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The influence of changes in Medicare reimbursement methods and competition from nonphysicians on primary care education in medical schools. It also covers prescribing practices of physicians and the role of nurse practitioners in prescriptive authority. General pharmacokinetic and pharmacodynamic principles are explained, including factors that affect drug excretion and the importance of using generic drug names. The document also covers different drug administration routes and their effects on drug absorption and distribution.
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MULTIPLE CHOICE
ANS: D Even though most physicians claim to place little weight on drug advertisements, pharmaceutical representatives, and patient preference and state that they rely on academic sources for drug information, a study showed that commercial rather than scientific sources of drug information dominated their drug information materials. Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have dropped out of the top five classifications of drugs prescribed. Most physicians have a therapeutic armamentarium of about 144 drugs. DIF: Cognitive Level: Remembering (Knowledge) REF: 3
MULTIPLE CHOICE
ANS: B CNMs have prescriptive authority in all 50 states. They may treat partners of women for sexually transmitted diseases. They have full prescriptive authority and are not limited to drugs used during childbirth. They practice in many other types of settings. DIF: Cognitive Level: Remembering (Knowledge) REF: 9
b. (^) are not required to follow drug treatment protocols. c. (^) may write for all drug categories with physician co-signatures. d. (^) have both inpatient and outpatient independent prescriptive authority. ANS: A PAs commonly have co-signature requirements and work under physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 17
MULTIPLE CHOICE
a. (^) is absorbed less quickly. b. (^) has reduced bioavailability. c. (^) has fewer systemic side effects. d. (^) provides dosing that is easier to regulate. ANS: C An inhaled corticosteroid goes directly to the site of action and does not have to pass through gastrointestinal tract absorption or the liver to get to the lungs. It is generally well absorbed at this site, although dosing is not necessarily easier to regulate because it is not always clear how much of an inhaled drug gets into the lungs. DIF: Cognitive Level: Applying (Application) REF: 21
will not affect this. DIF: Cognitive Level: Applying (Application) REF: 25
c. (^) order medications that can be given on an empty stomach. d. (^) instruct the patient to take a lower dose if side effects occur. ANS: A To promote adherence in elderly patients, selecting the smallest number of medications with the simplest dose regimens is recommended, with once-daily dosing preferred. Instructions should be simplified. Drug dosing should be timed with mealtimes to help patients remember to take them. Lower dosing may be necessary with some drugs, but patients should not do this without consulting their provider. DIF: Cognitive Level: Applying (Application) REF: 57 - 58
d. (^) counsel the patient to take the drug with food to enhance absorption. ANS: B A common age change that affects the distribution of drugs in older adults is a decrease in serum albumin. Significant changes that may affect drug therapy may be seen in malnourished elderly patients. Warfarin has a high binding affinity with albumin. Significant decreases in albumin may result in a greater free concentration of highly protein-bound drugs. It is important to order the lowest possible dose and titrate upward as needed. A baseline LFT is not indicated. A diet high in fat and protein is not indicated. DIF: Cognitive Level: Applying (Application) REF: 50 - 51
MULTIPLE CHOICE
a. (^) 100 mg daily. b. (^) 100 mg tid. c. (^) 300 mg daily. d. (^) 300 mg tid. ANS: B The NP should first convert the child’s weight to kg, which is about 10 kg. The dose is then calculated to be 250 to 300 mg per day in three divided doses, which is 83 to 100 mg per dose given tid. DIF: Cognitive Level: Applying (Application) REF: 65
ANS: D Because the measured volume of “teaspoons” ranges from 2.5 to 7.8 mL, parents should obtain a calibrated medicine spoon or syringe from the pharmacy for dosing small children. Elixirs are solutions in which the drug molecules are dissolved and evenly distributed, so there is no need to shake the drug before each dose. Mixing a drug with food can be problematic if the child does not eat all of the food. An elixir does not need to be administered on an empty stomach. DIF: Cognitive Level: Understanding (Comprehension) REF: 66 - 67| 69
DIF: Cognitive Level: Applying (Application) REF: 62| 66 - 67
MULTIPLE CHOICE
rhinitis, which can trigger symptoms. Antihistamines are recommended after the first trimester, if possible. Asthma medications should be continued during pregnancy because poorly controlled asthma can be detrimental to the fetus; she should continue using her daily inhaled corticosteroid. Although discontinuing seizure medications is optimal, this must be done in conjunction with this woman’s neurologist because management of epilepsy during pregnancy is beyond the scope of the primary care provider. Oral corticosteroids have greater systemic side effects and greater effects on the fetus and should be used only as necessary. DIF: Cognitive Level: Applying (Application) REF: 78 - 79
added as needed for poor control. There is insufficient evidence to support the use of oral antidiabetic agents during pregnancy, and some of these are pregnancy category D. Insulin injections may be used but are not the initial intervention. Although glucose levels will return to prepregnancy values in the postpartum period, the NP must initiate therapy. DIF: Cognitive Level: Applying (Application) REF: 79 - 80