Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions
... [Show More] include:
1. Understanding that obesity is a contraindication to prescribing phentermine
2. Anorexiants may cause tolerance and should only be prescribed for 6 months
3. Patients should be monitored for postural hypotension
4. Renal function should be monitored closely while on anorexiants
Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John's wort due to:
1. Additive respiratory depression risk
2. Additive effects affecting liver function
3. The risk of serotonin syndrome
4. The risk of altered cognitive functioning
Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus.
1. IV phenobarbital
2. Rectal diazepam (Diastat)
3. IV phenytoin (Dilantin)
4. Oral carbamazepine (Tegretol)
Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2. For pedal edema throughout therapy
3. Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
4. For vision changes, such as red-green blindness, at least annually
Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:
1. Dwayne hasn't been taking his carbamazepine because it causes insomnia.
2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
3. Dwayne was not originally prescribed the correct amount of carbamazepine.
4. Carbamazepine is probably not the right antiseizure medication for Dwayne.
Carbamazepine has a Black Box Warning due to life-threatening:
1. Renal toxicity, leading to renal failure
2. Hepatotoxicity, leading to liver failure
3. Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis
4. Cardiac effects, including supraventricular tachycardia
Long-term monitoring of patients who are taking carbamazepine includes:
1. Routine troponin levels to assess for cardiac damage
2. Annual eye examinations to assess for cataract development
3. Monthly pregnancy tests for all women of childbearing age
4. Complete blood count every 3 to 4 months
Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:
1. Increased seizure activity, as this drug may auto-induce seizures
2. Altered renal function, including renal failure
3. Blood dyscrasias, which are uncommon but possible
4. Central nervous system excitement, leading to insomnia
Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:
1. Increase her dose
2. Assess for suicidal ideation
3. Discontinue the medication immediately
4. Decrease her dose to half then slowly titrate up the dose
Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:
1. Tell her to increase her caloric intake to counter the effects of the topiramate.
2. Consult with a neurologist, as this is not a common adverse effect of topiramate.
3. Decrease her dose of topiramate.
4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.
Monitoring of a patient on gabapentin to treat seizures includes:
1. Routine therapeutic drug levels every 3 to 4 months
2. Assessing for dermatologic reactions, including Steven's Johnson
3. Routine serum electrolytes, especially in hot weather
4. Recording seizure frequency, duration, and severity
Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:
1. He should not play sports due to the risk of increased seizures
2. He should monitor his temperature and ability to sweat in the heat while playing
3. Reminding him that he may need higher dosages of topiramate when exercising
4. Encouraging him to use sunscreen due to photosensitivity from topiramate
Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:
1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
2. To wear sunscreen due to photosensitivity from levetiracetam
3. To get an annual eye exam while on levetiracetam
4. To report weight loss if it occurs
Levetiracetam has known drug interactions with:
1. Combined oral contraceptives
2. Carbamazepine
3. Warfarin
4. Few, if any, drugs
Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:
1. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3. Rapid strep test and symptomatic care if strep test is negative
4. Observation only, with further assessment if she worsens
Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:
1. Contraceptive failure
2. Excessive weight gain
3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed
The tricyclic antidepressants should be prescribed cautiously in patients with:
1. Eczema
2. Asthma
3. Diabetes
4. Heart disease
A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):
1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex)
2. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce
3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment
4. All of the above
Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:
1. Fluoxetine
2. Fluvoxamine
3. Sertraline
4. Escitalopram
Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:
1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
2. Red-green color blindness may occur and should be reported.
3. If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately.
4. She should eat lots of food high in fiber to prevent constipation.
Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Amitriptyline (Elavil)
4. Duloxetine (Cymbalta)
Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:
1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients
Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:
1. Reduce the chance of tardive dyskinesia
2. Potentiate the effects of the drug
3. Reduce the tolerance that tends to occur
4. Increase central nervous system (CNS) depression
Patients who are prescribed olanzapine (Zyprexa) should be monitored for:
1. Insomnia
2. Weight gain
3. Hypertension
4. Galactorrhea
A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:
1. Bradykinesia, akathisia, and agitation
2. Excessive weight gain
3. Hypertension
4. Potentially fatal agranulocytosis
In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:
1. Chlordiazepoxide (Librium)
2. Clonazepam (Klonopin)
3. Alprazolam (Xanax)
4. Oxazepam (Serax)
A patient with anxiety and depression may respond to:
1. Duloxetine (Cymbalta)
2. Fluoxetine (Prozac)
3. Oxazepam (Serax)
4. Buspirone (Buspar) and an SSRI combined
When prescribing temazepam (Restoril) for insomnia, patient education includes:
1. Take temazepam nightly approximately 15 minutes before bedtime.
2. Temazepam should not be used more than three times a week for less than 3 months.
3. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better.
4. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam.
Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:
1. Zolpidem should be taken just before going to bed.
2. Zolpidem may cause dry mouth and constipation.
3. Patients may need to double the dose for effectiveness.
4. They should stop drinking alcohol at least 30 minutes before taking zolpidem.
One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:
1. Orthostatic hypotension
2. Agitation and irritability
3. Drowsiness and nausea
4. Painful urination and abdominal distention
Tom is taking lithium for bipolar disorder. He should be taught to:
1. Take his lithium with food
2. Eat a diet with consistent levels of salt (sodium)
3. Drink at least 2 quarts of water if he is in a hot environment
4. Monitor blood glucose levels
Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?
1. Valproate is safe during all trimesters of pregnancy.
2. She can get pregnant while taking valproate, but she should take adequate folic acid.
3. Valproate is not safe at any time during pregnancy.
4. Valproate is a known teratogen, but may be taken after the first trimester if necessary.
When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:
1. The medication may cause sedation and they should not drive.
2. Constipation is a common side effect and they should increase fluids and fiber.
3. Patients should not take any other acetaminophen-containing medications at the same time.
4. All of the above
Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:
1. Ibuprofen (Advil)
2. Acetaminophen with hydrocodone (Vicodin)
3. Oxycodone (Oxycontin)
4. Oral morphine (Roxanol)
Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:
1. Ibuprofen (Advil)
2. Acetaminophen with hydrocodone (Vicodin)
3. Oxycodone (Oxycontin)
4. Oral morphine (Roxanol)
Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:
1. Slurred speech and insomnia
2. Bradycardia and confusion
3. Dizziness and orthostatic hypotension
4. Insomnia and decreased appetite
Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:
1. ADHD symptoms
2. Routine height and weight checks
3. Amount of methylphenidate being used
4. All of the above
When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:
1. Blood pressure
2. Blood glucose levels
3. Urine ketone levels
4. Liver function
Common mistakes practitioners make in treating anxiety disorders include:
1. Switching medications after an 8- to 12-week trial
2. Maximizing dosing of antianxiety medications
3. Encouraging exercise and relaxation therapy before starting medication
4. Thinking a partial response to medication is acceptable
An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
1. Alprazolam (Xanax)
2. Diazepam (Valium)
3. Buspirone (Buspar)
4. Amitriptyline (Elavil)
An appropriate drug to initially treat panic disorder is:
1. Alprazolam (Xanax)
2. Diazepam (Valium)
3. Buspirone (Buspar)
4. Amitriptyline (Elavil)
Prior to starting antidepressants, patients should have laboratory testing to rule out:
1. Hypothyroidism
2. Anemia
3. Diabetes mellitus
4. Low estrogen levels
David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include:
1. Paroxetine may cause intermittent diarrhea.
2. He may experience sexual dysfunction beginning a month after he starts therapy.
3. He may have constipation and he should increase fluids and fiber.
4. Paroxetine has a long half-life so he may occasionally skip a dose.
Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:
1. Appetite and concentration improve in the first 1 to 2 weeks.
2. Sleep should improve almost immediately upon starting citalopram.
3. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose.
4. His dysphoric mood will improve in 1 to 2 weeks.
An appropriate drug for the treatment of depression with anxiety would be:
1. Alprazolam (Xanax)
2. Escitalopram (Lexapro)
3. Buspirone (Buspar)
4. Amitriptyline (Elavil)
An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:
1. Venlafaxine (Effexor)
2. Escitalopram (Lexapro)
3. Buspirone (Buspar)
4. Amitriptyline (Elavil)
The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is:
1. Complete blood count every 3 to 4 months
2. Therapeutic blood levels every 6 months after a steady state is achieved
3. Blood glucose every 3 to 4 months
4. There is no laboratory monitoring required
Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants?
1. Change dose to every other day dosing for a week
2. Reduce dose by 50% for 3 to 4 days
3. Reduce dose by 50% every other day
4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life
The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?
1. They have become tolerant of the medication, which is characterized by the need for higher and higher doses.
2. They are a drug seeker.
3. They are suicidal.
4. They only need additional counseling on lifestyle modification.
What "onset of action" symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor?
1. They will have insomnia for a week.
2. They can feel a bit of nausea, but this resolves in a week.
3. They will have an "onset seizure" but this is considered normal.
4. They will no longer dream.
Which of the following should not be taken with a selective serotonin reuptake inhibitor?
1. Aged blue cheese
2. Grapefruit
3. Alcohol
4. Green leafy vegetables
Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?
1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.
2. It has the longest half-life and the withdrawal syndrome has a faster onset.
3. It is quasi-addictive in the dopaminergic reward system.
4. It is the most activating of SSRI medications and will cause the person to have sudden deep sadness.
The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response?
1. This is a good idea because this class of medications generally makes people sleepy.
2. Have you noticed that you are having more sleep issues since you started that?
3. This a good way to remember to take your daily medications because it is near your toothbrush.
4. This is a good plan because you can eat grapefruit if there is 8-12 hours difference in the time each are ingested.
Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes:
1. Medication is taken at the beginning of the headache to prevent it from getting worse.
2. Medication alone is the best preventative against migraines occurring.
3. Medication should not be used more than four times a month.
4. The goal of treatment is to reduce migraine occurrence by 50%.
A first-line drug for abortive therapy in simple migraine is:
1. Sumatriptan (Imitrex)
2. Naproxen (Aleve)
3. Butorphanol nasal spray (Stadol NS)
4. Butalbital and acetaminophen (Fioricet)
Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?
1. Switch her to sumatriptan (Imitrex) to treat her migraines.
2. Assess how often she is using Fiorinal and refill her medication.
3. Switch her to a beta blocker such as propranolol to prevent her migraine.
4. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines.
When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:
1. Ergotamine will briefly make the migraine worse before the migraine resolves.
2. The patient may experience bradycardia and dizziness.
3. They may need premedication with an antinausea medication.
4. Ergotamine works best if the patient starts off with a full suppository to get the full effect.
Migraines in pregnancy may be safely treated with:
1. Acetaminophen with codeine (Tylenol #3)
2. Sumatriptan (Imitrex)
3. Ergotamine tablets (Ergostat)
4. Dihydroergotamine (DHE)
Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:
1. Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use.
2. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.
3. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).
4. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.
Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:
1. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.
2. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.
3. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine.
4. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.
Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?
1. Prescribe amitriptyline (Elavil) daily, start at a low dose and increase dosage slowly every 2 weeks until it's effective in eliminating migraines.
2. Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.
3. Prescribe propranolol (Inderal) to be taken daily for at least 3 months.
4. Explain that it is rare for a 9-year-old child to get migraines and she needs an MRI to rule out a brain tumor.
Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber's naratriptan, education would include:
1. Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St John's wort, and she should inform any providers she sees that she has migraines.
2. Continue to monitor her headaches, if the migraine is consistently happening around her menses there is preventive therapy available.
3. Pregnancy is contraindicated when taking a triptan.
4. All of the above
When prescribing for migraines, patient education includes:
1. Triptans are safe to be used as often as needed as long as the patient is healthy.
2. Use triptan before trying OTC meds such as acetaminophen or naproxen.
3. Stress reduction and regular sleep are integral to migraine treatment.
4. If migraines worsen, they are to increase their medication.
Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel like someone is "squeezing" her head. She occasionally takes Tylenol for the pain, but usually just "toughs it out." Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for:
1. Sumatriptan (Imitrex)
2. Naproxen (Aleve)
3. Ergotamine (Ergostat)
4. Tylenol with codeine (Tylenol #3)
Nonpharmacologic therapy for tension headaches includes:
1. Biofeedback
2. Stress management
3. Massage therapy
4. All of the above
James has been diagnosed with cluster headaches. Appropriate acute therapy would be:
1. Butalbital and aspirin (Fiorinal)
2. Meperidine IM (Demerol)
3. Oxygen 100% for 15 to 30 minutes
4. Indomethacin (Indocin)
Preventative therapy for cluster headaches includes:
1. Massage or relaxation therapy
2. Ergotamine nightly before bed
3. Intranasal lidocaine four times a day during "clusters" of headaches
4. Propranolol (Inderal) daily
When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-
overuse headaches is that they:
1. Are increasing in frequency
2. Are increasing in intensity
3. Recur when medication wears off
4. Begin to "cluster" into a pattern [Show Less]