(Test Bank) Advanced Pharmacology Study Guide

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NSG 6005 ADV PHARM FINAL EXAM TEST BANK QUESTIONS AND ANSWERS Chapter 1. The Role of the Nurse Practitioner 1. Nurse practitioner prescriptive authority is regulated by: 1 . The National Council of State Boards of Nursing 2 . The U.S. Drug Enforcement Administration 3 . The State Board of Nursing for each state 4 . The State Board of Pharmacy 2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: 1 . Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program & in their APRN program. 2 . Nurses care for the patient from a holistic approach & include the patient in decision making regarding their care. 3 . APRNs are less likely to prescribe narcotics & other controlled substances. 4 . APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. 3. Clinical judgment in prescribing includes: 1 . Factoring in the cost to the patient of the medication prescribed 2 . Always prescribing the newest medication available for the disease process 3 . H&ing out drug samples to poor patients 4 . Prescribing all generic medications to cut costs 4. Criteria for choosing an effective drug for a disorder include: 1. Asking the patient what drug they think would work best for them 2. Consulting nationally recognized guidelines for disease management 3. Prescribing medications that are available as samples before writing a prescription 4. Following U.S. Drug Enforcement Administration guidelines for prescribing 5. Nurse practitioner practice may thrive under health-care reform because of: 1 . The demonstrated ability of nurse practitioners to control costs & improve patient outcomes 2 . The fact that nurse practitioners will be able to practice independently 3 . The fact that nurse practitioners will have full reimbursement under health-care reform 4 . The ability to shift accountability for Medicaid to the state level Chapter 2. Review of Basic Principles of Pharmacology 1. A patient’s nutritional intake & laboratory results reflect hypoalbuminemia. This is critical to prescribing because: 1 . Distribution of drugs to target tissue may be affected. 2 . The solubility of the drug will not match the site of absorption. 3 . There will be less free drug available to generate an effect. 4 . Drugs bound to albumin are readily excreted by the kidneys. 2. Drugs that have a significant first-pass effect: 1 . Must be given by the enteral (oral) route only 2 . Bypass the hepatic circulation 2 ADV Pharm | TextBook | StudyGuide 3 . Are rapidly metabolized by the liver & may have little if any desired action 4 . Are converted by the liver to more active & fat-soluble forms 3. The route of excretion of a volatile drug will likely be the: 1 . Kidneys 2 . Lungs 3 . Bile & feces 4 . Skin 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: 1 . Assure that the drug will reach its intended target tissue 2 . Are the reason for giving loading doses 3 . Increase the length of time a drug is available & active 4 . Are most common in collagen tissues 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: 1 . Propensity to go to the target receptor 2 . Biological half-life 3 . Pharmacodynamics 4 . Safety & side effects 6. 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: 1 . Rapidly achieves drug levels in the therapeutic range 2 . Requires four- to five-half-lives to attain 3 . Is influenced by renal function 4 . Is directly related to the drug circulating to the target tissues 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: 1 . Minimum adverse effect level 2 . Peak of action 3 . Onset of action 4 . Therapeutic range 8. Phenytoin requires that a trough level be drawn. Peak & trough levels are done: 1 . When the drug has a wide therapeutic range 2 . When the drug will be administered for a short time only 3 . When there is a high correlation between the dose & saturation of receptor sites 4 . To determine if a drug is in the therapeutic range 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: 1 . Concentration will produce therapeutic effects 2 . Concentration will produce an adverse response 3 ADV Pharm | TextBook | StudyGuide 3 . Time between doses must be shortened 4 . Duration of action of the drug is too long 10. Drugs that are receptor agonists may demonstrate what property? 1 . Irreversible binding to the drug receptor site 2 . Upregulation with chronic use 3 . Desensitization or downregulation with continuous use 4 . Inverse relationship between drug concentration & drug action 11. Drugs that are receptor antagonists, such as beta blockers, may cause: 1 . Downregulation of the drug receptor 2 . An exaggerated response if abruptly discontinued 3 . Partial blockade of the effects of agonist drugs 4 . An exaggerated response to competitive drug agonists 12. Factors that affect gastric drug absorption include: 1 . Liver enzyme activity 2 . Protein-binding properties of the drug molecule 3 . Lipid solubility of the drug 4 . Ability to chew & swallow 13. Drugs administered via IV: 1 . Need to be lipid soluble in order to be easily absorbed 2 . Begin distribution into the body immediately 3 . Are easily absorbed if they are nonionized 4 . May use pinocytosis to be absorbed 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: 1 . The sum of the effects of each drug individually 2 . Greater than the sum of the effects of each drug individually 3 . Less than the effect of each drug individually 4 . Not predictable, as it varies with each individual 15. Which of the following statements about bioavailability is true? 1 . Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2 . All brands of a drug have the same bioavailability. 3 . Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4 . Combining an active drug with an inert substance does not affect bioavailability. 16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1 . Water soluble & ionized drugs cross these barriers rapidly. 2 . The blood-brain barrier slows the entry of many drugs into & from brain cells. 3 . The fetal-placental barrier protects the fetus from drugs taken by the mother. 4 ADV Pharm | TextBook | StudyGuide 4 . Lipid-soluble drugs do not pass these barriers & are safe for pregnant women. 17. 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: 1 . Inactivate prodrugs before they can be activated by target tissues 2 . Change the drugs so they can cross plasma membranes 3 . Change drug molecules to a form that an excretory organ can excrete 4 . Make these drugs more ionized & polar to facilitate excretion 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above 19. 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: 1 . Reduced circulation & perfusion of the kidney 2 . Chronic renal disease 3 . Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. When the amount of drug in the body remains constant 3. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above 21. Two different pain medications are given together for pain relief. The drug —drug interaction is: 1 . Synergistic 2 . Antagonistic 3 . Potentiative 4 . Additive 22. 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 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? 1. Protein malnutrition 2. Iron-deficiency anemia 3. Both 1 & 2 4. Neither 1 nor 2 24. The time required for the amount of drug in the body to decrease by 50% is called: 1 . Steady state 2 . Half-life 3 . Phase II metabolism 4 Reduced bioavailability time 5 ADV Pharm | TextBook | StudyGuide . 25. An agonist activates a receptor & stimulates a response. When given frequently over time, the body may: 1 . Upregulate the total number of receptors 2 . Block the receptor with a partial agonist 3 . Alter the drug’s metabolism 4 . Downregulate the numbers of that specific receptor 26. Drug antagonism is best defined as an effect of a drug that: 1 . Leads to major physiological & 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 27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1 . “Avoid any other oral medicines while taking this drug.” 2 . “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3 . “The tablet may be crushed if you have any difficulty taking it.” 4 . “To achieve best effect, take the tablet with at least 8 ounces of fluid.” 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1 . Disintegration 2 . Toxicity 3 . Malabsorption 4 . Deterioration 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1 . Sodium bicarbonate 2 . Ascorbic acid 3 . Salicylic acid 4 . Glucose 30. Which of the following variables is a factor in drug absorption? 1 . The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2 . A rich blood supply to the area of absorption leads to better absorption. 3 . The less soluble the drug, the more easily it is absorbed. 4 . Ionized drugs are easily absorbed across the cell membrane. 31. An advantage of prescribing a sublingual medication is that the medication is: 1 . Absorbed rapidly 2 . Excreted rapidly 3 . Metabolized minimally 4 . Distributed equally6 ADV Pharm | TextBook | StudyGuide 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 & 2 4. Neither 1 nor 2 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1 . After the second dose 2 . After four to five half-lives 3 . When the patient feels the full effect of the drug 4 . One hour after IV administration 34. Upregulation or hypersensitization may lead to: 1 . Increased response to a drug 2 . Decreased response to a drug 3 . An exaggerated response if the drug is withdrawn 4 . Refractoriness or complete lack of response Chapter 3. Rational Drug Selection 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because: 1 . Drugs given in liquid form are less irritating to the stomach. 2 . A 6-year-old child may have problems swallowing a pill. 3 . Liquid forms of medication eliminate the concern for first-pass effect. 4. Liquid ibuprofen does not have to be dosed as often as the tablet form. 2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it: 1. Has serious side effects & it is not being used for a life-threatening condition 2. Will be taken twice daily & will be taken at home 3. Is expensive, but covered by health insurance 4. None of these are important in choosing a drug 3. A client asks the NP about the differences in drug effects between men & women. What is known about the differences between the pharmacokinetics of men & women? 1 . Body temperature varies between men & women. 2 . Muscle mass is greater in women. 3 . Percentage of fat differs between genders. 4 . Proven subjective factors exist between the genders. 4. The first step in the prescribing process according to the World Health Organization is: 1 . Choosing the treatment 2 . Educating the patient about the medication 3 . Diagnosing the patient’s problem 4 . Starting the treatment 5. Treatment goals in prescribing should: 1 . Always be curative 2 . Be patient-centered7 ADV Pharm | TextBook | StudyGuide 3 . Be convenient for the provider 4 . Focus on the cost of therapy 6. The therapeutic goals when prescribing include(s): 1. Curative 2. Palliative 3. Preventive 4. All of the above 7. When determining drug treatment the NP prescriber should: 1 . Always use evidence-based guidelines 2 . Individualize the drug choice for the specific patient 3 . Rely on his or her experience when prescribing for complex patients 4 . Use the newest drug on the market for the condition being treated 8. Patient education regarding prescribed medication includes: 1 . Instructions written at the high school reading level 2 . Discussion of expected adverse drug reactions 3 . How to store leftover medication such as antibiotics 4 . Verbal instructions always in English 9. 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 10. Pharmacokinetic factors that affect prescribing include: 1 . Therapeutic index 2 . Minimum effective concentration 3 . Bioavailability 4 . Ease of titration 11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine: 1 . Conflicts of interest & financial relationships should be disclosed by those providing education. 2 . Providers should ban all pharmaceutical representatives from their office setting. 3 . Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication. 4 . Providers should only accept low-value gifts, such as pens & pads of paper, from the pharmaceutical representative. 12. Under new U.S. Food & Drug Administration labeling, Pregnancy Categories will be: 1 . Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus 2 . Changed to incorporate a pregnancy risk summary & clinical considerations on the drug label 3 . Eliminated, & replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns 4 Clarified to include information such as safe dosages in each trimester of pregnancy 8 ADV Pharm | TextBook | StudyGuide . Chapter 4. Legal & Professional Issues in Prescribing 1. The U.S. Food & Drug Administration regulates: 1 . Prescribing of drugs by MDs & NPs 2 . The official labeling for all prescription & over-the-counter drugs 3 . Off-label recommendations for prescribing 4 . Pharmaceutical educational offerings 2. The U.S. Food & Drug Administration approval is required for: 1 . Medical devices, including artificial joints 2 . Over-the-counter vitamins 3 . Herbal products, such as St John’s wort 4 . Dietary supplements, such as Ensure 3. An Investigational New Drug is filed with the U.S. Food & Drug Administration: 1 . When the manufacturer has completed phase III trials 2 . When a new drug is discovered 3 . Prior to animal testing of any new drug entity 4 . Prior to human testing of any new drug entity 4. Phase IV clinical trials in the United States are also known as: 1 . Human bioavailability trials 2 . Postmarketing research 3 . Human safety & efficacy studies 4 . The last stage of animal trials before the human trials begin 5. Off-label prescribing is: 1 . Regulated by the U.S. Food & Drug Administration 2 . Illegal by NPs in all states (provinces) 3 . Legal if there is scientific evidence for the use 4 . Regulated by the Drug Enforcement Administration 6. The U.S. Drug Enforcement Administration: 1 . Registers manufacturers & prescribers of controlled substances 2 . Regulates NP prescribing at the state level 3 . Sanctions providers who prescribe drugs off-label 4 . Provides prescribers with a number they can use for insurance billing 7. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: 1 . Are known teratogens during pregnancy 2 . May not be refilled; a new prescription must be written 3 . Have a low abuse potential 4 May be dispensed without a prescription unless regulated by the state 9 ADV Pharm | TextBook | StudyGuide . 8. Precautions that should be taken when prescribing controlled substances include: 1 . Faxing the prescription for a Schedule II drug directly to the pharmacy 2 . Using tamper-proof paper for all prescriptions written for controlled drugs 3 . Keeping any pre-signed prescription pads in a locked drawer in the clinic 4 . Using only numbers to indicate the amount of drug to be prescribed 9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include: 1. Use of chemical dependency screening tools 2. Firm limit-setting regarding prescribing controlled substances 3. Practicing “just say no” to deal with patients who are pushing the provider to prescribe controlled substances 4. All of the above 10. Behaviors predictive of addiction to controlled substances include: 1 . Stealing or borrowing another patient’s drugs 2 . Requiring increasing doses of opiates for pain associated with malignancy 3. Receiving refills of a Schedule II prescription on a regular basis 4 . Requesting that only their own primary care provider prescribe for them 11. Medication agreements or “Pain Medication Contracts” are recommended to be used: 1 . Universally for all prescribing for chronic pain 2 . For patients who have repeated requests for pain medication 3 . When you suspect a patient is exhibiting drug-seeking behavior 4 . For patients with pain associated with malignancy 12. A prescription needs to be written for: 1. Legend drugs 2. Most controlled drugs 3. Medical devices 4. All of the above Chapter 6. Factors That Foster Positive Outcomes 1. A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment? 1 . Financial status 2 . Mobility 3 . Social support 4 . Sexual practices 2. Elena Vasquez’s primary language is Spanish, & she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? 1 . Use correct medical terminology because Spanish has a Latin base. 2 . Use a family member who speaks more English to act as an interpreter. 3 . Use a professional interpreter or a reliable staff member who can act as an interpreter. 4 . Use careful, detailed explanations. 3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug? 1 St& facing him & speak slowly & clearly. 10 ADV Pharm | TextBook | StudyGuide . 2 . Speak in low tones or find a provider who has a lower voice. 3. Write down the instructions as well as speaking them. 4 . If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. 4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen? 1. Complexity of the drug regimen 2. Patient perception of the potential adverse effects of the drugs 3. Both 1 & 2 4. Neither 1 nor 2 5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier? 1 . Increasing copayments for care 2 . Unrestricted formularies for drugs, including brand names 3 . Increasing the number of people who have access to care 4 . Treating a wider range of disorders 6. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent? 1. Ralph states that he always takes the drug “when I feel my pressure is going up.” 2. Ralph contacts his NP to discuss the need to increase the dosage. 3. Ralph consistently keeps his follow-up appointments to check his blood pressure. 4. All of the above show that he is adherent to the drug regimen. 7. Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that: 1 . Has a short half-life so that missing one dose has limited effect 2 . Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down 3 . Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea & dizziness 4 . Must be taken no more than twice a day 8. Factors in chronic conditions that contribute to nonadherence include: 1. The complexity of the treatment regimen 2. The length of time over which it must be taken 3. Breaks in the usual daily routine, such as vacations & weekends 4. All of the above 9. While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when: 1 . The provider spent a lot of time discussing the drugs with them 2 . Their concerns & specific area of knowledge deficit were addressed 3. They were given written material, such as pamphlets, about the drugs 4 . The provider used appropriate medical & pharmacological terms 10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% & 60%. To improve adherence in this population, prescribe drugs: 1 . With a longer half-life so that missed doses produce a longer taper on the drug curve 2 . In oral formulations that are more easily taken 3 . That do not require frequent monitoring 4 . Combined with patient education about the need to adhere even when symptoms are absent 11 ADV Pharm | TextBook | StudyGuide 11. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence? 1 . Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing. 2 . Match the clinic appointment to the next time the drug is to be refilled. 3 . Write prescriptions for new drugs with shorter times between refills. 4 . Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. 12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include: 1 . Older adults & those on fixed incomes 2 . Patients with chronic illnesses 3 . Patients with copayments for drugs on their insurance 4 . Patients on public assistance 13. Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who: 1. Are well-educated & affluent 2. Have chronic conditions 3. Self-monitor drug effects on their symptoms 4. None of the above guarantee adherence 14. Monitoring adherence can take several forms, including: 1. Patient reports from data in a drug diary 2. Pill counts 3. Laboratory reports & other diagnostic markers 4. All of the above 15. Factors that explain & predict medication adherence include: 1. Social 2. Financial 3. Health system 4. All of the above Chapter 7. Cultural & Ethnic Influences in Pharmacotherapeutics 1. Cultural factors that must be taken into account when prescribing include(s): 1. Who the decision maker is in the family regarding health-care decisions 2. The patient’s view of health & illness 3. Attitudes regarding the use of drugs to treat illness 4. All of the above 2. Ethnic differences have been found in drug: 1 . Absorption 2 . Hepatic metabolism 3 . Filtration at the glomerulus 4 . Passive tubular reabsorption 3. The National Standards of Culturally & Linguistically Appropriate Services are required to be implemented in all: 1 . Hospitals 2 . Clinics that serve the poor 3 . Organizations that receive federal funds 4 . Clinics that serve ethnic minorities 12 ADV Pharm | TextBook | StudyGuide 4. According to the National Standards of Culturally & Linguistically Appropriate Services, an interpreter for health care: 1 . May be a bilingual family member 2 . May be a bilingual nurse or other health-care provider 3 . Must be a professionally trained medical interpreter 4 . Must be an employee of the organization 5. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: 1 . The belief among African Americans that prayer is more powerful than drugs 2 . Poor compliance on the part of the African American patient 3 . The genetic predisposition for illness found among African Americans 4 . Discrimination, cultural barriers, & lack of access to health care 6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: 1 . Increased CYP 2D6 activity, leading to rapid metabolism of some drugs 2 . Largely unknown due to lack of studies of this population 3 . Rapid metabolism of alcohol, leading to increased tolerance 4 . Decreased elimination of opioids, leading to increased risk for addiction 7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups. 1 . True 2 . False 8. Alterations in drug metabolism among Asians may lead to: 1 . Slower metabolism of antidepressants, requiring lower doses 2 . Faster metabolism of neuroleptics, requiring higher doses 3 . Altered metabolism of omeprazole, requiring higher doses 4 . Slower metabolism of alcohol, requiring higher doses 9. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: 1 . Require acetylization in order to metabolize drugs 2 . Are unable to tolerate higher doses of some drugs that require acetylization 3 . May have a toxic reaction to drugs that require acetylization 4 . Require higher doses of drugs metabolized by acetylization to achieve efficacy 10. Hispanic native healers (cur&eras): 1 . Are not heavily utilized by Hispanics who immigrate to the United States 2 . Use herbs & teas in their treatment of illness 3 . Provide unsafe advice to Hispanics & should not be trusted 4 . Need to be licensed in their home country in order to practice in the United States Chapter 8. An Introduction to Pharmacogenomics 1. Genetic polymorphisms account for differences in metabolism, including: 1. Poor metabolizers, who lack a working enzyme 2. Intermediate metabolizers, who have one working, wild-type allele & one mutant allele 13 ADV Pharm | TextBook | StudyGuide 3. Extensive metabolizers, with two normally functioning alleles 4. All of the above 2. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: 1 . A need to monitor drugs metabolized by 2D6 for toxicity 2 . Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors 3 . Decreased conversion of codeine to morphine by CYP 2D6 4 . The need for lowered dosages of drugs, such as beta blockers 3. Rifampin is a nonspecific CYP450 inducer that may: 1 . Lead to toxic levels of rifampin & must be monitored closely 2 . Cause toxic levels of drugs, such as oral contraceptives, when coadministered 3 . Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure 4 . Cause nonspecific changes in drug metabolism 4. Inhibition of P-glycoprotein by a drug such as quinidine may lead to: 1 . Decreased therapeutic levels of quinidine 2 . Increased therapeutic levels of quinidine 3 . Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption & elimination 4 . Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption & elimination 5. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: 1 . Toxic levels of warfarin building up 2 . Decreased response to warfarin 3 . Increased risk for significant drug interactions with warfarin 4 . Less risk of drug interactions with warfarin 6. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. 1 . True 2. False 7. Pharmacogenetic testing is required by the U.S. Food & Drug Administration prior to prescribing: 1 . Erythromycin 2 . Digoxin 3 . Cetuximab 4 . Rifampin 8. 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: 1 . Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele 2 . Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele 3 . Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 4 . Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine 9. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:14 ADV Pharm | TextBook | StudyGuide 1 . Decreased effectiveness of irinotecan in the treatment of cancer 2 . Increased adverse drug reactions, such as neutropenia 3 . Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 4 . Increased concerns for irinotecan being carcinogenic 10. Patients who have a poor metabolism phenotype will have: 1 . Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 2 . Accumulation of inactive metabolites of drugs 3 . A need for increased dosages of medications 4 . Increased elimination of an active drug 11. Ultra-rapid metabolizers of drugs may have: 1 . To have dosages of drugs adjusted downward to prevent drug accumulation 2 . Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 3 . Increased elimination of active, nonmetabolized drug 4 . Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug 12. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: 1 . Ensure the patient will not have increased adverse drug reactions to the tamoxifen 2 . Identify potential drug-drug interactions that may occur with tamoxifen 3 . Reduce the likelihood of therapeutic failure with tamoxifen treatment 4 . Identify poor metabolizers of tamoxifen Chapter 10. Herbal Therapy & Nutritional Supplements 1. A good history of herb & supplement use is critical before prescribing because approximately % of patients in the United States are using herbal products. 1 . 10 2 . 5 3 . 38 4 . 70 2. A potential harmful effect on patients who take some herbal medication is: 1 . Constipation 2 . Lead poisoning 3 . Diarrhea 4 . Life-threatening rash 3. A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: 1 . Coumadin, which may lead to bleeding problems 2 . Coumarin, which can cause liver & kidney damage 3 . Cinnamic aldehyde, which is toxic to the kidney 4 Cinnamate eugenol, which is toxic to the liver 15 ADV Pharm | TextBook | StudyGuide . 4. Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing & treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: 1 . Herbs which are yang in nature 2 . Herbs that are yin in nature 3 . Ginger 4 . Golden seal 5. According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will: 1 . Get worse 2 . Get better 3 . Not be adequately treated 4 . Need additional herbs to treat the yang 6. In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s: 1 . Vata 2 . Pitta 3 . Kapha 4 . Prakriti 7. Herbs & supplements are regulated by the U.S. Food & Drug Administration. 1 . True 2 . False 8. When melatonin is used to induce sleep, the recommendation is that the patient: 1 . Take 10 mg 30 minutes before bed nightly 2 . Take 1 to 5 mg 30 minutes before bed nightly 3 . Not take melatonin more than three nights a week 4 . Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep 9. Valerian tea causes relaxation & can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to: 1 . Cardiac disturbances 2 . Central nervous system depression 3 . Respiratory depression 4 . Skin rashes 10. The standard dosage of St John’s wort for the treatment of mild depression is: 1 . 300 mg daily 2 . 100 mg three times a day 3 . 300 mg three times a day 4 . 600 mg three times a day 11. Patients need to be instructed regarding the drug interactions with St John’s wort, including: 1. MAO inhibitors16 ADV Pharm | TextBook | StudyGuide 2. Serotonin reuptake inhibitors 3. Over-the-counter cough & cold medications 4. All of the above 12. Ginseng, which is taken to assist with memory, may potentiate: 1 . Aricept 2 . Insulin 3 . Digoxin 4 . Propranolol 13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: 1. Antihypertensives, diuretics, & digoxin 2. Antidiarrheals, antihistamines, & omeprazole 3. Penicillin antibiotic class & benzodiazepines 4. None of the above 14. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: 1 . Respiratory depression 2 . Cardiac disturbance 3 . Salicylates poisoning 4 . Life-threatening rashes 15. The role of the NP in the use of herbal medication is to: 1 . Maintain competence in the prescribing of common herbal remedies 2 . Recommend common over-the-counter herbs to patients 3 . Educate patients & guide them to appropriate sources of care 4 . Encourage patients to not use herbal therapy due to the documented dangers Chapter 11. Information Technology & Pharmacotherapeutics 1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: 1 . Search for information using the most common search engines 2 . Serve as content experts in developing, implementing, & evaluating information systems 3 . Write programs to assure the integrity of health information 4 . Use information technology to prescribe drugs 2. You are going to prescribe a drug & the electronic health record (EHR) alerts you that there is a potential drug– drug interaction. The alert is generated by: 1 . The Food & Drug Administration MedWatch system 2 . TOXNET, the National Institutes of Health alert system 3 . The EHR clinical decision support system 4 . Lexicomp, a commercial medication alert system 3. Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? 1 . Reduces time that prescribing drugs takes 2 . Eliminates the need to chart drugs prescribed 3 . Decreases prescribing & transcription errors 17 ADV Pharm | TextBook | StudyGuide 4 . Helps keep the number of drugs prescribed to a minimum 4. A number of barriers & concerns exist before the goals of a safe & efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption & use of IT in prescribing drugs? 1 . Cost of initial setup 2 . Access to highly skilled experts 3 . Compatibility between systems 4 . Patient confidentiality risks 5. EHRs: 1 . Are being discouraged by the Centers for Medicare & Medicaid Services due to cost issues 2 . Allow for all patient data to be centralized in one location for access by multiple providers 3 . Use macros & templates to individualize care 4 . Use standardized software to facilitate interoperability between systems 6. Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include: 1 . Designing software so that only those who need the information can gain access 2 . Requiring providers to log off at the end of the clinical day 3 . Keeping a file of the login & password information for each provider in a secure place 4 . Having patients sign informed consent documents to have their data on an EHR 7. Decision support systems often provide medication alerts that tell the prescriber: 1 . Patient history data with a summary of their diagnoses 2 . The usual dosage for the drug being prescribed 3 . The patient’s latest laboratory values, such as potassium levels 4 . Potential drug-to-drug interactions with other medications the patient is taking 8. Prescribers have been shown to override a medication alert about a patient’s allergies when: 1. The history showed that the patient had tolerated the medication in the past 2. The benefit outweighed the risk 3. The medication was therapeutically appropriate & needed 4. All of the above 9. The use of information technology for quality improvement in pharmacotherapeutics includes: 1 . Incorporating the use of “apps” into all patient encounters 2 . Tracking data trends within the practice via the electronic health record database 3. Informing patients that they have access to their medication list via the Internet 4 . Using macros for individualizing patient care management 10. The advantage of using information technology for patient education includes: 1 . The ability to track the number of times you have given the patient the same instructions regarding their medication 2 . Standardized & individualized patient education that is simultaneously recorded into the patient record 3 . Easy access to private patient information specific to populations with a similar diagnosis 4 . The ability to download & interpret patient information in multiple languages, easily & accurately 11. One barrier to use of the Internet for both prescribing & for patient teaching is: 18 ADV Pharm | TextBook | StudyGuide 1 . Lack of free public access to the Internet 2 . Age, with older adults rarely understanding how to use a computer 3 . Web pages & hyperlinks may change, be deleted, or be replaced 4 . Few Web sites with information about drugs are free 12. Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to: 1 . Prioritize what is needed information & avoid spending time reading “interesting” information not central to the problem at h& 2 . Integrate professional & personal searching so that the same browser does not need to be accessed repeatedly 3 . Check e-mail frequently so that patient questions can be addressed promptly 4 . Check for viruses, spyware, & malware 13. Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review: 1. The patient’s current diagnosis & history 2. Drugs the patient is currently taking 3. Any recent previous encounter for the same problem as this visit & what was done 4. All of the above 14. Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true? 1 . Patients feel the provider does not care about them if they are not seen in a face-to-face encounter. 2