CS Exam

Question 1

List 3 common classes and examples of drugs often prescribed as ADJUNCTIVE first line therapies in combination with analgesics, opioids, and non-opioid for pain

Answer 1

Anticonvulsants: Neuropathic pain (gabapentin, pregabalin) * check renal function

Antidepressants: neuropathic pain, co-analgesic for cancer pain, concurrent treatment of depression (TCA-amitriptyline *caution with ederly, cardiac; SSRI- paroxetine; SNRI- Venlafaxine-liver

Local anesthetics: topic/local discomfort, neuropathic pain- lidoderm patch, lidocaine injections

Steroids: inflammatory neuropathic pain, chronic cancer pain; short term only (IE Dexamethasone)

Muscle Relaxants: temporary relief of acute muscle injury

Question 2

Which DEA schedule has the least potential for abuse?

Answer 2

Schedule V

Question 3

Which DEA schedule has the most potential for abuse?

Answer 3

Schedule II

Question 4

What are the COMMON side effects of opioid medications?

Answer 4

constipation, dry mouth, nausea, vomiting, drowsiness, confusion, tolerance, physical dependence, withdrawal symptoms

Question 5

What is the maximum dose of Lidocaine into a subcutaneous site at one time?

What drug can be added to Lidocaine for subcutaneous injection to potentiate its effects?

Answer 5

Lidocaine without epinephrine: 4.5 mg/kg, max 300mg or 30 mL

Lidocaine with epinephrine: 7g/kg, max 500 mg or 50mL of Lidocaine 1%

Question 6

Can nurse practitioners furnish or prescribe drugs or devices to family members or friends?

Answer 6

No

Question 7

Certified NPs who hold active prescribing or furnishing licenses and valid DEA registration numbers can prescribe or order controlled substances from what schedules?

Answer 7

Schedule II-V

Question 8

What are the criteria for being classified as dangerous controlled substance drugs by the federal Drug Enforcement Agency (DEA)?

Answer 8

Substances are placed in their respective schedule based on their relative abuse potential and likelihood of causing dependence when abused

Question 9

9. What controlled schedules (I, II, III, IV, V) are the following drugs?

Methylphenidate (Ritalin)
Diazepam (Valium)
Lomotil
Marijuana (THC)
Fentanyl (Duragesic)
Morphine
Guaifenesin/Hydrocodone (Hycotuss)
Acetaminophen/Hydrocodone (Norco, Vicodin)
AndroGel (Testosterone)
Phentermine
Alprazolam (Xanax)
Carisoprodol (Soma)
Zolpidem (Ambien)
Adderall (amphetamine/dextroamphetamine)
Methadone

Answer 9

Methylphenidate (Ritalin): II
Diazepam (Valium): IV
Lomotil: V
Marijuana (THC): I
Fentanyl (Duragesic): II
Morphine: II
Guaifenesin/Hydrocodone (Hycotuss): II
Acetaminophen/Hydrocodone (Norco, Vicodin): II
AndroGel (Testosterone): III
Phentermine: IV
Alprazolam (Xanax): IV
Carisoprodol (Soma): IV
Zolpidem (Ambien): IV
Adderall (amphetamine/dextroamphetamine): II
Methadone: II

Question 10

10. Vicodin has been changed from a Schedule ? to a Schedule ? drug due to its increased risk of abuse and addiction.

Answer 10

Schedule III to a Schedule II

Question 11

11. List two (2) different Schedule I substances (of which NPs are not permitted to prescribe).

Answer 11

• Heroin and marijuana

Question 12

12. What class of pain medications typically should not be ordered for a renal-impaired patient (GFR < 50 ml/min)?

Answer 12

• NSAIDs

Question 13

According to the Pharmacotherapeutics for Advanced Practice Providers textbook, among ultra rapid metabolizers who carry copies of the CYP2D6 gene, codeine is unusually effective and has led to ? in some children

Answer 13

fatalities

Question 14

14. What class of pain medications typically should not be ordered for a moderately hepatic-impaired patient, or must be hepatic dosed adjusted?

Answer 14

• Acetaminophen

Question 15

15. According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, pure opioid agonists such as Morphine have the effects such as respiratory depression. From your textbook, list 5 more possible effects of pure opioid agonists.

Answer 15

Relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, respiratory depression

• serotonin syndrome: high body temp., agitation, hyperreflexia, tremor, dilated pupils

Question 16

16. Cough medications with codeine or antidiarrheal are what type of Scheduled medication?

Answer 16

• Schedule V

Question 17

17. Benzodiazepines must be (fill in the blank) when you plan to discontinue them? Here’s your choices- Abruptly stopped, tapered, dosed around the clock to be effective, or have thorough renal and hepatic labs before prescribing.

Answer 17

• Slowly tapered

Question 18

18. How many refills can a patient have for Methylphenidate (Ritalin)?

Answer 18

• No refills – no prescription schedule II substances may be refilled

Question 19

19. What are the unique characteristics of Oxycodone (Oxycontin), aside from its potency? What Controlled Drug Schedule is it?

Answer 19

• Time released, Schedule II

Question 20

20. According to the Pharmacotherapeutics for Advanced Practice Providers textbook, severe toxicity has occurred in ? infants whose mothers are taking codeine.

Answer 20

breastfed

Question 21

21. What are the signs and symptoms of opiate withdrawal?

Answer 21

similiar to a severe influenza infection: n/v, sweating, joint aches, agitation, tremor

pulse >120
sweat streaming off face
unable to sit still for more than a few seconds
pupils so dilated
rubbing joints or muscles & unable to sit still because of discomfort
nose constantly running or tears streaming down face
multiple episodes of diarrhea or vomitting
gross tremor or muscle twitching
yawning several times/ minute
irritable and anxious
prominent piloerrection

Question 22

22. Which DEA Schedule contains drugs that have very high abuse potential and are not usually used as prescribed medications?

Answer 22

• Schedule I

Question 23

23. According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, about 10% of each dose of codeine in the liver converts to ? .

Answer 23

morphine

Question 24

24. True or false: Using benzodiazepines can lead to a potential for tolerance and dependency.

Answer 24

• True

Question 25

25. According to the assigned reading handout "OTC Analgesia Checklist", what indications show that your patient may be at risk if you prescribe NSAIDs? And when should have a risk vs. benefit analysis and/or medication adjustment before prescribing NSAIDs?

Answer 25

* Have increased risk of GI bleeding? * Have GERD, dyspepsia, or peptic ulceration or a history of stomach problems? * Have kidney disease? * Have cardiovascular disease or a history of stroke? * Have hypertension? * Take aspirin to protect against heart attack or stroke * Have liver cirrhosis? * Have asthma? * Have edema (due to CHF)? * Drink 3 or more alcoholic beverages every day? * Take prescription meds, such as NSAIDS, antihypertensive agents, diuretics, or anticoagulants? * Take OTC medications containing NSAIDs, including cough and cold or allergy products, sleep aids, antipyretics and analgesics? * Take steroids or have condition that requires long term steroid use? * Is your patient over 60 years old * Has your patient ever had an allergic reaction or serious side effects from taking pain relievers * Has your patient recently had heart surgery or he/ she about to have heart surgery?

Question 26

26. According to the assigned reading handout "OTC Analgesia Checklist", what indications show that your patient may be at risk if you prescribe acetaminophen? And when should your patient have a risk vs. benefit analysis and/or medication adjustment completed by you before prescribing acetaminophen? (Select 4)

Answer 26

* Drink 3 or more alcoholic beverages every day? * Have liver disease? * Take warfarin? * Take prescription medication containing acetaminophen, including acetaminophen containing opiods?

Question 27

27. What are the criteria for a Nurse Practitioner to be able to prescribe Buprenorphine (Suboxone) for heroin addiction to prevent opiate withdrawal?

Answer 27

* NPs with a furnishing and DEA license may now prescribe Buprenorphine (Suboxone) for heroin addiction to prevent opiate withdrawal