Exam 1 Flashcards
(127 cards)
1
Q
Regulates NP prescriptive authority
A
State Board of Nursing
2
Q
APRNs care for the patient from a
A
holistic approach and include the patient in decision making regarding their care
3
Q
Clinical judgement in prescribing includes:
A
factoring in the cost to the patient of the medications prescribed
4
Q
Criteria for choosing an effective drug for a disorder include:
A
consulting nationally recognized guidelines for disease management
5
Q
The time required for the amount of drug in the body to decrease by 50%
A
Half-life
6
Q
When prescribing based on schedule, be aware of:
A
half-life
7
Q
After four to five half-lives, what does a drug reach?
A
Steady state
8
Q
Drugs that have a significant first-pass effect are
A
rapidly metabolized by the liver and may have little if any desire action
9
Q
Drugs metabolized in the liver by phase I or phase II reactions
A
change drug molecules to a form that an excretory organ can excrete
10
Q
Hypoalbuminemia
A
May affect the distribution of drugs to target tissues
11
Q
Bioavailability issues are especially important for drugs with:
A
narrow therapeutic ranges or sustained-release mechanisms
12
Q
CYP3A4 enzyme can:
A
induce or inhibit metabolism of another drug
13
Q
Grapefruit juice contains furanocoumarins that have been found to:
A
inhibit CYP3A4, leading to decreased first-pass metabolism
14
Q
To achieve the best effect, take enteric-coated tablets with:
A
at least 8 ounces of fluid
15
Q
If crushed could possibly result in toxicity
A
sustained-release capsules
16
Q
What is an advantage of sublingual medication?
A
Absorbed rapidly
17
Q
Factors that affect gastric drug absorption include:
A
lipid solubility of the drug
18
Q
A rich blood supply to the area of absorption leads to:
A
better absorption
19
Q
Treatment goals in prescribing should always be:
A
patient-centered
20
Q
Therapeutic goals when prescribing include:
A
curative, palliative, preventative
21
Q
When determining drug treatment, the NP should:
A
individualize the drug choice for the specific patient
22
Q
Patient education regarding prescribed medications includes:
A
discussion of expected adverse drug reactions
23
Q
What is passive monitoring?
A
Instructing the patient to report if the drug is not effective
24
Q
Who regulates the official labeling for all prescription and OTC drugs?
A
FDA
25
FDA approval is also required for:
medical devices
26
Off-label prescribing is legal if:
there is scientific evidence to support use
27
Which drugs require a new prescription each month?
Schedule II drugs
28
Which scheduled drugs cannot be faxed to the pharmacy?
Schedule I and II
29
Which scheduled drugs can be faxed to the pharmacy?
Schedule III-V
30
What are some strategies to prevent misuse of controlled prescription drugs?
Limit-setting, chemical dependency screening tools, and practicing "just say no"
31
Actions to reduce drug-to-drug interactions include:
not prescribing drugs to counteract adverse drug reactions
32
Infant/children are at higher risk for adverse reactions due to:
Lack of safety/efficacy studies in the pediatric population, weight-based drugs, and differences in fat content
33
Elderly are also at risk for adverse reactions due to:
Age-related decreases in hepatic and renal function
34
Type I reaction
Immediate hypersensitivity reaction, anaphylactic shock
35
Type II reaction
Cytotoxic hypersensitivity reaction, neutropenia from using topical Silvadene for burns
36
Type III reaction
Immune complex hypersensitivity reaction
37
Type IV reaction
Delayed hypersensitivity reaction, rash after using a topical medication
38
FDA MedWatch system is activated when:
an adverse event or serious problem occurs with a medication that is not already identified on the label
39
Vaccine Adverse Events Reporting System is:
a voluntary reporting system that healthcare providers/consumers may use to report adverse events
40
Genetic testing is required by the FDA prior to prescribing:
Cetuximab
41
Rifampin is a nonspecific CYP450 inducer that may:
induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
42
21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
increased dosages of drugs metabolized by 2D6, such as selective serotonin reuptake inhibitors
43
Carbamazepine has a Black Box warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry due to:
increased risk for Stevens-Johnson syndrome
44
Alterations in drug metabolism among Asians may lead to:
slower metabolism of antidepressants, requiring lower doses
45
Asians from Eastern Asia are known to be fast acetylations and:
require higher doses of drugs metabolized by acetylization to achieve efficacy
46
Ethnic differences have been found in drug:
hepatic metabolism
47
An interpreter for healthcare must be:
a professionally trained medical interpreter
48
Hispanic native healers or curanderas use:
herbs and teas in their treatment of illness
49
When the costs of specific treatments of interventions are calculated and then compared with the dollar value of the benefit received
Cost-benefit analysis
50
Compares two or more treatments or programs that are not necessarily therapeutically equivalent
Cost-effectiveness analysis
51
What increases compliance by reducing the financial burden of drug costs to the patient?
Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists
52
The most frequent type of drug-food interaction is:
food affecting the gastrointestinal absorption of drugs
53
Food in the gastrointestinal tract affects drug absorption by:
altering gastric emptying time
54
Food can alter the pH of the stomach, leading to:
altered drug bioavailability
55
Fasting for an extended period can:
cause vasoconstriction, leading to decreased drug absorption
56
A low-carbohydrate, high-protein diet may:
increase drug-metabolizing enzymes
57
Antacids such as calcium carbonate (Tums) can reduce absorption of:
iron
58
Phenytoin decreases folic acid absorption by:
inhibiting intestinal enzymes required for folic acid absorption
59
Vitamin B12 deficiency may lead to:
numbness and tingling of hands
60
There is strong evidence to support that adequate Vitamin C intake prevents:
scurvy
61
Symptoms of folate deficiency include:
glossitis
62
Patients with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency?
Folate
63
Patients with iron deficiency will develop:
microcytic-hypochromic anemia
64
It is reasonable to add __________ to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori
Probiotics
65
These are NOT regulated by the FDA
herbs and supplements
66
Overdosage of Valerian tea may lead to:
cardiac disturbances
67
What is the standard dosage of St.John's Wort for the treatment of mild depression?
300 mg, three times a day
68
Patients need to be instructed regarding drug interactions with St.John's Wort, including:
MAO inhibitors, serotonin reuptake inhibitors, and OTC cough/cold medications
69
Ginseng may potentiate:
insulin
70
The choice of diuretic to use in treating hypertension is based on:
kidney function, with a thiazide diuretic being used for GFR higher than the mid-40 range
71
Why is Chlorthalidone preferred over HCTZ?
Longer half-life and better cardiovascular benefits
72
HCTZ and Furosemide can cause:
hypokalemia, patients may need a potassium supplement
73
Aldosterone inhibitors:
typically do not need a potassium supplement
74
Prior to prescribing ACE inhibitors:
assess for decreased renal function
75
ACE inhibitors are the drug of choice in treating hypertension in diabetic patients because they:
improve insulin sensitivity, improve renal hemodynamics, and reduce the productions of angiotensin II
76
A potentially life-threatening adverse response to ACE inhibitors is:
angioedema, swelling of the tongue or hoarseness are the most common symptoms
77
ACE inhibitors are useful in stable angina because:
they decrease the thickening of vascular walls due to decreased modified release
78
ACE inhibitors are useful in heart failure because:
they reduce remodeling of injured myocardial tissues
79
If a patient is experiencing a dry, hacking cough from an ACE inhibitor, consider changing to:
an ARB
80
ACE inhibitors are contraindicated in:
pregnant women
81
While taking an ARB, patients need to avoid certain OTC drugs without first consulting the provider because:
Cimetidine is metabolized by CYPA3A4 isoenzymes, NSAID drugs reduce prostaglandin levels
82
Calcium channel blockers help control blood pressure because they:
decrease the amount of calcium inside the cell
83
Patient teaching related to amlodipine includes:
avoid grapefruit juice, as it affects the metabolism of this drug
84
Calcium channel blockers are contraindicated in patients with:
heart failure
85
Older adults are at risk for Digoxin toxicity due to:
reduced renal function
86
Monitoring of serum levels of Digoxin should occur:
within 6 hours of the last dose
87
Digoxin is used for heart failure patients with:
an ejection fraction less than 40% and an audible S3
88
ACE inhibitors are beneficial in angina because they:
increase myocardial oxygen supply
89
What is a common side effect of nitrates?
Headache
90
Nitrates that are taken with erectile dysfunction medications may cause:
profound hypotension
91
Nitrates should be taken:
in an eccentric dosing schedule to prevent tolerance
92
All patients with angina should be on a:
Aspirin regimen, to thin the blood and prevent blockage
93
Patients who have angina and who are also diabetic should be on:
ACE inhibitors
94
Nitrates are especially helpful for patients who have angina who also have:
heart failure and hypertension
95
Nitrates are contraindicated in:
head trauma, cerebral hemorrhage, and closed-angle glaucoma
96
Rationale for prescribing calcium channel blockers for angina can be based on the need for:
help with rate control
97
The most common cause of angina is:
atherosclerosis
98
What is the drug of choice for heart failure?
ACE inhibitors
99
Beta-blockers are favorable in patients with heart failure with left ventricular dysfunction because:
they decrease the cardiac load
100
Diuretics may be added for heart failure patients with:
SOB, fatigue, exercise intolerance (Stage C heart failure)
101
Drug of choice for the pregnant patient with heart failure:
Beta-blockers
102
The overall goal of treating hyperlipidemia is:
to reduce atherogenesis
103
Anticoagulants are typically used in patients with heart failure when:
there is concurrent AFib
104
What is the first-line therapy for treating hyperlipidemia?
Lifestyle modification
105
It is reasonable to recommend supplementation with _______ in the treatment of hyperlipidemia
Plant sterols
106
If lifestyle modifications and dietary changes fail to lower LDL levels and patient has appropriate risk factors:
start a statin
107
Order of statin strength from lowest to highest:
lovastatin, simvastatin, rosuvastatin
108
What is a non-statin that can be prescribed if needed?
Ezetimibe (Zetia)
109
Moderate intensity statins should produce an LDL reduction of:
30%-49%
110
Before starting therapy with a statin:
baseline liver function (AST/ALT) and creatine kinase should be evaluated
111
What is a rare side effect of statins?
Rhabdomyolysis
112
Monitoring of a patient who is on lipid-lowering drug includes:
lipid profile with attention to serum LDL 6-8 weeks after starting therapy, then again in 6 weeks
113
Statins are traditionally ordered to be taken:
with the evening meal
114
Primary prevention best for life-style associated hyperlipidemia in children/adolescents is:
diet and exercise
115
Treatment of hyperlipidemia in children/adolescents:
fiber, plant sterols, and omega-3 fatty acids
116
Thiazide diuretics treat hypertension because they:
deplete body sodium and reduce fluid volume
117
All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
African Americans
118
Beta-blockers treat hypertension because they:
reduce peripheral resistance
119
Nonselective beta-blockers can worsen:
asthma and diabetes
120
ACE inhibitors treat hypertension because they:
reduce sodium and water retention, decrease vasoconstriction, and increase vasodilation
121
ACE inhibitors and nondihydropyridine calcium channel blockers taken together may:
reduce proteinuria in patients with diabetes
122
Hypertensive African Americans are typically listed as not being as responsive to:
ACE inhibitors
123
Borderline hypertension with hyperlipidemia:
Lifestyle modification and Chlorthalidone 25 mg daily
124
Hypertension (when lifestyle modification is ineffective) and hyperlipidemia:
Chlorthalidone and Lisinopril
125
Patients with hypertension should be aware that OTC cold and cough medications can:
cause blood pressure to go up
126
OTC daily dosage for Ibuprofen
1,200 mg
127
What is a potential side effect of diuretics?
Hyperuricemia, high uric acid
