NR 565 Advanced Pharmacology Fundamentals Midterm Exam Test Bank 2026 Latest Questions and Answers

Chamberlain College NR 565-Advanced Pharmacology Fundamentals Midterm Exam Test Bank 2025 Latest Questions and Answers Up to Date and Verified Complete Solution PackageNR 565 Midterm Exam Test Bank QUESTION Drugs not safe to take with opioids? Answer: -Benzos -Other opioids -Antihistamines - CNS depressants QUESTION What are the key responsibilities of prescribing opioids? Answer: -Check the PDMP -Assess for abuse -Non pharm options used -Assess when to d/c -Med reconciliation -Give lowest dose -Provide education -Never prescribe to family or friends QUESTION In what patient population are statins contraindicated?Answer: -Pregnancy QUESTION In what patient population is Warfarin contraindicated? Answer: -Pregnancy (typically Heparin or lovenox is used) QUESTION What patient population needs a lower dose of Warfarin? Answer: Pediatrics QUESTION What BP meds are okay to use during pregnancy? Answer: -Labetalol -Methaldopa little mama QUESTION What are some examples of drug-drug interactions of Warfarin? Answer: -Carba- mazepine -Aspirin -Dig -Amiodarone-Vit K -Phenobarbital -birth control -Phenytoin QUESTION Statins can have potentiating AE effects from which inhibitor? Answer: -Grapefruit from CYP family QUESTION Furosemide can have a drug-drug interaction with what medications? Answer: - -Potassium sparing meds -Digoxin -gentamycin (auto toxic) QUESTION What are some medications for the treatment of Angina? Answer: -Nifedipine -Nitro -beta blockers -ranolazine QUESTION Contraindications for Ranolazine?Answer: -QT prolongation and drugs that may cause QT prolongation -Liver impairment -Renal impairment QUESTION A 41 year old patient comes into the clinic complaining of increased heart rate after starting Nitro patches for stable angina. What would an appropriate response be? 1. Lets lower the dose and frequency of use 2. I will prescribe a beta blocker to help with this 3. Next time this happens, lie down and practice deep breathing, this will bring your heart rate down. Answer: 2. I will prescribe a beta blocker to help with this. (Barrow receptor reflex- when the pressure senses that the blood pressure dropped, it tells the heart to raise the HR leading to reflex tachycardia) QUESTION HF and HTN What is the role of aldosterone? Answer: Increase sodium and water retention angio 1 -- angio 2- constricts the blood vessels and promotes the stimulation of aldosterone QUESTION AE of aldosterone? Answer: Increases heart fibrosis, remodeling of the heart, causing fibrotic changes. QUESTION A patient with HF develops fibrotic changes, what should the provider do next?Answer: -Initiate: -ACE inhibitor -ARBS -DRI They decrease aldosterone production by acting on angio 2 QUESTION How to mitigate adverse effects of aldosterone? Answer: -implement ACE inhibitors -ARBS -anything that stops angio 2 QUESTION For the general population what class of HTN medication is appropriate?- Answer: -Thiazides considering no comorbid issues QUESTION For a CKD patient, what class of HTN is appropriate? Answer: -ACE inhibitors help vasodilate the vassals in the kidneys -If a cough develops or med not tolerated start ARBS QUESTION For the Africans American patient, what class of HTN medication is appropriate? Answer:-Thiazide & CCB -Avoid ACEI QUESTION What is contraindicated in ACEI? Answer: -Pregnancy in the 2nd and 3rd trimesters -Bilateral renal stenosis -Hypotension, renal failure, hx of ACEI-induced cough or angioedema QUESTION What is contraindicated in Ranolazine? Answer: -QT prolongation history QUESTION What is contraindicated in Beta Blockers? Answer: -Asthma** -Diabetics (Can mask hypoglycemia) -Bradycardia, persistent hypotension, advanced heart block Can promote constriction of vessels in the airway QUESTION Clinic tools used to treat hyperlipidemia? Answer: -ASCVD (Risk assessment score based on LDL, Age, ethnicity, cholesterol levels what you are at risk for) helps decide intensity of the statinQUESTION When would you use the ASCVD? Answer: When risk factors are present (smok- er)(sedentary) QUESTION A 55 year old male comes into the clinic with gouty arthritis. He states that he has one flareup a year. your response is? 1. I will prescribe you glucocorticoids to help with inflammation 2. Lets start you on a prophylactic therapy of colchicine. 3. It will be helpful to take an NSAID to start with to help relieve some inflammation. Ill prescribe Naproxen Answer: 3. It will be helpful to take an NSAID to start with to help relieve some inflammation. Ill prescribe Naproxen or indomethacin (NSAIDS are first line) QUESTION A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it just hasn't helped. He asks, "what are my options" He further states that he has attacks every few years but when he does NSAIDS "never help". Your response is? 1. I can prescribe a glucocorticoid and that will bring down the inflamma- tion/pain. 2. Have you tried increasing your dosage of NSAIDS and drink plenty of water. 3. Lets start by making some changes in your diet, can you tell me what you eat regularly. Answer: 1. I can prescribe a glucocorticoid and that will bring down the inflammation/pain. (but 1 & 3 are right) (2nd line is a steroid) (stay away from beer)QUESTION Colchicine is considered for long-term treatment if a person has or more gouty attacks per year. Answer: 3 QUESTION Colchicine should not be taken with what meds? Answer: Statins- because similar side effects QUESTION Side effects of Colchicine Answer: Nausea, vomiting, diarrhea, myelosuppression and myopathy QUESTION Side effects of Allopurinol Answer: SCAR can develop, generally well tolerated with minimal GI and neuro effects QUESTION Side effects of Probenecid Answer: Take with food to minimize GI side effects and drink 2. 5-3L of water to prevent uric acid crystal formation in the kydneys QUESTION True or FalseColchicine requires a renal and liver dose adjustment? Answer: True -We don't start with allopurinol or colchicine because it can precipitate another attack QUESTION What should be Co-administered with febuxostat? Answer: (lowers urate levels) (can cause flare ups) NSAIDS or Colchicine for about six months QUESTION Which schedule drugs can APRNs prescribe? Answer: Schedule 2-5 drugs; collabo- rative QUESTION Who determines and regulates prescriptive authority? Answer: o State law deter- mines the prescriptive authority o Health professional board (Board of Nursing) regulates the prescriptive authority QUESTION How does limited prescriptive authority impact patients within the health- care system? Answer: o This creates numerous barriers to quality, affordable, and acces- sible patient care o Requirement to obtain physician cosign on prescriptions may increase patient waits ): o Restrictions on the distance of APRNs from physicians may prevent outreach to areas of most needQUESTION What are the key responsibilities of prescribing? Answer: -The ability to prescribe medications is both a privilege and a burden. Have a documented providerpatient relationship, do not prescribe medications to family or friends or yourself, exercise Safe and competent practice -Document a thorough history and physical examination, including any discussions you have with the patient about risk factors, side effects, or therapy options, have documented plan regarding drug monitoring or titration if you consult additional providers not that you did so. Use the references provided in the following boxes to assist in safely and rationally choosing one medication over another. -Be sensible, accept responsibility, do not fear it, know constraints and limitations, always learn and update, keep Rx pads in a safe place, confirm allergies, verify medication list with the patient, do not let insurance dictate the quantity of Rx, Charting is key (particularly with off label use), Provide use and rationale. QUESTION What should be used to make prescribing decisions? Answer: -The best way to keep your patients (and yourself) safe is to be prudent and deliberate in your decisionmaking process. -Follow CPG o Cost o Guidelines o Availability o Interactions o Side effects o Allergies o Hepatic and renal function o Need for monitoring o Special populations -Cost, availability, current practice guidelines, medication interactions including in- teractions with food, side effects, need for monitoring, how the drug is metabolized (hepatic or renal), special populations (pregnancy, nursing, older adults) QUESTION Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how that would translate to baseline information needed to pre- scribe.Answer: o Pharmacokinetic changes: Decreased absorption d/t increased gastric pH, decreased absorptive surface area decreased splanchnic blood flow, decreased GI motility, delayed gastric emptying Decreased Distribution of drugs d/t increased body fat, decreased lean body mass, decreased serum albumin, decreased cardiac output Decreased metabolism of drugs d/t decreased hepatic blood flow, decreased hepat- ic mass, decreased activity of hepatic enzymes Decreased excretion of drugs d/t decreased renal blood flow, glomular filtration rate, decreased tubular secretion, and decreased the number of nephrons. o Beta-adrenergic blocking agents (primarily used for cardiac disorders) are less effective in older adults than in younger adults. Possible reduction in the number of beta receptors and a reduction in the affinity of beta receptors for beta receptor blocking agents. o Other drugs such as warfarin and central nervous system depressants produce effects that are more intense in older adults. QUESTION Beer's Criteria What is it? Answer: This is a list created recently updated by the American geriatrics society designed to reduce older adults' drug-related problems including, but not limited to exposure to potentially inappropriate medications, drug-disease interactions, and medications that warrant extra caution in the older adult population. QUESTION Beer's Criteria Why is it important? Answer: It's important because older adults experience the highest prevalence of adverse drug events and many of these events are avoidable. QUESTION Impacts/outcomes of polypharmacyAnswer: nonadherence, inability to pay for med- ications, failure to comprehend the regimen increased Drug-drug interactions. Polypharmacy greatly increases the risk of interactions. Drug interactions with mild side effects to lifethreatening consequences. The Elderly is at a higher risk of polypharmacy due to taking five or more medications daily. QUESTION CYP450 inhibitors mnemonic Answer: SICKFACES. COM S- Sodiumvalporate I-Isoniziad C- Cimetdine K- Ketocanozole F-Fluconazole A- Alcohol - binge C-Chloramphenicol E-Erythromycin S-Sulfonamides C-Ciprofloxacin O-Omerprazole M- Metronidazole GGrapefruit Juice QUESTION CYP450 inhibitors examples Answer: Liver enzymes. It's not just a single molecular entity but rather a group of 12 closely related enzyme families.VISACKGQ Valproate, Isoniazid, Sulfonamides, amiodarone, Chloramphenicol, ketoconazole, grapefruit juice, Quinidine QUESTION CYP450 inhibitors What do they do? Answer: inhibit metabolic activity of one or more CYP450 enzymes They are xenobiotics that inhibit one of the enzymes in the CYP450 family. This slows the enzymes activities and thereby can increase the level of the drug by decreasing metabolism of certain drugs affected by those enzymes. QUESTION CYP450 inhibitors What do they cause if not used correctly? (What would the patient experi- ence?) Answer: Toxicity. drug build up QUESTION Examples of CYP450 inducers Answer: CRAPGPS- Carbamazepine, rifampin, alco- hol, phenytoin, griseofulvin, phenobarbital, sulfonylureas barbiturates, St Johns wart QUESTION CYP450 inducers What do they do? Answer:Elevates CYP450 enzyme activity by increasing enzyme syn- thesis elevates the activity of the CYP450 enzymes by increasing enzyme synthesis. The increased number of sites increases the metabolism of the medications. This can cause the medication to metabolize quicker and lose effectiveness QUESTION CYP450 inducers What do they cause if not used correctly? (What would the patient experi- ence?) Answer: Decreases serum concentration of other drugs that use same enzyme QUESTION What happens when someone has a poor metabolism phenotype? Answer: -Med- ication is broken down very slowly It is possible to have side effects even with a very low drug dose because the enzyme is very slow to break down the drug. -Rapid or Ultrarapid Metabolizers. These enzymes are very active, often breaking down drugs, before they can have any effect. QUESTION What does the U. S. Food and Drug Administration regulate when it comes to medications? Answer: Safety and effectiveness of drugs in the US- the government agency responsible for reviewing, approving, and regulating medical products, in- cluding pharmaceutical drugs and medical devices QUESTION Reasons for medication non-adherence Answer: (1) forgetfulness, (2) lack of planning, (3) cost, (4) dissatisfaction, and (5) altered dosing. Statements: -medication wasn't working-It's expensive so I cut the dose -I was busy or travelling -I ran out -I forgot to take it QUESTION Black Box Warnings o What are they? o Why are they issued? Answer: o What are they? Highest safety-related warning for high-risk medications. Concise summaries of adverse effects of concern in a box surrounded by a thick black line. o Why are they issued? -To make healthcare professionals aware and put careful consideration before prescribing -Neonate and infant drug absorption -Purpose is to alert the provider to potentially severe side effects and ways to prevent or reduce harm. Provides a concise summary of the adverse effects of concerns. The FDA requires a boxed warning on drugs with serious or life-threatening risks. QUESTION Neonate and infant drug absorption o Be familiar with general development and when absorption would reach adult levels Answer: Adult values by 6-8 months Increased absorption in stomach Decreased absorption in intestines Neonates metabolize faster than adults then declines after 2 years until puberty QUESTION Common fears with genetic testingAnswer: Fear of discrimination from employers, insurance companies, or providers QUESTION Guiding principles for prescribers Answer: . . . QUESTION Examples of pure opioid agonists Answer: -Morphine (strong or moderate-strong) -Codeine (moderate-strong) -Fentanyl -Heroin -Methadone -oxycodone These are active U and K receptors. By doing so the pure agonists can produce analgesia, euphoria, sedation, respiratory depression, physical dependence, consti- pation, and other effects. They can be divided into two groups: strong opioid agonists and moderate to strong opioid agonists. Morphine is strong. Codeine is moderate to strong. QUESTION What is used to calculate a patient's overdose risk? (An actual calculation won't be done on the exam) Answer: NIDA-Modified ASSIST; Morphine milligram equiva- lents QUESTION How would you know when to refer someone to a pain specialist for pain management?Answer: If they are taking 120 mg/per day morphine equivalent QUESTION Prescription Drug Monitoring Program (PDMP) o What is it? o Why is it important? o When to use it? Answer: o What is it? Prescription Drug Monitoring Program - track controlled substance prescriptions by state for a patient o Why is it important? Can provide important patient information that assists with patient care and improve opioid prescribing o When to use it? Checked before prescribing any opioids, should be checked periodically or every 3 months during treatment. QUESTION How renal and hepatic function impact medication levels in the body Answer: - -Patients with renal or hepatic insufficiency can experience greater peak effects and longer duration of action for medications, thereby reducing the dose at which respiratory depression and overdose may occur. -Similarly, for patients aged 65 years and older, reduced renal function and medica- tion clearance due to age can result in a smaller therapeutic window between safe dosages and dosages associated with respiratory depression and overdose QUESTION How to assess someone for possible drug diversion Answer: Multiple prescribers given prescription drugs, refill requested early-Patient history of multi providers or abuse -Watch patterns -Urine Tox Statements or stories: -I dropped my meds on the floor. -I lost the med bottle QUESTION When should naloxone be prescribed for a patient? Answer: o When patients are prescribed opioids and are at high risk of opioid overdose Those using CNS depressants You may want to consider prescribing naloxone for the following patients at risk: -Patients taking benzodiazepines concurrently with opioids Patients receiving high opioid dosages (e 50 MME per day) Patients diagnosed or suspected of having OUD Patients with a history of nonfatal overdoses Patients who have concurrent alcohol or substance use Naloxone can cause acute withdrawal symptoms with adverse effects in patients physically dependent on opioids. -Caution must be exercised with a review of needs, benefits, and risks. QUESTION An 82-year-old male visits the clinic complaining that his pain meds "Take forever" to work after he takes his pill. What are possible reasons you can explain to him? 1. Perhaps we need to increase your dose. 2. Sometimes as you get older, absorption may be slower resulting in a delayed response. 3. As we get older the gastric acid decreases making it harder to break up the med, causing a slower absorption. Answer: -Sometimes as you get older, absorption may be slower resulting in a delayed response. - As we get older the gastric acid decreases making it harder to break up the med, causing a slower absorption.QUESTION Distribution of medication can be affected in the elderly in what ways? 1. Decrease hormones 2. Increased body fat 3. Decreased lean mass 4. Decreased Albumen Answer: 2. Increased body fat 3. Decreased lean mass 4. Decreased Albumen (less protein binding sites available- mostly seen in malnour- ished) QUESTION When prescribing medications, we must understand that liver function declines with age due to what cause? 1. enlarged liver 2. decreased blood flow to liver 3. increased activity of the hepatic enzymes Answer: 2. decreased blood flow to liver (Liver usually shrinks, enzyme activity usually decreases) QUESTION What is the most important cause of adverse drug reactions? 1. High drug dosages 2. Lack of monitoring of meds 3. Decreased renal excretion 4. Overprescribing/Polypharmacy Answer:QUESTION Overprescribing/Polypharmacy QUESTION How does poor metabolism affect a high or low therapeutic index? Answer: results in low efficacy or toxicity QUESTION Plavix If Plavix is not converted to its active form what adverse effects can occur? Answer: - Clot formation leading to stroke QUESTION Black Box (BB) warning for opioids? Answer: Resp depression QUESTION Black Box (BB) warning for Fentanyl? Answer: Fatal resp depression (fent is 100x stronger than morphine) QUESTION Black Box (BB) warning for Methadone?Answer: Prolonged QT- typically has an EKG ordered with it QUESTION Black Box (BB) warning for Codeine? Answer: 10% of the drug can be converted to morphine by the liver- concerns for breastfeeding mothers. QUESTION Black Box (BB) warning for Hydromorphone and Oxymorphone? Answer: Resp depression -High abuse potential QUESTION Black Box (BB) warning for Oxycodone? Answer: Resp depression -High abuse potential QUESTION What are the therapeutic uses for morphine? Answer: Pain control for palliative, cancer, labor, post-op patients. QUESTION What are the therapeutic uses for Fentanyl? Answer: Anesthesia and breakthrough, sometimes used for opioid tolerant patients.QUESTION When should a patient be referred to a pain specialist? Answer: Chronic pain patients who reach an MME of 120 or greater QUESTION What is MME and when to use it? Answer: Morphine Milligram Equivalents - It is a way to calculate how much pain meds someone is getting based on the type of med they are getting, helps safely prescribe. -Typically used when there is a dosage change or when trying to establish a dosage. QUESTION At what MME would you prescribe naloxone? Answer: At 50 MME QUESTION Risk factors for OUD? Answer: -Family history of abuse -History of depression - History of anxiety - History of S. I. -Poor social history QUESTION Behaviors that predict controlled substance addictionAnswer: QUESTION Schedule II drugs examples Answer: Examples Morphine Hydrocodone (Vicodin) Hydromorphone (Dilaudid) Oxycodone (OxyContin, Percocet) Meperidine (Demerol) Fentanyl Methadone Methamphetamine Adderall, Ritalin QUESTION Schedule II drugs o Rules around prescribing Answer: -Use PDMP prior to prescribing -Establish a relationship with the patient -Document clinical needs and progression 1. Opioids are not first-line therapy 2. Establish goals for pain and function 3. Discuss risks and benefits 4. Use immediate-release opioids when starting 5. Use the lowest effective dose 6. Prescribe short durations for acute pain 7. Evaluate benefits and harms frequently 8. Use strategies to mitigate risk 9. Review PDMP data 10. Use urine drug testing 11. Avoid concurrent opioid and benzodiazepine prescribing; high risk for respiratory depression and deaths 12. Offer treatment for the opioid disorder.QUESTION US Drug Enforcement Administration description of the scheduled drugsAnswer: . . . QUESTION Treatment of Chronic Pain o Example Answer: How should something like osteoarthritis be treated? Answer: Salicylates: 3. 6-5. 4 g/day Use of pregabalin- can help relieve neuropathic pain. Acute pain (sharp, darting pain) is especially responsive, although other forms of neuropathic pain (cramping pain, aching pain, and burning pain) also respond. -Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate. QUESTION Risk factors for Opioid Use Disorder Answer: history of overdose, history of substance use disorder, higher opioid dosages (e50 MME/day), or concurrent benzodiazepine useQUESTION Methadone o Black Box Warning Answer: QT prolongation and severe respiratory depression QUESTION Methadone o Benefits of use in opioid use disorder Answer: Maintenance and suppressive therapy Creates tolerance - patient less likely to seek out illicit drugs because no desirable effects QUESTION Buprenorphine and Naloxone o Benefit of using this combination Answer: Discourages IV use Makes risk for withdrawal low QUESTION Treatment of chronic pain o Use of pregabalin Answer: For seizures and neuropathic pain Regulated as a controlled substance Effects similar to diazepam when given with other sedative-hypnotic drugsQUESTION Treatment of chronic pain o Use of pregabalin Side effects Answer: o Sedation, dizziness, and ataxia are more commonly linked to pregabalin. Gastrointestinal bleeding may be caused by COX-2 inhibitors and NSAIDs. QUESTION How to treat hypertension o Order HTN medications are typically prescribed in Answer: ACEs, ARBs, thiazides, calcium channel blockers QUESTION How to treat hypertension Which is best for someone with diabetes Answer: ACE - ARB - calcium channel blocker - diuretic QUESTION How to treat hypertension Best approach or drug to use during pregnancy or someone wishing to become pregnant Answer: Labetolol, nifedipine, and methyldopa (little mama) QUESTION How to treat hypertensionThe therapeutic action of drug classifications used Answer: QUESTION How to treat hypertension Ethnic groups impacted by certain drug classifications Answer: African Americans- African americans do not respond well to ACE-I or ARBs. First line would be thiazide diuretics and then CCB's. QUESTION Prescribing considerations when carbamazepine is prescribed with war- farin Answer: Decreases effects of warfarin - consider increasing dosage QUESTION Beta-blockers o Their use with nitroglycerin and tachycardia Answer: May mask common signs of hypoglycemia Can help suppress nitro-induced tachycardia QUESTION Beta-blockers Know examples Answer: Cardioselective examples include: Atenolol (Tenormin), bisoprolol (Bystolic), metoprolol (Lopressor) and metoprolol succinate (Toprol-XL) Non-selective beta blockersCarvedilol (Coreg), labetalol (Trandate), nadolol (Corgard), propranolol (Inderal) and Sotalol (BetapaceQUESTION Beta-blockers Risk of stopping them abruptly Answer: tachycardia QUESTION Beta-blockers What happens when given to someone with asthma? Answer: May cause dry cough from constriction of the bronchi QUESTION Diuretics action Answer: decreases preload on the heart (what's coming back to the heart) by diuresing fluid volume and vasodilation -decrease blood volume, venous pressure, and preload Blocks sodium-chloride channel in the kidney QUESTION Diuretics Contradictions to thiazide diuretics Answer: Sensitivity to sulfa drugs Sensitivity to thiazides Hepatic comaQUESTION Diuretics Monitoring needs Answer: Daily weights, edema BP and HR Signs of hypokalemia QUESTION Heart failure o What to prescribe in response to fibrotic changes Answer: ACEIs QUESTION Heart failure Effects of cardiac glycosides (digoxin) Answer: Positive inotropic effect on the heart - increases cardiac output -Increase myocardial contractility and CO by inhibiting Na+ K+ QUESTION Heart failure Quinidine and digoxin o What happens when they are combined? Answer: Quinidine increases digoxin levels by decreasing excretion of digoxin, altering distribution of digoxin, or bothQUESTION Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score o What is it? Answer: Cholesterol guideline with 4 categories of patients who would benefit from statin treatment QUESTION ASCVD) Risk Score When is it used? Answer: Based on. . . The presence or absence of ASCVD Number of risk factors an individual has 10-year ASCVD score QUESTION Hyperlipidemia o Statin Drugs At what age can they be prescribed Answer: Over 10 years old QUESTION Hyperlipidemia o Ezetimibe (Zetia) What is it? Answer: Reduces plasma cholesterol, LDL, Blocks cholesterol absorption in the small intestine Can produce a small increase in HDLQUESTION Hyperlipidemia o Ezetimibe (Zetia) When would it be used? Answer: Adjunct to diet modification Approved for monotherapy and combined use with statin QUESTION Hyperlipidemia o Pharmacological option to minimize side effects In other words, how would you treat high cholesterol if someone was con- cerned about or experiencing side effects from other medications? Which drug classification would be a good choice? Answer: Usually statins at lowest dose then bile acid sequestrants QUESTION Angina o Therapeutic action of organic nitrates Answer: Acts directly on vascular smooth muscle to promote vasodilation QUESTION Angina o Contraindications for ranolazine Answer: Pre-existing QT prolongationHepatic impairment Taking drugs that inhibit CYP3A4 (most calcium channel blockers EXCEPT for amlodipine) QUESTION Most appropriate treatment approach for OA o Pharmacological Answer: NSAIDS, corticosteroids, colchicine QUESTION Most appropriate treatment approach for OA o Non-Pharmacological Answer: Exercise QUESTION Gout o Complications of untreated gout Answer: EROSION, irreversible joint damage, renal calculi QUESTION Gout o Treatment of acute flare with colchicine Patient education Adverse effects Answer: Adverse effects: GI toxicity - nausea and vomiting, diarrhea and abdominal pain and bone marrow suppression Patient edu- If GI effects occur then colchicine must be d/c immediately.QUESTION Gout o Long-term use of allopurinol What condition can be developed? Answer: Formation of cataracts with long-term use more than 3 years QUESTION Gout o Drug interactions with allopurinol Answer: Warfarin - inhibits hepatic drug-metabolizing enzymes, delays interaction of this drug; dosage should be reduced Mercaptopurine and azathioprine - accumulate to toxic levels, reduce dosage Theophylline - should not be combined Ampicillin - high incidence of rash QUESTION Gout o What should be co-administered with febuxostat? Answer: Prophylactic NSAIDs or colchicine for up to 6 months because of gout flare-up QUESTION NSAIDS o Black Box Warning Answer: thrombotic events, GI ulceration, bleedingQUESTION NSAIDS o Drug interactions Answer: Warfarin, heparin, and other anticoagulants - increases risk for bleeding Glucocorticoids - promotes gastric ulceration ACEI - increases risk for renal impairment Other NSAIDs - can negate effects of ASA Vaccines - may blunt immune response to vaccines QUESTION NSAIDS o Therapeutic action Answer: Provides rapid relief, anti-inflammatory QUESTION NSAIDS o Mechanism of action Answer: Non-selective inhibitor of cyclooxygenase COX 1 - protection against MI and ischemic stroke COX 2 - reduces inflammation, pain, and fever QUESTION DMARDs o What baseline diagnostics are needed for all DMARDs Answer: Liver enzymes creatinineLFTs, kidney function, and bone marrow function, WBC, and pregnancy test (Can be hard on the liver and kidneys) QUESTION DMARDs o Therapeutic response of methotrexate Answer: Reduces joint destruction and SLOWS disease progression QUESTION Osteoporosis o Alendronate Patient education Answer: Remain upright for 30 min. Take on empty stomach Take in AM QUESTION Osteoporosis o Ibandronate Which dietary supplement can interfere with absorption? Answer: Antacids, calcium, vit D, or other vitamin supplements Remain upright for 60 min. Don't eat/drink for 60 min. QUESTION Rheumatoid Arthritis o Treatment during pregnancy Answer:Biologic DMARDs: -TNF antagonists are US Food and Drug Administration (FDA) Pregnancy Risk Category B. -Rituximab and abatacept are Pregnancy Risk Category C. -Nonbiologic DMARDs: Azathioprine is teratogenic. Both leflunomide and methotrexate can cause fetal death and congenital abnormalities. -Hydroxychloroquine may cause fetal ocular toxicity; however, in some conditions, such as maternal lupus or malaria, the drug decreases the fetal risk associated with the conditions it treats. -Sulfasalazine is Pregnancy Risk Category B. QUESTION Rheumatoid Arthritis Which drugs have highest risk vs which ones are the safest Answer: NSAIDs and DMARDS are highest risk Corticosteroids are safest option QUESTION Hydrocodone/Acetaminophen (Lortab) 1. directions for use 2. indication 3. common doses Answer: 1. Directions: take 2. 5 mg po every 4-6 hours 2. Indication: moderate-severe pain 3. Dose: 2. 5-10 mg po q4-6 prn QUESTION Lisinopril 1. directions for use2. indication 3. common doses Answer:1. Directions: take 10 mg po daily Check HR and BP before taking medication Monitor for symptoms - dry, productive cough First-dose hypotension 2. Indication: hypertension 3. Dose: 10-40 mg po daily QUESTION Colchicine 1. directions for use 2. indication 3. common doses Answer: 1. Directions: take 1. 2 mg po then 0. 6 mg one hour after (acute) Take 0. 6 mg po 3x daily for 1. 8 mg max dose 2. Indication: acute gout flare-up and prophylaxis 3. Dose: 1. 2 mg initial dose then 0. 6 mg one hour after or 0. 6 mg 3x, should not exceed 1. 8 mg QUESTION Amlodipine (Norvasc) 1. directions for use 2. indication 3. common doses Answer: 1. Directions: take 5 mg po daily (2. 5 mg if elderly) visit the provider to evaluate the dose adjustment in 1-2 weeks Check HR and BP before taking medication 2. Indication: hypertension 3. Dose: start at 5 mg po daily, adjust the dose in 1-2 weeks2. QUESTION Which medications are schedule II drugs, select all that apply Answer: 1. valium & Ativan Oxy 3. Fentanyl 4. Methadone Answer: 2. Oxy 3. Fentanyl 4. Methadone (also includes Adderall- requires monthly visit including drug and tox screening) QUESTION Which medications are schedule III drugs, select all that apply Answer: 1. Xanax 2. Tramadol 3. 90mg of codeine 4. Anabolic steroids Answer: 3. 90mg of codeine 4. Anabolic steroids QUESTION What is the abuse potential with schedule III drugs? Answer: Moderate to Low potential for abuse3. QUESTION Which medications are schedule IV drugs, select all that apply Answer: 1. Ativan 2. Tramadol Methadone 4. Adderall Answer: 1. Ativan 2. Tramadol QUESTION Lesinurad should be combined with what other gout medication? Answer: Allop- urinol or febuxostat (helps excrete uric acid out, not a monotherapy) Can send patient into renal insuffi- ciency QUESTION Allopurinol can cause what condition when taken long-term? Answer: Cataracts (taking for greater than 3 years) QUESTION Initiation of allopurinol can elicit an acute gouty attack. What can be taken in conjunction to prevent that?4. Answer: Colchicine or low dose NSAIDS QUESTION Adverse effects of Colchicine? Answer: nausea, vomiting, abdominal pain, diarrhea, Myopathy5. QUESTION Complications of untreated gout? Answer: -Renal injury, irreversible joint damage QUESTION Osteoporosis Patient education of Alendronate? Answer: -sit up for 30 mins after taking (can cause esophagitis) -take with water -Must be able to sit up QUESTION Denosumab adverse effects? Answer: osteonecrosis of the jaw, decreased ability to fight infections, Hypocalcemia need dexa-scan QUESTION Ibandronate Answer: Do not take with Calcium, magnesium, or iron. QUESTION Alendronate Answer: 1st line treatment of Osteoporosis6. QUESTION Raloxifene Answer: DVT, PR and risk of stroke QUESTION DMARDS baseline data needed for all? Answer: -CBC w/ Diff -TB check -Hepatitis -pregnancy -Check for malignancies on the skin -Liver and renal function -No live vaccines -Up to date prior to treatment LFTs, kidney function, and bone marrow function, WBC (Can be hard on the liver and kidneys) QUESTION Baseline diagnostics for all DMARDS? Answer: -Dexa -Xray look for TB and pneumonitis -Pregnancy test -opthomological exam (retinal damage with hydrochloroquine) -EKG (BBB caused by DMARDS)7. QUESTION DMARDS patient teaching? Answer: -Do not get pregnant take oral contraceptives -You are immunocompromised -No active vaccines -Avoid alcohol -Don't stop taking med QUESTION Methotrexate side effects Answer: *DMARDs I* bone marrow suppression increased risk of infection liver damage GI ulceration pulmonary fibrosis pneumonitis QUESTION What is a typical dose of Alendronate? Answer: 5 mg QUESTION What is the most common CYP450 subtypes? Answer: CYP3A4, CYP2C9 QUESTION Schedule III drugs examples8. Answer: -Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine) -ketamine -anabolic steroids - testosterone QUESTION Schedule IV drugs examples Answer: -Xanax -Valium -Ativan -Ambien -Tramadol Soma, Darvon, Darvocet, Talwin QUESTION Quinidine can double the levels of what antidysrhythmic? Answer: Digoxin9. NR565 / NR565 Advanced Pharmacology Fundamentals Midterm Exam LATEST 2025 Chamberlain College10. NR 565 1. Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: - Acetaminophen with hydrocodone (Vicodin) 2. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: - Insomnia and decreased appetite 3. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: - ADHD symptoms - Routine height and weight checks - Amount of methylphenidate being used 4. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: - Blood pressure 5. Common mistakes practitioners make in treating anxiety disorders include: - Thinking a partial response to medication is acceptable 6. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: - Buspirone (Buspar) 7. An appropriate drug to initially treat panic disorder is: - Diazepam (Valium) 8. Prior to starting antidepressants, patients should have laboratory testing to rule out: - Hypothyroidism 9. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include: - He may experience sexual dysfunction beginning a month after he starts therapy.11. 10. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: - Appetite and concentration improve in the first 1 to 2 weeks. 11. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: - Largely unknown due to lack of studies of this population 12. Pharmacokinetics among Asians are universal to all the Asian ethnic groups. A. True B. False 13. Alterations in drug metabolism among Asians may lead to: - Slower metabolism of antidepressants, requiring lower doses 14. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: - Require higher doses of drugs metabolized by acetylization to achieve efficacy 15. Hispanic native healers (curanderas): A. Are not heavily utilized by Hispanics who immigrate to the United States B. Use herbs and teas in their treatment of illness C. Provide unsafe advice to Hispanics and should not be trusted D. Need to be licensed in their home country in order to practice in the United States 16. Genetic polymorphisms account for differences in metabolism, including: - Poor metabolizers, who lack a working enzyme - Intermediate metabolizers, who have one working, wild-type allele and one mutant allele - Extensive metabolizers, with two normally functioning alleles 17. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: - Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors 18. Drugs that use CYP 3A4 isoenzymes for metabolism may: - Induce the metabolism of another drug - Inhibit the metabolism of another drug12. 19. Rifampin is a nonspecific CYP450 inducer that may: - Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure 20. Inhibition of P-glycoprotein by a drug such as quinidine may lead to: - Increased levels of a co-administered drug, such as digoxin, that requires Pglycoprotein for absorption and elimination 21. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: - Decreased response to warfarin 22. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. A. True B. False 23. Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing: - Cetuximab 24. Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to: - Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 25. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to - Increased adverse drug reactions, such as neutropenia 26. Patients who have a poor metabolism phenotype will have: - Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 27. A patient's nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: - Distribution of drugs to target tissue may be affected. 28. Drugs that have a significant first-pass effect: - Are rapidly metabolized by the liver and may have little if any desired action 29. The route of excretion of a volatile drug will likely be the: - Lungs13. 30. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: - Increase the length of time a drug is available and active 31. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's: - Biological half-life 32. Azithromycin dosing requires that the first day's dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: - Rapidly achieves drug levels in the therapeutic range 33. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - Onset of action 34. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: - To determine if a drug is in the therapeutic range 35. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: - Concentration will produce an adverse response 36. Drugs that are receptor agonists may demonstrate what property? - Desensitization or downregulation with continuous use 37. Drugs that are receptor antagonists, such as beta blockers, may cause: - An exaggerated response if abruptly discontinued 38. Factors that affect gastric drug absorption include: - Lipid solubility of the drug 39. Drugs administered via IV: - Begin distribution into the body immediately 40. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: - Greater than the sum of the effects of each drug individually 41. Which of the following statements about bioavailability is true? A. B. All brands of a drug have the same bioavailability. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.14. C. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. D. Combining an active drug with an inert substance does not affect bioavailability. 42. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? A. Water soluble and ionized drugs cross these barriers rapidly. B. The blood-brain barrier slows the entry of many drugs into and from brain cells. C. The fetal-placental barrier protects the fetus from drugs taken by the mother. D. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women. 43. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: - Change drug molecules to a form that an excretory organ can excrete 44. Once they have been metabolized by the liver, the metabolites may be: - More active than the parent drug - Less active than the parent drug - Totally "deactivated" so they are excreted without any effect 45. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: - Unbinding a nonvolatile drug from plasma proteins 46. Steady state is: - When the amount of drug in the body remains constant 47. Two different pain medications are given together for pain relief. The drug—drug interaction is: - Additive 48. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: A. Reducing the dosage of one of the drugs B. Scheduling their administration at different times C. Prescribing a third drug to counteract the adverse reaction of the combination D. Reducing the dosage of both drugs 49. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?15. A. Protein malnutrition B. Iron-deficiency anemia C. Both 1 and 2 D. Neither 1 nor 2 50. The time required for the amount of drug in the body to decrease by 50% is called: - Half-life 51. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: - Downregulate the numbers of that specific receptor 52. Drug antagonism is best defined as an effect of a drug that: - Is modified by the concurrent administration of another drug 53. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? - "To achieve best effect, take the tablet with at least 8 ounces of fluid." 54. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: - Toxicity 55. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? - Sodium bicarbonate 56. Which of the following variables is a factor in drug absorption? - A rich blood supply to the area of absorption leads to better absorption. 57. An advantage of prescribing a sublingual medication is that the medication is: - Absorbed rapidly 58. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: - After four to five half-lives 59. Upregulation or hypersensitization may lead to: - An exaggerated response if the drug is withdrawn 60. Cultural factors that must be taken into account when prescribing include(s): - Who the decision maker is in the family regarding health-care decisions - The patient's view of health and illness16. - Attitudes regarding the use of drugs to treat illness 61. Ethnic differences have been found in drug: - Hepatic metabolism 62. The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all: - Organizations that receive federal funds 63. According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care: - Must be a professionally trained medical interpreter 64. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: - Discrimination, cultural barriers, and lack of access to health care 65. Ultra-rapid metabolizers of drugs may have: - Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 66. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: - Reduce the likelihood of therapeutic failure with tamoxifen treatment 67. An appropriate drug for the treatment of depression with anxiety would be: - Escitalopram (Lexapro) 68. An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: - Venlafaxine (Effexor) 69. The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is: - There is no laboratory monitoring required 70. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants? - Reduce dose by 50% for 3 to 4 days 71. The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety.17. What is the probable reason? - They have become tolerant of the medication, which is characterized by the need for higher and higher doses. 72. What "onset of action" symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor? - They can feel a bit of nausea, but this resolves in a week. 73. Which of the following should not be taken with a selective serotonin reuptake inhibitor? - Alcohol 74. Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? - It has a shorter half-life and withdrawal syndrome has a faster onset without taper. 75. The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response? - Have you noticed that you are having more sleep issues since you started that? 76. Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes: - The goal of treatment is to reduce migraine occurrence by 50%. 77. A first-line drug for abortive therapy in simple migraine is: - Naproxen (Aleve) 78. Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her? - Assess how often she is using Fiorinal and refill her medication. 79. When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include: - They may need premedication with an antinausea medication. 80. Migraines in pregnancy may be safely treated with: - Acetaminophen with codeine (Tylenol #3) 81. Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:18. - Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose. 82. Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: - Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers. 83. Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? - Prescribe propranolol (Inderal) to be taken daily for at least 3 months. 84. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: - Anorexiants may cause tolerance and should only be prescribed for 6 months 85. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John's wort due to: - The risk of serotonin syndrome 86. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus. - Rectal diazepam (Diastat) 87. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: - For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment 88. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: - Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. 89. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? - African American 90. Bethanechol: - Increases detrusor muscle tone to empty the bladder 91. Clinical dosing of Bethanechol:19. - Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved 92. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects? - Diphenhydramine 93. Anticholinesterase inhibitors are used to treat: - Myasthenia gravis 94. Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? - Memantine 95. Taking which drug with food maximizes it bioavailability? - Rivastigmine 96. Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? - Pyridostigmine 97. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: - Fasciculations of voluntary muscles 98. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? - Donepezil 99. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? - Vasodilation and decreased heart rate 100. Nicotine gum products are: - Bound to exchange resins so the nicotine is only released during chewing 101. Nicotine replacement therapy (NRT): - Delays healing of esophagitis and peptic ulcers 102. Success rates for smoking cessation using NRT: - Vary from 40% to 50% at 12 months 103. Cholinergic blockers are used to: - Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines20. - Control tremors and relax smooth muscle in Parkinson's disease - Inhibit the muscarinic action of ACh on bladder muscle 104. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? - Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. 105. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: - Swallow the tablet 1 hour before traveling where motion sickness is possible. 106. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: - Discontinue the tamsulosin and start doxazosin. 107. You are treating a patient with a diagnosis of Alzheimer's disease. The patient's wife mentions difficulty with transportation to the clinic. Which medication is the best choice? - Donepezil 108. A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause? - Bethanechol 109. Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid lifethreatening complications? - Carvedilol 110. Activation of central alpha2 receptors results in inhibition of cardio acceleration and ______________ centers in the brain. - Vasoconstriction 111. Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: - Relaxes smooth muscle in the bladder neck 112. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:21. A. Take the dose at bedtime B. Sit up slowly and dangle their feet before standing C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 D. Weigh daily and report weight gain of greater than 2 pounds in one day 113. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: - Not miss a dose or stop taking the drug because of potential rebound hypertension 114. Clonidine has several off-label uses, including: A. Alcohol and nicotine withdrawal B. 2.Post-herpetic neuralgia C. Both 1 and 2 D. Neither 1 nor 2 115. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: - Reducing vascular smooth muscle tone 116. Which of the following adverse effects are less likely in a beta1-selective blocker? - Impaired insulin release 117. Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? - Extend the dosage interval. 118. Beta blockers are the drugs of choice for exertional angina because they: - Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance 119. Adherence to beta blocker therapy may be affected by their: - Effects on the male genitalia, which may produce impotence 120. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: - Left ventricular dysfunction is diagnosed 121. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: - Angina - Coronary artery disease22. 122. To prevent life-threatening events from rapid withdrawal of a beta blocker: - The dosage should be decreased by one-half every 4 days. 123. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? - Diaphoresis 124. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: - Vasodilate the peripheral vasculature 125. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? - Histamine 2 blockers - Quinolones - Serotonin re-uptake - inhibitors 126. Carbamazepine has a Black Box Warning due to life-threatening:23. - - Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis 127. Long-term monitoring of patients who are taking carbamazepine includes: - Complete blood count every 3 to 4 months 128. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: - Blood dyscrasias, which are uncommon but possible 129. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be: - Assess for suicidal ideation 130. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: - Reassure her that this is a normal side effect of topiramate and continue to monitor her weight. 131. Monitoring of a patient on gabapentin to treat seizures includes: - Recording seizure frequency, duration, and severity 132. Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: - He should monitor his temperature and ability to sweat in the heat while playing 133. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: - To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 134. Levetiracetam has known drug interactions with: - Few, if any, drugs 135. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: - Ruling out a hypersensitivity reaction that may lead to multi-organ failure 136. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: - Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 137. The tricyclic antidepressants should be prescribed cautiously in patients with:24. - Heart disease 138. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): - He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) - MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce - Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment 139. Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is: - Fluoxetine 140. Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes: - SSRIs may take 2 to 6 weeks before she will have maximum drug effects. 141. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: - Duloxetine (Cymbalta) 142. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: - With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) 143. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: - Potentiate the effects of the drug 144. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: - Insomnia 145. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: - Bradykinesia, akathisia, and agitation 146. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: - Alprazolam (Xanax)25. - 147. A patient with anxiety and depression may respond to: - Buspirone (Buspar) and an SSRI combined 148. When prescribing temazepam (Restoril) for insomnia, patient education includes: - Temazepam should not be used more than three times a week for less than 3 months. 149. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: - Zolpidem should be taken just before going to bed. 150. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: - Drowsiness and nausea 151. Tom is taking lithium for bipolar disorder. He should be taught to: - Eat a diet with consistent levels of salt (sodium) 152. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? - Valproate is a known teratogen, but may be taken after the first trimester if necessary. 153. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: - The medication may cause sedation and they should not drive. - Constipation is a common side effect and they should increase fluids and fiber. - Patients should not take any other acetaminophen-containing medications at the same time. 154. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be: - Ibuprofen (Advil) 155. Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber's naratriptan, education would include: - Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St John's wort, and she should inform any providers she sees that she has migraines. - Continue to monitor her he