1. Which of the following drugs interact with warfarin/coumadin?
a. Imodium (loperamide)
b. Diltiazem Hydrochloride SR (diltiazem)
c. trimethoporim-sulfamethoxazole (Bactrim)
d. sumatriptan (Imitrex)
Answer>: c
Sulfa drugs will interact with warfarin (increases the blood level), which results in an
elevation of the INR and the risk of bleeding.
2. The following drugs are potent inhibitors of the CYP450 system except:
a. Erythromycin (Erythrocin)
b. Cimetidine (Tagamet)
c. Ceftazidime (Tazicef)
d. Diltiazem (Cardizem)
Answer>: A
Erythromycin acts as inhibitors slow down drug clearance, increasing drug concen-
tration. This may lead to drug overdose.
3. A 57 year old patient comes to the clinic for her routine physical. She has
no new complaints. The only medication that she takes is digoxin (Lanoxin)
for her atrial fibrillation. Which of the following electrolyte levels should be
monitored in this patient?
a. potassium, calcium, chloride
b. magnesium, calcium, chloride
c. potassium, calcium, magnesium
d. magnesium, calcium, phosphate
Answer>: c
Monitor digoxin level, EKG, electrolytes (potassium, magnesium, and calcium)
,a. TSH
b. CBC
c. LFT
d. BUN
Answer>: A
Patients taking lithium have an increased risk of developing hypothyroidism by de-
creasing the production of T4. Levothyroxine replacement therapy concurrently with
lithium administration especially in the presence of clinically overt hypothyroidism.
,5. A patient has recently been prescribed omeprazole (Prilosec) for GERD. He
also takes lisinopril (Zestril). His PMH includes migraines, hypertension, and
chronic kidney disease. The nurse practitioner notes:
a. The patient should stop taking the omeprazole (Prilosec) due his diagnosis
of chronic kidney disease.
b. The patient should stop taking omeprazole (Prilosec) due to drug interaction
with lisinopril (Zestril).
c. The patient may continue taking the omeprazole (Prilosec) but should
monitor blood pressure.
d. The patient may continue taking omeprazole (Prilosec) as prescribed.
Answer>: A
Studies suggest that PPIs may increase the risk of kidney disease. Using PPIs may
also cause acute interstitial nephritis. A patient that has already been diagnosed
with CKD should not take PPIs.
6. A patient taking Warfarin (Coumadin) is having abdominal surgery in
one month. She wants to know when she should stop taking her Warfarin
(Coumadin). The nurse practitioner advises:
a. The day before scheduled surgery.
b. Do not stop taking Warfarin (Coumadin)
c. 3 days before surgery.
d. 7 days before surgery.
Answer>: D
Patients should discontinue warfarin 7 days before surgery.
7. A 71 year old patient has been diagnosed with stage III congestive heart
failure. Which of the following class of medications may cause an exacerbation
of congestive heart failure>
, Improved glycemic control decreases the risk of end organ damage and heart failure
in patients with diabetes. Thiazolidinediones are very useful drugs, particularly
for patients with marked insulin resistance and hyperlipidemia. However, they do
precipitate edema and heart failure. The edema can be severe enough to lead to
discontinuation of the drug, and the risk of heart failure limits the population in which
they can be used. They can be used safely in some cardiac patients but, as noted in
the article, they should be avoided or used with caution in patients with CHF. Patients
a. Imodium (loperamide)
b. Diltiazem Hydrochloride SR (diltiazem)
c. trimethoporim-sulfamethoxazole (Bactrim)
d. sumatriptan (Imitrex)
Answer>: c
Sulfa drugs will interact with warfarin (increases the blood level), which results in an
elevation of the INR and the risk of bleeding.
2. The following drugs are potent inhibitors of the CYP450 system except:
a. Erythromycin (Erythrocin)
b. Cimetidine (Tagamet)
c. Ceftazidime (Tazicef)
d. Diltiazem (Cardizem)
Answer>: A
Erythromycin acts as inhibitors slow down drug clearance, increasing drug concen-
tration. This may lead to drug overdose.
3. A 57 year old patient comes to the clinic for her routine physical. She has
no new complaints. The only medication that she takes is digoxin (Lanoxin)
for her atrial fibrillation. Which of the following electrolyte levels should be
monitored in this patient?
a. potassium, calcium, chloride
b. magnesium, calcium, chloride
c. potassium, calcium, magnesium
d. magnesium, calcium, phosphate
Answer>: c
Monitor digoxin level, EKG, electrolytes (potassium, magnesium, and calcium)
,a. TSH
b. CBC
c. LFT
d. BUN
Answer>: A
Patients taking lithium have an increased risk of developing hypothyroidism by de-
creasing the production of T4. Levothyroxine replacement therapy concurrently with
lithium administration especially in the presence of clinically overt hypothyroidism.
,5. A patient has recently been prescribed omeprazole (Prilosec) for GERD. He
also takes lisinopril (Zestril). His PMH includes migraines, hypertension, and
chronic kidney disease. The nurse practitioner notes:
a. The patient should stop taking the omeprazole (Prilosec) due his diagnosis
of chronic kidney disease.
b. The patient should stop taking omeprazole (Prilosec) due to drug interaction
with lisinopril (Zestril).
c. The patient may continue taking the omeprazole (Prilosec) but should
monitor blood pressure.
d. The patient may continue taking omeprazole (Prilosec) as prescribed.
Answer>: A
Studies suggest that PPIs may increase the risk of kidney disease. Using PPIs may
also cause acute interstitial nephritis. A patient that has already been diagnosed
with CKD should not take PPIs.
6. A patient taking Warfarin (Coumadin) is having abdominal surgery in
one month. She wants to know when she should stop taking her Warfarin
(Coumadin). The nurse practitioner advises:
a. The day before scheduled surgery.
b. Do not stop taking Warfarin (Coumadin)
c. 3 days before surgery.
d. 7 days before surgery.
Answer>: D
Patients should discontinue warfarin 7 days before surgery.
7. A 71 year old patient has been diagnosed with stage III congestive heart
failure. Which of the following class of medications may cause an exacerbation
of congestive heart failure>
, Improved glycemic control decreases the risk of end organ damage and heart failure
in patients with diabetes. Thiazolidinediones are very useful drugs, particularly
for patients with marked insulin resistance and hyperlipidemia. However, they do
precipitate edema and heart failure. The edema can be severe enough to lead to
discontinuation of the drug, and the risk of heart failure limits the population in which
they can be used. They can be used safely in some cardiac patients but, as noted in
the article, they should be avoided or used with caution in patients with CHF. Patients
