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Final exam review
- Patients with allergic rhinitis may benefit from a prescription of:
- Fluticasone (Flonase)
- Cetirizine (Zyrtec)
- OTC cromolyn nasal spray (Nasalcrom)
- Any of the above
- Decongestants such as pseudoephedrine (Sudafed):
- Are Schedule III drugs in all states
- Should not be prescribed or recommended for children under 4 years of age
- Are effective in treating the congestion children experience with the common cold
- May cause drowsiness in patients of all ages What drug therapy could a provider select to administer to a client seeking treatment for rhinosinusitis? chloride channel activators nitrofurantoin antimotility agents amoxicillin Allergic Rhinitis – corticosteroids are used to e manage seasonal or perennial allergies; used intranasal 1-2 times daily; Decongestants are used for allergic rhinitis Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they: A. Are more effective than first-generation antihistamines B. Are less sedating than first-generation antihistamines C. Are prescription products and, therefore, are covered by insurance D. Can be taken with CNS sedatives, such as alcohol B. Are less sedating than first-generation antihistamines Patients with allergic rhinitis may benefit from a prescription of:
- Fluticasone (Flonase)
- Cetirizine (Zyrtec)
- OTC cromolyn nasal spray (Nasalcrom)
- All of the above Nonpharmacological therapy includes increasing fluid intake, using nonmedicated cough drops, nasal saline spray/drops to decrease viscosity of nasal secretions, and rest. Anorexia is often associated with the common cold and fluids may need to be forced to maintain hydration. Infants who are congested cannot breathe and feed at the same time causing fluid intake to be inadequate. Nasal suctioning may be required to clear secretions. Oral decongestants are used for the temporary relief of nasal congestion from the common cold, sinus infections, and allergic rhinitis. They may be used to promote nasal or sinus drainage and are also indicated in the relief of eustachian tube congestion. Pseudoephedrine for those over 4 y/o Viral URI (the common cold) are self-limiting and require no treatment, the goal is relieving irritating symptoms, specifically nasal congestion. ANTIBIOTICS HAVE NO PLACE IN THE TREATMENT OF VIRAL URIs. They can cause antimicrobial resistances to secondary bacterial infections. Antihistamines have not been shown to change the course of the common cold. But many OTC medications contain antihistamines, most likely for their “drying out” effect. Decongestants are the mainstay treatment for the common cold (systemic or topical). Tylenol/Ibuprofen/ASA can be given for fever and malaise. Topical decongestants are safe for 3 consecutive days of use. Topical decongestants adverse effects – transient stinging, burning, sneezing, dryness, local irritation, rebound congestion with prolonged use. Topical decongestants can symptomatically relieve nasal congestion and relieve ear blockage and pressure pain. Topical decongestant adverse reactions – insomnia, dizziness, weakness, tremor, or irregular heartbeat. Topical decongestant meds – Afrin, phenylephrine, oxylmetazoline, Neo-Synephrine
Albuterol, beta agonists, is generally considered the first-choice medication for treatment of asthma. Inhaled corticosteroids are recommended as first-line therapy for athletes who have persistent asthma to prevent worsening symptoms with exercise. How is first-line treatment for COPD the same as for asthma? Both diseases require maintenance therapies. Both diseases are treated based on the number of hospitalizations. Both diseases results from first- or second-hand smoking. Both diseases are first always treated with short-acting muscarinic antagonists (SAMAs). Mast cell stabilizer – cromolyn ; works by inhibiting antigen-induced bronchospasm, blocks histamine release, stabilizes mast cells. Monoclonal antibody binds to free IgE and prevents them from responding to relevant allergens
- What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients?
- 99% of T3 and the rest is T4 to get rapid resolution.
- Most needs to be T4 to mimic natural ratios of hormone.
- The ratio is unimportant.
- The mix needs to be 50-50 at first.
- After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every:
- 1 to 2 weeks
- 3 to 4 weeks
- 2 to 3 months
- 6 to 9 months
- Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every:
- 2 weeks
- 4 weeks
- 2 months
- 6 months TSH levels determine hpyo- or hyperthyroidism. Level is between 0.5-5.0 mU/I. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.
- When methimazole is started for hyperthyroidism it may take to see a total reversal of hyperthyroid symptoms.
- 2 to 4 weeks
- 1 to 2 months
- 3 to 4 months
- 6 to 12 months Hypothyroidism during pregnancy is safe to treat with thyroid replacement hormones, they are a Pregnancy Cat A drug, and may require higher doses due to increase metabolism.
- What happens to the typical hormone replacement dose when a woman becomes pregnant?
- Most women need less medication.
- Most women do not require a dose change.
- The average woman needs more medication during pregnancy.
- The average woman needs more medication only if carrying multiples. Which of the following is the mechanism of action of oral combined contraceptives that prevent pregnancy? A. Estrogen prevents the LH surge necessary for ovulation. B. Progestins thicken cervical mucous and slow tubal motility. C. Estrogen thins the endometrium, making implantation difficult. D. Progestin suppresses FSH release. Progesterone-only pills are recommended for women who: A. Are breastfeeding B. Have a history of migraine C. Have a medical history that contradicts the use of estrogen D. All of the above
- Hypertension medication in pregnancy
- How do Beta1 blockers affect the heart
- Beta-adrenergic blockers related to heart failure
- Commonalities of prazosin, terazosin, doxazosin
- Amlodipine vs Nifedipine
- Calcium channel antagonists of DHP vs. NDHP
- Cautions when using NDHP
- Hypertension treatment
- Use of calcium containing antacids
- Antacids related to fluid retention
- Strep throat related to treatment and diarrhea
- IBS related to diarrhea
- Diarrhea related to travel
- IBS treatment
- Inflammatory bowel disease treatment
- Tx of Alzheimer’s Disease
- Tx of Parkinson’s Disease
- Tx of Major Depression
- Tx for anxiety
- Tx for insomnia
- Tx for PTSD
- Z-drugs for insomnia
- Clinical judgement in prescribing
- Reducing costs of medications
- Managed care organizations r/t health improvement
- Managed care organizations r/t quality of life
- Managed care organizations r/t to dollars per life-year saved
- Managed care organizations r/t concrete monetary end-point
- Managed care organizations r/t comparing drug benefits
- Cost effectiveness in prescribing
- Copays from state to state
- Review of drugs recently placed on the market
- Vital signs related to prescribing
- Pentoxifylline
- First vs second generation antihistamines
- Naproxen related to Rheumatoid arthritis
- Medications for muscle spasms
- Prevention of osteoporosis
- Alendronate
- Treatment of acute pain
- Pain related to different ages
- Acute vs chronic pain
- Diarrhea post hospitalization
- Antidiarrheal medications related to stool changes
- Activated charcoal
- Antibiotics related to antacids
- Probiotics
- Bismuth subsalicylate therapy
- Laser trabeculoplasty
- Antiglaucoma agents related to kidney stones
- Uses for ketotifen
- Treatment of Type II DM
- Tx hypothyroidism
- Tx of partial seizures
- Tx of narcolepsy
- Tx of ADHD
- Tx Schizophrenia
- Tx Bipolar disorder
- Penicillin and Cephalosporin cross sensitivity
- Tx for strep throat
- UTI treatment in pregnancy
- Side effects of amoxicillin
- Cephalosporins related to bacterial bronchitis
- Penicillin allergies
- Doxycycline use/avoidance in children 1) An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? A. Beta blockers B. Diuretics C. Nondihydropyridine calcium channel blockers D. Angiotensin II receptor blockers 2) Adam has type I diabetes and plays tennis for his university. He exhibits knowledge deficit about his insulin and his diagnosis. He should be taught that: A. He should increase his increase his carbohydrate intake during times of exercise intake during times of exercise. B. Each brand of insulin is equal in bioavailability, so buy the least expensive. C. Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts. D. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes. 3) Age is a factor in different responses to pain. Which of the following age- related statements about pain is not true? A. Preterm and newborn infants do not yet have functional pain pathways. B. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. C. Increases in pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. D. Decreases in pain tolerance are evident in older adults. 4) Alterations in drug metabolism among Asians may lead to: A. Slower metabolism of antidepressants, requiring lower doses B. Faster metabolism of neuroleptics, requiring higher doses
10) Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a "red flag" about potential chemical dependency? A. Use of more than one drug to treat the pain B. Multiple times when prescriptions are lost with requests to refill C. Preferences for treatments that include alternative medicines D. Presence of a family member who has abused drugs 11) Common mistakes practitioners make in treating anxiety disorders include: A. Switching medications after an eight-week trial to a twelve-week trial B. Maximizing dosing of antianxiety medications C. Encouraging exercise and relaxation therapy before starting medication D. Thinking a partial response to medication is acceptable 12) David presents to clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eyedrops. The education regarding using cromolyn eyedrops includes which one of the following tips? A. He should not wear his soft contacts while using the cromolyn eyedrops. B. Cromolyn drops are instilled once a day to prevent allergy symptoms. C. Long-term use of the eyedrop may cause glaucoma. D. He may experience bradycardia as an adverse effect. 13) The DEA: A. Registers manufacturers and prescribes controlled substances B. Regulates NP prescribing at the state level C. Sanctions providers who prescribe drugs off-label D. Provides prescribers with a number they can use for insurance billing 14) Diagnostic criteria for diabetes include: A. Fasting blood glucose greater than 140 mg/dl on two occasions B. Postprandial blood glucose greater than 140 mg/dl C. Fasting blood glucose 100 to 125 mg/dl on two occasions D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl 15) Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: A. Heart failure B. Angina C. MI D. Dyslipidemia
16) The drug of choice for type II diabetics is metformin. Metformin: A. Decreases glycogenolysis by the liver B. Increases the release of insulin from beta cells C. Increases intestinal uptake of glucose D. Prevents weight gain associated with hyperglycemia 17) The drug recommended as primary prevention of osteoporosis in men over seventy years is: A. Alendronate (Fosamax) B. Ibandronate (Boniva) C. Calcium carbonate D. Raloxifene (Evista) 18) The drug recommended as primary prevention of osteoporosis in women over seventy years old is: A. Alendronate (Fosamax) B. Ibandronate (Boniva) C. Calcium carbonate D. Raloxifene (Evista) 19) The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: A. Metformin and insulin B. Sulfonylureas and insulin glargine C. Split-mixed dose insulin and GLP-1 agonists D. Biguanides and insulin lispro 20) Drugs that have a significant first-pass effect: A. Must be given by the enteral (oral) route only B. Bypass the hepatic circulation C. Are rapidly metabolized by the liver and may have little if any desired action D. Are converted by the liver to more active and fat-soluble forms 21) Dwayne has classic tinea capitis. Treatment for tinea on the scalp is: A. Rubbing in miconazole cream well for four weeks B. Intake of oral griseofulvin for six to eight weeks C. Shampooing with ketoconazole shampoo daily for six weeks D. Using ciclopirox cream daily for four weeks
27) Genetic polymorphisms account for differences in metabolism, including: A. Poor metabolizers (PMs) that lack a working enzyme B. Intermediate metabolizers (IMs) that have one working, wild-type allele and one mutant allele C. Extensive metabolizers (EMs), with two normally functioning alleles D. All of the above 28) Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. A. True B. False 29) Goals of treatment when treating hypothyroidism with thyroid replacement include: A. Normal TSH and free T4 levels B. Resolution of fatigue C. Weight loss to baseline D. All of the above 30) Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: A. Symptoms markedly worsen or the patient becomes hypotensive and has syncope. B. There is evidence of progressive renal insufficiency or failure. C. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic. D. All the above options are correct. 31) Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: A. "Fruity" breath odor and rapid respiration B. Diarrhea, abdominal pain, weight loss, and hypertension C. Dizziness, confusion, diaphoresis, and tachycardia D. Easy bruising, palpitations, cardiac dysrhythmias, and coma 32) If a patient with H. pylori positive PUD fails first-line therapy, the second- line treatment is: A. A PPI BID plus metronidazole plus tetracycline plus bismuth subsalicylate for fourteen days B. Testing H. pylori for resistance to common treatment regimens C. A PPI plus clarithromycin plus amoxicillin for fourteen days D. A PPI and levofloxacin for fourteen days
33) In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: A. A calcium channel blocker B. A beta blocker C. Liothyronine D. An alpha blocker 34) Inadequate vitamin D intake can contribute to the development of osteoporosis by: A. Increasing calcitonin production B. Increasing calcium absorption from the intestine C. Altering calcium metabolism D. Stimulating bone formation 35) Incorporating IT into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by: A. Turning the screen around so the patient can see material being recorded B. Not placing the computer screen between the provider and the patient C. Both A and B D. Neither A nor B 36) Infants with reflux are initially treated with: A. Histamine 2 receptor antagonist (ranitidine) B. A PPI (omeprazole) C. Antireflux maneuvers (elevate the head of the bed) D. Prokinetic (metoclopramide) 37) In five- to eleven-year-old children, mild-persistent asthma is diagnosed when asthma symptoms occur: A. At nighttime one to two times a month B. At nighttime three to four times a month C. Less than twice a week D. Daily 38) Jack, eight years old, 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: A. Slurred speech and insomnia B. Bradycardia and confusion C. Dizziness and orthostatic hypotension D. Insomnia and decreased appetite
C. oxycodone (OxyContin) D. oral morphine (Roxanol) 44) Liza is breastfeeding her two-month-old son, and she has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant? A. Maternal drug levels B. Half-life C. Lipid solubility D. All of the above 45) Long-acting beta-agonists received a black box warning from the US Food and Drug Administration due to the: A. Risk of life-threatening dermatological reactions B. Increased incidence of cardiac events when long-acting beta-agonists are used C. Increased risk of asthma-related deaths when long-acting beta-agonists are used D. Risk for life-threatening alterations in electrolytes 46) Long-term treatment of moderate atopic dermatitis includes: A. Topical corticosteroids and emollients B. Topical corticosteroids alone C. Topical antipruritics D. Oral corticosteroids for exacerbations of atopic dermatitis 47) Medications used in the management of patients with COPD include: A. Inhaled beta 2 agonists B. Inhaled anticholinergics (ipratropium) C. Inhaled corticosteroids D. All of the above 48) Monitoring for a child on methylphenidate for ADHD includes: A. ADHD symptoms B. Routine height and weight checks C. Amount of methylphenidate being used D. All of the above 49) Narcotics are exogenous opiates. They act by. A. inhibiting pain transmission in the spinal cord
B. attaching to receptors in the afferent neuron to inhibit the release of substance P C. blocking neurotransmitters in the midbrain D. increasing beta-lipoprotein excretion from the pituitary 50) A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: A. Bradykinesia, akathisia, and agitation B. Excessive weight gain C. Hypertension D. Potentially fatal agranulocytosis 51) 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: A. Has a short half-life so that missing one dose has limited effect B. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down C. Has a tolerability profile with less of the adverse effects that are considered "irritating," such as nausea and dizziness D. Must be taken no more than twice a day 52) Off-Label prescribing is: A. Regulated by the FDA B. Illegal by NPs in all states (provinces) C. Legal if there is scientific evidence for the use D. Regulated by the DEA 53) One goal of asthma management in children is: A. They should independently manage their asthma. B. They should participate in school and sports activities. C. There should be no exacerbations. D. The use of inhaled corticosteroids should be minimal. 54) The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is: A. Annual dual energy X-ray absorptiometry (DEXA) scans B. Annual vitamin D level C. Annual renal function evaluation D. Electrolytes every three month
A. Swelling of the tongue and hoarseness are the most common symptoms. B. It appears to be related to a decrease in aldosterone production. C. The presence of a dry, hacky cough indicates a high risk for this adverse response. D. Because it takes time to build up a blood level, it occurs after being on the drug for about one week. 62) Prescribing for women during their childbearing years requires constant awareness of the possibility of: A. Pregnancy unless the women is on birth control B. Risk for silent bacterial or viral infections of the genitalia C. High risk for developmental disorders in their infants D. Decreased risk for abuse during this time 63) Prior to prescribing metformin, the provider should: A. Draw a serum creatinine to assess renal function. B. Try the patient on insulin. C. Tell the patient to increase iodine intake. D. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions. 64) Progesterone-only pills are recommended for women who: A. Are breastfeeding B. Have a history of migraine C. Have a medical history that contradicts the use of estrogen D. All of the above 65) Sadie is a seventy-two-year-old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: A Megaloblastic anemia B. Osteoporosis C. Hypertension D. Strokes 66) Sarah, a forty-two-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include understanding that: A. Obesity is a contraindication to prescribing phentermine. B. Anorexiants may cause tolerance and should only be prescribed for six months. C. Patients should be monitored for postural hypotension. D. Renal function should be monitored closely while the patient is on anorexiants.
67) Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be: A. Atorvastatin (Lipitor) B. Niacin (Niaspan) C. Simvastatin and ezetimibe (Vytorin) D. Gemfibrozil (Lopid) 68) Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they: A. Are more effective than first-generation antihistamines B. Are less sedating than first-generation antihistamines C. Are prescription products and, therefore, are covered by insurance D. Can be taken with CNS sedatives, such as alcohol 69) Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: A. Topical antipruritics B. Oral corticosteroids for two to three weeks C. Thickly applied topical intermediate-dose corticosteroids D. Isolation of the patient to prevent spread of the dermatitis 70) Sitagliptin has been approved for: A. Monotherapy in once-daily doses B. Combination therapy with metformin C. Both A and B D. Neither A nor B 71) A sixty-six-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner managing his primary healthcare needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): A. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex). B. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce. C. Symptoms of hypertensive crisis (headache, tachycardia, sweating, etc.) require immediate treatment. D. All the above options are correct.
