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PHRM 845 Therapeutics > Exam 5 - Random Multiple Choice > Flashcards

Exam 5 - Random Multiple Choice Flashcards

1
Q

LD is a 62-year-old patient with chronic pain due to an automobile accident several years ago. LD has chronic moderate to severe nociceptive pain and has been taking short-acting opioids for years. Additional past medical history (PMH) includes diabetes and chronic kidney disease (CKD). The patient needs a long-acting opioid and does not want to take pills or tablets. What is the BEST medication for LD’s chronic pain?

a. morphine
b. oxycodone
c. meperidine
d. fentanyl

A

d. fentanyl

(a and c should not be used with CKD; b does have an oral solution, but a patch would be better)

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2
Q

IT is a 74-year-old man with severe chronic nociceptive pain. He has been previously treated with scheduled acetaminophen, but is prescribed morphine today. The patient will be receiving morphine chronically. Select the medication that IT should receive in addition to the acetaminophen and morphine.

a. ibuprofen
b. gabapentin
c. capsaicin
d. bisacodyl

A

d. bisacodyl

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3
Q

which of the following statements regarding methadone is true?

A. The medication has a long-variable elimination half-life.
B. It can also be used to treat seizures.
C. The medication should be avoided in a patient with an elevated serum creatinine.
D. Monitoring for this medication should include rhabdomyolysis.

A

A. The medication has a long-variable elimination half-life. (8-59 hours)

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4
Q

John is a 52-year-old man with known CYP2D6 poor metabolism. He has been recently diagnosed with major depressive disorder and has a past medical history of tobacco use disorder. Which antidepressant would John predictably find ineffective due to his CYP2D6 poor metabolism?

a. mirtazapine
b. fluvoxamine
c. citalopram
d. venlafaxine
e. desvenlafaxine

A

d. venlafaxine (converted to active metabolite via 2D6)

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5
Q

Which of the following antidepressants is classified as a dopamine and norepinephrine reuptake inhibitor?

a. bupropion
b. amitriptyline
c. fluoxetine
d. duloxetine

A

a. bupropion

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6
Q

which is a common and expected AE of lithium?

a. alopecia
b. inc urination
c. hyperammonemia
d. hyperthyroidism
e. weight loss

A

b. inc urination

(a and c are valproate; d is hypothyroidism; e is weight gain)

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7
Q

A patient is started on venlafaxine XR 300 mg daily. Which parameter should be monitored?

a. chest X-ray
b. temperature
c. vitamin B12
d. BP
e. TSH

A

d. BP (SNRIs can inc BP)

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8
Q

PCOS has been associated with which of the following meds?

a. cariprazine
b. valproate
c. lithium
d. lamotrigine
e. olanzapine

A

b. valproate

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9
Q

Select the mechanism of action of trazodone that leads to the side effects of dizziness and sedation.

a. 5-HT receptor antagonist
b. 5-HT reuptake inhibitor
c. alpha1 adrenergic and histaminergic antagonism
d. angiotensin receptor blockade

A

c. alpha1 adrenergic and histaminergic antagonism

(a and b would lead to other SE; d is not a mech of trazodone)

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10
Q

A patient is experiencing a mild to moderate mixed nociceptive and neuropathic pain from acute shingles. The patient has no other significant past medical history (PMH) or other medications. Based on mechanism of action, select the BEST pain medication for this patient.

A. Ibuprofen
B. Amitriptyline
C. Carbamazepine
D. Tramadol
E. Morphine

A

D. Tramadol

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11
Q

It is recommended that the human leukocyte antigen type B, HLA-B *1502, allele is genotyped in Asian patients prior to taking which of the following medications?

a. lithium
b. carbamazepine
c. lorazepam
d. haloperidol
e. quetiapine

A

b. carbamazepine

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12
Q

Symbyax is a combination product with several therapeutic indications. This product contains fixed doses of which of the following agents for treating bipolar depression?

a. lithium + valproate
b. risperidone + fluoxetine
c. olanzapine + fluoxetine
d. risperidone + sertraline
e. lurasidone + sertraline

A

c. olanzapine + fluoxetine

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13
Q

Which of the following medications can be used safely in patients with cardiac conduction abnormalities and avoids alterations in the QTc interval?

a. citalopram
b. desipramine
c. sertraline
d. amitriptyline

A

c. sertraline

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14
Q

which of the following statements about the fentanyl patch is TRUE?

a. indicated for mild to moderate pain
b. has a delayed onset of action
c. effective for acute neuropathic pain
d. should be avoided in renal failure

A

b. has a delayed onset of action (72 hours)

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15
Q

which antidepressant can be administered to avoid a sexual dysfunction SE?

a. bupropion
b. nortriptyline
c. fluoxetine
d. duloxetine

A

a. bupropion

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16
Q

Which agent is considered the safest option for treating a pregnant female with acute bipolar mania?

a. carbamazepine
b. haloperidol
c. lithium
d. valproic acid

A

b. haloperidol

17
Q

max venlafaxine dose/day

a. 225 mg
b. 300 mg
c. 350 mg
d. 400 mg
e. 450 mg

A

a. 225 mg

18
Q

A patient has been taking lithium for 3 years and has been stable on it without relapse of symptoms. There has been no change in renal function or other laboratory monitoring parameters. The patient’s target therapeutic concentration should be which of the following ranges?

a. 4 to 12 ug/mL
b. 4 to 12 mEq/L
c. 50 to 125 ug/mL
d. 0.6 to 0.9 mEq/L
e. 1 to 1.8 mEq/L

A

d. 0.6 to 0.9 mEq/L (this is maintenance range)

19
Q

Which pain medication may interact and increase the risk of serotonin syndrome with an SSRI?

a. oxycodone
b. Norco
c. tramadol
d. hydromorphone
e. buprenorphine

A

c. tramadol

20
Q

Mia is a 49-year-old patient who suffered an MI 1 week ago. Upon discharge, it was noted that Mia appeared depressed. At a follow-up visit with her physician a week later, Mia met criteria for a diagnosis of major depressive disorder. Her past medical history includes: treatment-refractory hypertension, diabetes mellitus (type II), and severe uncontrolled narrow angle glaucoma. Select the antidepressant that would be the safest and most effective pharmacotherapy option for Mia.

a. amitriptyline
b. venlafaxine XR
c. sertraline
d. nortriptyline

A

c. sertraline

(a and d have CV SEs; b will inc BP and they already have hypertension)

21
Q

SQ is a patient from a motor vehicle collision. She suffered a broken leg during the accident and was given opioids for pain management. SQ’s pain has gone completely away but now has developed respiratory depression. Select the BEST medication to give SQ for her current symptoms.

a. flumazenil
b. naloxone
c. n-acetylcysteine
d. albuterol
e. ipratropium

A

b. naloxone

22
Q

A patient presents to the pharmacy who has chronic neuropathic pain. The patient prefers to use a topical product for their pain. Select the best medication for this patient’s pain.

a. capsaicin
b. amitriptyline
c. carbamazepine
d. topiramate
e. diclofenac gel

A

a. capsaicin

(b, c, and d are not topical; e is an NSAID and not generally preferred for chronic neuropathic pain)

23
Q

Justin is a 57-year-old man with a recent motor vehicle accident presents with significant neck and back pain with difficulty coping due to loss of immobility. He presents with depressed mood, irritability, and low motivation to return back to work and attend physical therapy. Since his accident, he has gained 30 lbs and concerned about his binge eating behavior. His physician would like to start an antidepressant to address both his depression and comorbid pain. Select the most appropriate antidepressant based on Justin’s presentation.

a. fluoxetine
b. citalopram
c. escitalopram
d. duloxetine
e. mirtazapine

A

d. duloxetine

(a, b, and c are SSRIs, while SNRIs are typically used for pain; e causes weight gain)

24
Q

Which of the following statements is correct when considering the addition of an SSRI to a medication regimen that includes a chronic NSAID prescription?

a. Combination must be avoided and is contraindicated
b. Use this combination with caution and monitor patient closely
c. Combination is associated with enhanced antidepressant efficacy
d. Combination is associated with increased risk for clot formation

A

b. Use this combination with caution and monitor patient closely

25
Q

Choose the most appropriate option for a 68-year-old patient with a history of coronary artery disease taking metoprolol and simvastatin?

a. Fluoxetine
b. Fluvoxamine
c. Sertraline
d. Nortriptyline

A

c. Sertraline

(a can inc metoprolol levels due to 2D6 inhibition; b can inc simvastatin due to 3A4 inhibition; d the pt has a CV history and is over 65)

26
Q

A patient taking tranylcypromine should avoid all of the following EXCEPT:

a. cured meats
b. beer
c. cheeses
d. peanut butter
e. bananas

A

d. peanut butter

PHRM 845 Therapeutics (34 decks)

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