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Questions and answers
Drugs that use CYP 3A4 isoenzymes for metabolism may:
- Induce the metabolism of another drug
- Inhibit the metabolism of another drug
- Both 1 and 2
4. Neither 1 nor 2 CORRECT ANSWERS✅ 3
Medication agreements or "Pain Medication Contracts" are recommended to be used:
- Universally for all prescribing for chronic pain
- For patients who have repeated requests for pain medication
- When you suspect a patient is exhibiting drug-seeking behavior
4. For patients with pain associated with malignancy CORRECT ANSWERS✅ 1
Drugs that are prone to cause adverse drug effects include:
- Diuretics
- Inhaled anticholinergics
- Insulins
Questions and answers
4. Stimulants CORRECT ANSWERS✅ 3
The U.S. Food and Drug Administration MedWatch system is activated when:
- There is an adverse event to a vaccine.
- The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication label.
- A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
- An adverse event or serious problem occurs with a medication that is not already identified on the
label. CORRECT ANSWERS✅ 4
The Vaccine Adverse Events Reporting System is:
- A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event
- A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events
- Utilized to send out safety alerts regarding emerging vaccine safety issues
4. Activated when a vaccine has been proven to cause significant adverse effects CORRECT ANSWERS✅
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?
Questions and answers
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. CORRECT
ANSWERS✅ 4
Which of the following factors may adversely affect a patient's adherence to a therapeutic drug regimen?
- Complexity of the drug regimen
- Patient perception of the potential adverse effects of the drugs
- Both 1 and 2
4. Neither 1 nor 2 CORRECT ANSWERS✅ 3
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?
- Increasing copayments for care
- Unrestricted formularies for drugs, including brand names
- Increasing the number of people who have access to care
4. Treating a wider range of disorders CORRECT ANSWERS✅ 1
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?
- Ralph states that he always takes the drug "when I feel my pressure is going up."
Questions and answers
- Ralph contacts his NP to discuss the need to increase the dosage.
- 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. CORRECT ANSWERS✅ 1
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:
- Has a short half-life so that missing one dose has limited effect
- Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
- Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
4. Must be taken no more than twice a day CORRECT ANSWERS✅ 3
Factors in chronic conditions that contribute to nonadherence include:
- The complexity of the treatment regimen
- The length of time over which it must be taken
- Breaks in the usual daily routine, such as vacations and weekends
4. All of the above CORRECT ANSWERS✅ 4
Questions and answers
- Match the clinic appointment to the next time the drug is to be refilled.
- Write prescriptions for new drugs with shorter times between refills.
- Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.
CORRECT ANSWERS✅ 4
Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
- Older adults and those on fixed incomes
- Patients with chronic illnesses
- Patients with copayments for drugs on their insurance
4. Patients on public assistance CORRECT ANSWERS✅ 1
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:
- Are well-educated and affluent
- Have chronic conditions
- Self-monitor drug effects on their symptoms
Questions and answers
4. None of the above guarantee adherence CORRECT ANSWERS✅ 4
Monitoring adherence can take several forms, including:
- Patient reports from data in a drug diary
- Pill counts
- Laboratory reports and other diagnostic markers
4. All of the above CORRECT ANSWERS✅ 4
Factors that explain and predict medication adherence include:
- Social
- Financial
- Health system
4. All of the above CORRECT ANSWERS✅ 4
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 illness
Questions and answers
- May be a bilingual family member
- May be a bilingual nurse or other health-care provider
- Must be a professionally trained medical interpreter
4. Must be an employee of the organization CORRECT ANSWERS✅ 3
According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
- The belief among African Americans that prayer is more powerful than drugs
- Poor compliance on the part of the African American patient
- The genetic predisposition for illness found among African Americans
4. Discrimination, cultural barriers, and lack of access to health care CORRECT ANSWERS✅ 4
The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
- Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
- Largely unknown due to lack of studies of this population
- Rapid metabolism of alcohol, leading to increased tolerance
4. Decreased elimination of opioids, leading to increased risk for addiction CORRECT ANSWERS✅ 2
Questions and answers
Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
- True
2. False CORRECT ANSWERS✅ 2
Alterations in drug metabolism among Asians may lead to:
- Slower metabolism of antidepressants, requiring lower doses
- Faster metabolism of neuroleptics, requiring higher doses
- Altered metabolism of omeprazole, requiring higher doses
4. Slower metabolism of alcohol, requiring higher doses CORRECT ANSWERS✅ 1
Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
- Require acetylization in order to metabolize drugs
- Are unable to tolerate higher doses of some drugs that require acetylization
- May have a toxic reaction to drugs that require acetylization
4. Require higher doses of drugs metabolized by acetylization to achieve efficacy CORRECT ANSWERS✅
Questions and answers
- Decreased conversion of codeine to morphine by CYP 2D
4. The need for lowered dosages of drugs, such as beta blockers CORRECT ANSWERS✅ 2
Rifampin is a nonspecific CYP450 inducer that may:
- Lead to toxic levels of rifampin and must be monitored closely
- Cause toxic levels of drugs, such as oral contraceptives, when coadministered
- Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
4. Cause nonspecific changes in drug metabolism CORRECT ANSWERS✅ 3
Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
- Decreased therapeutic levels of quinidine
- Increased therapeutic levels of quinidine
- Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
- Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption
and elimination CORRECT ANSWERS✅ 4
Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
Questions and answers
- Toxic levels of warfarin building up
- Decreased response to warfarin
- Increased risk for significant drug interactions with warfarin
4. Less risk of drug interactions with warfarin CORRECT ANSWERS✅ 2
Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
- True
2. False CORRECT ANSWERS✅ 2
Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
- Erythromycin
- Digoxin
- Cetuximab
4. Rifampin CORRECT ANSWERS✅ 3
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:
Questions and answers
4. Increased elimination of an active drug CORRECT ANSWERS✅ 1
Ultra-rapid metabolizers of drugs may have:
- To have dosages of drugs adjusted downward to prevent drug accumulation
- Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
- Increased elimination of active, nonmetabolized drug
4. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug CORRECT
ANSWERS✅ 2
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
- Ensure the patient will not have increased adverse drug reactions to the tamoxifen
- Identify potential drug-drug interactions that may occur with tamoxifen
- Reduce the likelihood of therapeutic failure with tamoxifen treatment
4. Identify poor metabolizers of tamoxifen CORRECT ANSWERS✅ 3
A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.
- 10
Questions and answers
4. 70 CORRECT ANSWERS✅ 3
A potential harmful effect on patients who take some herbal medication is:
- Constipation
- Lead poisoning
- Diarrhea
4. Life-threatening rash CORRECT ANSWERS✅ 2
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:
- Coumadin, which may lead to bleeding problems
- Coumarin, which can cause liver and kidney damage
- Cinnamic aldehyde, which is toxic to the kidney
4. Cinnamate eugenol, which is toxic to the liver CORRECT ANSWERS✅ 2
Questions and answers
- Kapha
4. Prakriti CORRECT ANSWERS✅ 4
Herbs and supplements are regulated by the U.S. Food and Drug Administration.
- True
2. False CORRECT ANSWERS✅ 2
When melatonin is used to induce sleep, the recommendation is that the patient:
- Take 10 mg 30 minutes before bed nightly
- Take 1 to 5 mg 30 minutes before bed nightly
- Not take melatonin more than three nights a week
4. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep CORRECT ANSWERS✅
Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to:
- Cardiac disturbances
- Central nervous system depression
Questions and answers
- Respiratory depression
4. Skin rashes CORRECT ANSWERS✅ 1
The standard dosage of St John's wort for the treatment of mild depression is:
- 300 mg daily
- 100 mg three times a day
- 300 mg three times a day
4. 600 mg three times a day CORRECT ANSWERS✅ 3
Patients need to be instructed regarding the drug interactions with St John's wort, including:
- MAO inhibitors
- Serotonin reuptake inhibitors
- Over-the-counter cough and cold medications
4. All of the above CORRECT ANSWERS✅ 4
Ginseng, which is taken to assist with memory, may potentiate:
- Aricept
