, Pregnancy Categories will be: - ** VERIFIED ANSWERS ** ✔✔ Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label What does the US FDA Regulate? - ** VERIFIED ANSWERS ** ✔✔ The official labeling of all prescriptions and over the counter drugs What is approval of the FDA required for? - ** VERIFIED ANSWERS ** ✔✔ Medical devices, including artificial joints When is an investigational new drug filed with the FDA? - ** VERIFIED ANSWERS ** ✔✔ Prior to human testing of any new drug entity

Phase IV clinical trials in the US are also known as - ** VERIFIED ANSWERS ** ✔✔ Postmarketing research trials Is off-label prescribing legal? - ** VERIFIED ANSWERS ** ✔✔ yes if there is scientific evidence for the use What does the US Drug Enforcement Administration Regulate? - ** VERIFIED ANSWERS ** ✔✔ Registers manufacturers and prescribers of controlled substances Are drugs that are disgnedated Schedule II by the DEA refillable - ** VERIFIED ANSWERS ** ✔✔ No. A new prescription needs to be written What are some precautions when prescribing a controlled substance? - ** VERIFIED ANSWERS ** ✔✔ Using tamper-proof paper for all prescriptions written for controlled drugs. What are some strategies for prescribers to use to prevent the misuse of controlled prescriptions? - ** VERIFIED ANSWERS ** ✔✔ Use a chemical dependency screening tool; fir limit-setting regarding controlled substances; and practicing saying no to deal with patients who are push overs What are some behaviors that predict addition to controlled substances - ** VERIFIED ANSWERS ** ✔✔ Stealing and borrowing another patients drugs When are medications agreements/pain medication contracts recommended? - ** VERIFIED ANSWERS ** ✔✔ Universally for all medications prescribed for chronic pain When and what do prescriptions needs to be written - ** VERIFIED ANSWERS ** ✔✔ Medical devices, controlled drugs, and legend drugs Based on the patients below, who is at high risk for experiencing an adverse drug reaction?

What time of reaction is someone using a corticosteroid at risk for? - ** VERIFIED ANSWERS ** ✔✔ Type C Why do immunomodulators such as azathioprine cause a delayed reaction (type D reaction) - ** VERIFIED ANSWERS ** ✔✔ because they are carcinogens An example of a first-dose reaction that may occur includes:

1. Orthostatic hypotension that does not occur with repeated doses
2. Purple glove syndrome with phenytoin use
3. Hemolytic anemia from ceftriaxone use
4. Contact dermatitis from neomycin use - ** VERIFIED ANSWERS ** ✔✔ Orthostatic hypotension that does not occur with repeated doses Drugs that are prone to cause adverse drug reactions include - ** VERIFIED ANSWERS ** ✔✔ Insulins US FDA MedWatch system is activated when: - ** VERIFIED ANSWERS ** ✔✔ An adverse even or serious problem occurs with a medication that is not already identified on the label The Vaccine Adverse Events Reporting System is - ** VERIFIED ANSWERS ** ✔✔ A voluntary reporting system that healthcare providers or consumers may use to report vaccine adverse events What is pharmacoeconomics? - ** VERIFIED ANSWERS ** ✔✔ The analysis of the cost and consequences of any health-care related treatment or services The direct cost of drug therapy includes - ** VERIFIED ANSWERS ** ✔✔ Pain and suffering due to inadequate drug therapy Indirect costs associated with drug therapy include? - ** VERIFIED ANSWERS ** ✔✔ Loss of wages while undergoing drug therapy

The intangible cost of drug therapy include? - ** VERIFIED ANSWERS ** ✔✔ Inconvenience, pain, and suffering incurred with therapy What is it called when a pharmacoeconomic analysis takes place regarding two similar treatments for a disease? - ** VERIFIED ANSWERS ** ✔✔ Cost-minimization analysis Cost-effectiveness analysis compares two or more treatments or programs that are:

• ** VERIFIED ANSWERS ** ✔✔ not necessarily therapeutically equivalent When the cost of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as - ** VERIFIED ANSWERS ** ✔✔ Cost-benefit analysis What is a two-tiered prescription benefit plan? - ** VERIFIED ANSWERS ** ✔✔ Higher co-pay for brand name drugs than for generic drugs When a provider proscribes a less expensive drug what does it increase and how? - ** VERIFIED ANSWERS ** ✔✔ Compliance & by decreasing the financial burden set on the patient When someone asks to explain what a coverage plan means, such as a Medicare plan, what should the NP do? - ** VERIFIED ANSWERS ** ✔✔ Refer the patient to a Medicare Specialist at his insurance carrier to explain the benefits of his insurance Digoxin levels need to be monitored closely when the following medication is started:

1. Loratadine
2. Diphenhydramine
3. Ipratropium
4. Albuterol - ** VERIFIED ANSWERS ** ✔✔ Albuterol Patients with pheochromocytoma should avoid what class of drug and why? - ** VERIFIED ANSWERS ** ✔✔ Beta-2-Agonists as it causes hypertensive crisis

1. Fluticasone
2. Cetirizine (Zyrtec)
3. OTC Cromolyn Nasap Spray (Nasalcrom)
4. Any of the Above? - ** VERIFIED ANSWERS ** ✔✔ Any of the above What should be monitor for those who are taking diphenhydramine? - ** VERIFIED ANSWERS ** ✔✔ Urinary retention Why are second generation antihistamines such as Claritin taking for seasonal allergies instead of first generation? - ** VERIFIED ANSWERS ** ✔✔ They are less sedating then first generation antihistamines Who can be prescribed Sudafed? - ** VERIFIED ANSWERS ** ✔✔ Anyone over the age of 4 years old In what populations should cough and cold medicines that contain sympathomimetic decongestion be used cautiously? - ** VERIFIED ANSWERS ** ✔✔ Older adults, infects, and hypertensive patients What is the first line decongestant for someone who is hypertensive? - ** VERIFIED ANSWERS ** ✔✔ Nasal Oxymetazoline What is the first line treatment for a 5 year old with a URI? - ** VERIFIED ANSWERS ** ✔✔ Fluids and symptomatic care What is an effective, cost effective treatment for impetigo form an insect bite? - ** VERIFIED ANSWERS ** ✔✔ Bacitracin and Ploymixin B What are the instructions for applying a topical antibiotic or antiviral ointment? - ** VERIFIED ANSWERS ** ✔✔ Was hands before and after the application of topical antimicrobials