pharm m5-7 Flashcards
(45 cards)
When prescribing inhalers for exercise induced asthma you teach and direct the patient to use their medication when?
A Take Combivent inhaler with spacer 15 minutes prior to exercise.
B. Two puffs salmeterol 30-60 minutes prior to exercise and two puffs albuterol 15 minutes before exercise
C. Salmeterol prevents exercise induced asthma for 12 hours and albuterol 2 to 3 hours
D. Take salmeterol twice daily and additional dose 30 minutes prior to exercise
When prescribing inhalers for exercise induced asthma you teach and direct the patient to use their medication when?
Take Combivent inhaler with spacer 15 minutes prior to exercise.
Two puffs salmeterol 30-60 minutes prior to exercise and two puffs albuterol 15 minutes before exercise
Salmeterol prevents exercise induced asthma for 12 hours and albuterol 2 to 3 hours
Take salmeterol twice daily and additional dose 30 minutes prior to exercise
A 35-year-old female with asthma is seen in your office for a sick appointment with increased cough, congestion, and shortness of breath, which statement by this patient is the most concerning?
A. “I feel like I get more relief from my Symbicort (Formoterol/Budesonide) inhaler, so I have been taking 2 puffs every 6 hours when I feel short of breath.”
B. “I was around my niece who tested flu + a couple of days ago.”
C. “I have been using my Proair (albuterol) Inhaler 2 puffs every 4-6 hours for the past two days.”
D. “I bought some guaifenesin tablets over the counter to help with my cough.”
A. “I feel like I get more relief from my Symbicort (Formoterol/Budesonide) inhaler, so I have been taking 2 puffs every 6 hours when I feel short of breath.”
Which vaccination(s) cause significant adverse reaction and should not be given to patients who are immunocompromised or on oral corticosteroids > 20mg per day?
A. All attenuated vaccinations
B. Oral Polio vaccine
C. JYNNEOS (monkey and small pox)
D. Diphtheria Tetanus and Pertussis
B. Oral Polio vaccine
Which statement is incorrect regarding the hepatitis B vaccination?
A. Immunosuppressed patients require larger doses to achieve immunity
B. The vaccine is made from genetically modified common baker’s yeast
C. People who are at risk for bodily fluid exposure can have anti HB testing done to confirm sufficient antibodies
D. The one to three dose series needs to be given sequentially 4 weeks apart. Series is restarted if any dose is missed.
D. The one to three dose series needs to be given sequentially 4 weeks apart. Series is restarted if any dose is missed.
A 32 y/o female is prescribed propranolol for migraines. Additional patient education includes all of the following except:
A. Avoid OTC cold medicines with ephedrine
B. Limit Tylenol use due to impact on liver
C. Do not abruptly stop taking medication
D. Additional birth control precautions should be taken as propranolol decreases effectiveness of birth control pill
D. Additional birth control precautions should be taken as propranolol decreases effectiveness of birth control pill
Which medication for seizures does not interact with oral contraceptives?
A. Phenytoin (Dilantin)
B. Levetiracetam (Keppra)
C. Oxcarbazepine (Trileptal)
D. Lamotrigine (Lamictal)
B. Levetiracetam (Keppra)
Which of the following instructions is of most concern for a 35-year-old African American male in terms of asthma management?
A. Take Salmeterol 1 puff BID, 12 hours apart, for short-term relief.
B. Use a spacer device with an MDI (metered-dose inhaler).
C. Pulmonary function and response to inhaler medications will be monitored with a peak flow meter.
D. Take Ipratropium bromide (Atrovent) 2-3 inhalations every 6 hours, with a maximum of 12 puffs/day for maintenance.
a. Salmeterol, formoterol, and arformoterol are long-acting inhaled bronchodilators with a half-life of 10 to 12 hours. Salmeterol is more selective for beta2 receptors than is albuterol and has minor beta1 activity (p.301). Salmeterol is not to be used for short-term bronchospasm relief (p.308). The risks of salmeterol (Serevent) and formoterol (Foradil) outweighed the benefits and that they should not be used singly in asthma for all ages.
Which of the following populations or coexisting conditions should be considered when you are prescribing Tiotropium Handihaler inhalation 18 mcg QID for COPD management?
a. 75-year-old male with benign prostatic hyperplasia
b. Patient with closed-angle glaucoma
c. Pregnant women
d. 4-year-old for long-term control of asthma
e. All of the above
e. All of these populations and conditions require special consideration due to potential contraindications or safety concerns with Tiotropium Handihaler use. The inhaled anticholinergics (aclidinium, ipratropium, and tiotropium) should not be used for the treatment for acute bronchospasm except ipratropium combined with albuterol in ER as a treatment of acute bronchospasm (p.316).
61-year-old patient in your office has not received any pneumococcal vaccine. Which of the following is the most appropriate action?
A. Administer 1 dose of PCV15 or PCV 20 or PCV21
B. Administer 1 dose of PPSV23
C. Ask patient’s preference between PCV13 or PCV 15
D. Tell him it is okay without pneumonia vaccine
For those aged 50 years or older who have not previously received a dose of PCV13, PCV15, PCV20, or PCV21 or whose previous vaccination history is unknown, administer 1 dose PCV15 or 1 dose PCV20 or 1 dose PCV21 (CDC, 2024).
A 54-year-old female patient asks about the shingles vaccine due to a previous painful skin eruption. Which of the following statements is appropriate?
A. “You don’t need a vaccination due to a previous infection.”
B. “A 2-dose series of recombinant zoster vaccine (RZV, Shingrix), given 2–6 months apart, should be administered regardless of previous infection.”
C. “Only one dose is needed because of your previous infection.”
D. “You should return for the zoster vaccine because the influenza vaccine given today interacts with the zoster vaccine.”
B. “A 2-dose series of recombinant zoster vaccine (RZV, Shingrix), given 2–6 months apart, should be administered regardless of previous infection.”
You prescribed tamsulosin 0.4 mg daily for a male patient with benign prostatic hyperplasia. You are aware that this medication is a selective Alpha-1 antagonist causing relaxation of the muscle. Which of the instructions is given correctly for this patient?
a. It’s a once-a-day medication and remember to take it during the day; timing is when you feel comfortable taking it.
b. You can take this medication crushed, mixed with applesauce or yogurt.
c. The most common adverse reaction is hypotension and potential syncopal episodes. Changing positions slowly and avoiding alcohol consumption.
d. It takes 2-3 days for this medication to be effective.
c. The most common adverse reaction is hypotension and potential syncopal episodes. Changing positions slowly and avoiding alcohol consumption.
A 56-year-old female patient with type 2 diabetes mellitus and neuropathic pain is recently diagnosed with major depression. She refuses in-person psychotherapy and prefers to try pharmacological treatment. Which of the following medications is the best choice for this patient?
a. Duloxetine (Cymbalta) 60 mg daily
b. Quetiapine (Seroquel) 25 mg BID on day 1
c. Olanzapine (Zyprexa) 5 mg daily
d. Carbidopa-levodopa (Sinemet) 1 tablet (25 mg carbidopa and 100 mg levodopa) TID
a. Duloxetine (Cymbalta) 60 mg daily
An 11-year-old patient was diagnosed with persistent asthma a year ago and has been using an inhaled corticosteroid but is still experiencing frequent exacerbations. The provider is considering adding a long-acting beta-agonist (LABA) to his treatment. What is the most appropriate recommendation for this patient?
A. Consult a Respiratory Therapist to choose the best treatment for the patient.
B. Discontinue the inhaled corticosteroid and start only an LABA for long-term management.
C. Prescribe a combination of corticosteroid and LABA inhalers.
D. Switch the patient to only a LABA inhaler to achieve better asthma control.
C. Prescribe a combination of corticosteroid and LABA inhalers.
A nurse practitioner is assessing a 2-year-old child with a history of asthma who is experiencing acute bronchospasm. Which one of the following medications is most appropriate for the NP to prescribe?
A. Albuterol
B. Ipratropium
C. Levalbuterol
D. Salmeterol
A. Albuterol
A nurse practitioner is educating a patient on the Ebola vaccine (Ervebo). Which statement is accurate regarding its use?
A. Ervebo is a medication that should be taken PO to decrease the risks of Ebola virus disease.
B. Ervebo is a live attenuated vaccine that was approved to be used in adults ages 18 and older or at high risk of occupational exposure.
C. The Ervebo is a vaccine specifically given to children under 18 in endemic regions.
D. The Ervebo vaccine will provide immediate effect against EVD after administration.
B. Ervebo is a live attenuated vaccine that was approved to be used in adults ages 18 and older or at high risk of occupational exposure.
RA is a 32-year-old male patient who presents for a routine check-up and reports a history of diphtheria infections when he was 8. He is not sure whether he needs further vaccinations due to a previous infection. What is the most appropriate recommendation regarding diphtheria immunization for this patient?
A. “No further vaccination is needed since you were previously infected and that provided you with lifelong immunity”.
B. “It is recommended that you receive a diphtheria booster only when you travel to an endemic area”.
C. “You should receive a diphtheria toxoid booster every 10 years regardless of past infection”.
D. “You should receive a full series of diphtheria vaccines again, even if you were vaccinated previously”.
C. “You should receive a diphtheria toxoid booster every 10 years regardless of past infection”.
An 80-year-old patient has been diagnosed with mild Alzheimer’s disease. The NP is considering prescribing medication to help with cognitive symptoms like donepezil. What is the most appropriate initial dosing and titration plan for the patient?
A. Start with the highest dose possible
B. Start with 5 mg in the morning and increase to 23 mg within one month.
C. Start with 5 mg at bedtime and increase the dose to 10 mg after at least 3 months if tolerated by the patient
D. Start at 10 mg immediately and tartrate every other day by 2.5 mg.
C. Start with 5 mg at bedtime and increase the dose to 10 mg after at least 3 months if tolerated by the patient
Which of the following statements about cough and cold medicine is correct?
A Decongestants like Pseudoephedrine reduce swelling associated with inflammation of the mucous membranes by vasodilation effects
B Antitussives are used to suppress cough for patients with pneumonia
C Expectorants effective for patients thinning respiratory secretions for clearance
D None of the above
C Expectorants effective for patients thinning respiratory secretions for clearance
Leanne is an emergency department nurse practitioner. She is caring for a patient who is in severe status asthmatics. Which of the following medications would you expect Leanne to order for emergency medications?
A Albuterol and Levalbuterol
B Salmeterol and formoterol
C Montelukast and Beclomethasone
D Cromolyn and Budesonide
A Albuterol and Levalbuterol
Melissa is a Nurse Practitioner student who is currently in a clinical rotation at her local primary care office. She is seeing a patient who was prescribed Adalimumab (Humira) for inflammatory bowel disease for 2 years. Which of the following statements indicates that Melissa is educated on biological drugs?
A “It is appropriate to receive the Herpes Zoster vaccine to protect you from Shingles.”
B “There is no indication that you should be taken off any biological agent while you are pregnant.”
C “You have pneumonia; you should stop taking Humira until the infection resolves.”
D None of the above
C “You have pneumonia; you should stop taking Humira until the infection resolves.”
Which of the following statements about the influenza vaccine is true?
A Influenza is recommended annually because influenza viruses are constantly changing, and immunity wanes over time.
B Influenza vaccine imparts immunity by stimulating the production of antibodies that are specific to the disease strain. People are only immune to the strains included in the vaccine for that year.
C The vaccine dose for a child and adult are the same.
D A higher dose vaccine is available for older adults
C The vaccine dose for a child and adult are the same.
Which of the following statements is true about prescribing an Anorexiant?
A It is recommended that a patient is prescribed to use an anorexiant for weight loss regardless of their history of supraventricular tachycardia
B It is recommended to assess a patient for alcohol dependence because anorexics are metabolized by the liver
C Anorexiants are beneficial to patients with difficult to monitor and control diabetes
D Anorexiants are beneficial for blood pressure control
B It is recommended to assess a patient for alcohol dependence because anorexics are metabolized by the liver
Joseph is a nurse practitioner who sees a patient for an annual physical. This patient has a past medical of hypertension and is on 50 mg BID of Metoprolol (Lopressor). Which of the following indicates a nontherapeutic effect caused by this medication?
A Depression
B Constipation
C HR: 41 bpm
D Insomnia
E All of the above
F None of the above
E All of the above
Max is a 6 year old boy who plays soccer. His mother has noticed that he has a hard time sometimes when he runs causing him to cough and have to take a break. This patient is diagnosed with exercise induced asthma with bronchospasm. What is the most appropriate medication prescription for this patient prior to exercise?
A Ipratropium bromide
B Theophylline
C Albuterol
D Indacaterol
C Albuterol