Genetic polymorphisms account for differences in metabolism, including:
1. Poor metabolizers, who lack a working enzyme
2. Intermediate metabolizers,
... [Show More] who have one working, wild-type allele and one mutant allele
3. Extensive metabolizers, with two normally functioning alleles
4. All of the above
Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
1. A need to monitor drugs metabolized by 2D6 for toxicity
2. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
3. Decreased conversion of codeine to morphine by CYP 2D6
4. The need for lowered dosages of drugs, such as beta blockers
Rifampin is a nonspecific CYP450 inducer that may:
1. Lead to toxic levels of rifampin and must be monitored closely
2. Cause toxic levels of drugs, such as oral contraceptives, when co-administered
3. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
4. Cause nonspecific changes in drug metabolism
Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
1. Decreased therapeutic levels of quinidine
2. Increased therapeutic levels of quinidine
3. Decreased levels of a co-administered drug, such as digoxin, that requires P-
glycoprotein for absorption and elimination
4. Increased levels of a co-administered drug, such as digoxin, that requires P-
glycoprotein for absorption and elimination
Warfarin resistance may be seen in patients with VCORC1 mutation, leading to
1. Toxic levels of warfarin building up
2. Decreased response to warfarin
3. Increased risk for significant drug interactions with warfarin
4. Less risk of drug interactions with warfarin
Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
1. True
2. False
Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
1. Erythromycin
2. Digoxin
3. Cetuximab
4. Rifampin
Carbamazepine has a Black Box Warning recommending testing for the HLA-
B*1502 allele in patients with Asian ancestry prior to starting therapy due to:
1. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele
2. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele
3. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele
4. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine
A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:
1. Decreased effectiveness of irinotecan in the treatment of cancer
2. Increased adverse drug reactions, such as neutropenia
3. Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38
4. Increased concerns for irinotecan being carcinogenic
Patients who have a poor metabolism phenotype will have:
1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
2. Accumulation of inactive metabolites of drugs
3. A need for increased dosages of medications
4. Increased elimination of an active drug
Ultra-rapid metabolizers of drugs may have:
1. To have dosages of drugs adjusted downward to prevent drug accumulation
2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
3. Increased elimination of active, nonmetabolized drug
4. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
1. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
2. Identify potential drug-drug interactions that may occur with tamoxifen
3. Reduce the likelihood of therapeutic failure with tamoxifen treatment
4. Identify poor metabolizers of tamoxifen
The most frequent type of drug-food interaction is food:
1. Causing increased therapeutic drug levels
2. Affecting the metabolism of the drug
3. Altering the volume of distribution of drugs
4. Affecting the gastrointestinal absorption of drugs
Food in the gastrointestinal tract affects drug absorption by:
1. Altering the pH of the colon, which decreases absorption
2. Competing with the drug for plasma proteins
3. Altering gastric emptying time
4. Altering the pH of urine
Food can alter the pH of the stomach, leading to:
1. Enhanced drug metabolism
2. Altered vitamin K absorption
3. Increased vitamin D absorption
4. Altered drug bioavailability
Fasting for an extended period can:
1. Increase drug absorption due to lack of competition between food and the drug
2. Alter the pH of the gastrointestinal tract, affecting absorption
3. Cause vasoconstriction, leading to decreased drug absorption
4. Shrink the stomach, causing decreased surface area for drug absorption
Tetracycline needs to be given on an empty stomach because it chelates with:
1. Calcium
2. Magnesium
3. Iron
4. All of the above
A low-carbohydrate, high-protein diet may:
1. Increase drug-metabolizing enzymes
2. Decrease drug absorption from the GI tract
3. Alter drug binding to plasma proteins
4. Enhance drug elimination
Grapefruit juice contains furanocoumarins that have been found to:
1. Alter absorption of drugs through competition for binding sites
2. Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs
3. Alter vitamin K metabolism, leading to prolonged bleeding
4. Enhance absorption of calcium and vitamin D
Cruciferous vegetables may alter drug pharmacokinetics by:
1. Enhancing absorption of weakly acidic drugs
2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins
3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2
4. Decreasing first-pass metabolism of drugs
Milk and other foods that alkalinize the urine may:
1. Result in basic drugs being reabsorbed in the renal tubule
2. Increase the elimination of basic drugs in the urine
3. Decrease the elimination of acidic drugs
4. Not alter drug elimination due to the minimal change in urine pH
Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following nutrients?
1. Protein
2. Calcium
3. Iron
4. Vitamin K
Phenytoin decreases folic acid absorption by:
1. Altering the pH of the stomach
2. Increasing gastric emptying time
3. Inhibiting intestinal enzymes required for folic acid absorption
4. Chelation of the folic acid into inactive ingredients
Patients taking warfarin need to be educated about the vitamin K content of foods to avoid therapeutic failure. Food high in vitamin K that should be limited to no more than one serving per day include:
1. Spinach
2. Milk
3. Romaine lettuce
4. Cauliflower
The American Dietetic Association has recommended the use of specific nutritional supplements in the following population(s):
1. 400 IU per day of vitamin D in all infants and children
2. 1,000 IU per day of vitamin D for all pregnant women
3. 60 mg per day of iron for all adults over age 50 years
4. All of the above
The American Dietetic Association recommends pregnant women take a supplement including:
1. 1,000 IU daily of vitamin D
2. 2.4 mcg/day of vitamin B12
3. 600 mcg/day of folic acid
4. 8 mg/day of iron
The American Heart Association and the American Dietetic Association recommend a minimum daily fiber intake of ______ for cardiovascular health:
1. 10 mg/day
2. 15 mg/day
3. 20 mg/day
4. 25 mg/day
Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount?
1. Iron
2. Vitamin A
3. Vitamin B6
4. Vitamin C
Vitamin B2 (riboflavin) may be prescribed to:
1. Decrease the incidence of beriberi
2. Reduce headaches and migraines
3. Prevent pernicious anemia
4. Treat hyperlipidemia
Isoniazid (INH) may induce a deficiency of which vitamin?
1. B6
2. C
3. D
4. E
Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent:
1. Beriberi
2. Peripheral neuropathy
3. Rickets
4. Megaloblastic anemia
Vitamin B12 deficiency may lead to:
1. Hair loss
2. Insomnia
3. Dry scales on the scalp
4. Numbness and tingling of the hands
Smokers are at risk for vitamin C deficiency. It is recommended that smokers take _______ vitamin C supplement.
1. 100 mg/day
2. 500 mg/day
3. 1,000 mg/day
4. 35 mg/day more than nonsmokers
There is strong evidence to support that adequate vitamin C intake prevents
1. The common cold
2. Breast cancer
3. Scurvy
4. All of the above
Adequate vitamin D is needed for:
1. Absorption of calcium from the gastrointestinal tract
2. Regulation of serum calcium levels
3. Regulation of serum phosphate levels
4. All of the above
Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of Pediatrics recommends that all newborns receive:
1. IM vitamin K (phytonadione) within 24 hours of birth
2. Oral vitamin K supplementation in the first 3 weeks of life
3. Formula containing vitamin K or breast milk
4. Oral vitamin K in the first 24 hours after birth
Symptoms of folate deficiency include:
1. Thinning of the hair
2. Bruising easily
3. Glossitis
4. Numbness and tingling of the hands and feet
A patient with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency?
1. Vitamin B12
2. Vitamin C
3. Folate
4. Niacin
According to the 2003-2006 National Health and Nutrition Examination Survey study of dietary intake, the group at highest risk for inadequate calcium intake was:
1. The elderly (over age 60 years)
2. Teenage females
3. Teenage males
4. Preschoolers
Patients with iron deficiency will develop:
1. Hemolytic anemia
2. Megaloblastic anemia
3. Macrocytic-hypochromic anemia
4. Microcytic-hypochromic anemia
There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well-documented:
1. Concern for developing cardiac dysrhythmias
2. Anti-inflammatory effects
3. Total cholesterol-lowering effects
4. Effects on fasting blood sugar
There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient?
1. Vitamin B1 (thiamine)
2. Vitamin B2 (riboflavin)
3. Calcium
4. Omega-3 fatty acids
There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s):
1. Asthma
2. Autism
3. Arthritis
4. All of the above
It is reasonable to recommend supplementation with _________ in the treatment of hyperlipidemia.
1. Omega-3 fatty acids
2. Probiotics
3. Plant sterols
4. Calcium
Probiotics are recommended to be co-administered when ____________ are prescribed:
1. Antacids
2. Antihypertensives
3. Antidiarrheals
4. Antibiotics
It is reasonable to add ___________ to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori.
1. Probiotics
2. Omega-3 fatty acids
3. Plant sterols
4. Fiber
A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.
1. 10
2. 5
3. 38
4. 70
A potential harmful effect on patients who take some herbal medication is:
1. Constipation
2. Lead poisoning
3. Diarrhea
4. Life-threatening rash
A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:
1. Coumadin, which may lead to bleeding problems
2. Coumarin, which can cause liver and kidney damage
3. Cinnamic aldehyde, which is toxic to the kidney
4. Cinnamate eugenol, which is toxic to the liver
Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance; therefore, the Chinese herbalist would prescribe:
1. Herbs which are yang in nature
2. Herbs that are yin in nature
3. Ginger
4. Golden seal
According to traditional Chinese medicine, if a person who has a fever is given an herb that is yang in nature, such as golden seal, the patient's illness will:
1. Get worse
2. Get better
3. Not be adequately treated
4. Need additional herbs to treat the yang
In Ayurvedic medicine, treatment is based on the patient's dominant dosha, which is referred to as the person's:
1. Vata
2. Pitta
3. Kapha
4. Prakriti
Herbs and supplements are regulated by the U.S. Food and Drug Administration.
1. True
2. False
When melatonin is used to induce sleep, the recommendation is that the patient:
1. Take 10 mg 30 minutes before bed nightly
2. Take 1 to 5 mg 30 minutes before bed nightly
3. Not take melatonin more than three nights a week
4. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep
Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to:
1. Cardiac disturbances
2. Central nervous system depression
3. Respiratory depression
4. Skin rashes
The standard dosage of St John's wort for the treatment of mild depression is:
1. 300 mg daily
2. 100 mg three times a day
3. 300 mg three times a day
4. 600 mg three times a day
Patients need to be instructed regarding the drug interactions with St John's wort, including:
1. MAO inhibitors
2. Serotonin reuptake inhibitors
3. Over-the-counter cough and cold medications
4. All of the above
Ginseng, which is taken to assist with memory, may potentiate:
1. Aricept
2. Insulin
3. Digoxin
4. Propranolol
Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
1. Antihypertensives, diuretics, and digoxin
2. Antidiarrheals, antihistamines, and omeprazole
3. Penicillin antibiotic class and benzodiazepines
4. None of the above
Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
1. Respiratory depression
2. Cardiac disturbance
3. Salicylates poisoning
4. Life-threatening rashes
The role of the NP in the use of herbal medication is to:
1. Maintain competence in the prescribing of common herbal remedies
2. Recommend common over-the-counter herbs to patients
3. Educate patients and guide them to appropriate sources of care
4. Encourage patients to not use herbal therapy due to the documented dangers
Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:
1. Search for information using the most common search engines
2. Serve as content experts in developing, implementing, and evaluating information systems
3. Write programs to assure the integrity of health information
4. Use information technology to prescribe drugs
You are going to prescribe a drug and the electronic health record (EHR) alerts you that there is a potential drug-drug interaction. The alert is generated by:
1. The Food and Drug Administration MedWatch system
2. TOXNET, the National Institutes of Health alert system
3. The EHR clinical decision support system
4. Lexicomp, a commercial medication alert system
Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?
1. Reduces time that prescribing drugs takes
2. Eliminates the need to chart drugs prescribed
3. Decreases prescribing and transcription errors
4. Helps keep the number of drugs prescribed to a minimum
A number of barriers and concerns exist before the goals of a safe and efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs?
1. Cost of initial setup
2. Access to highly skilled experts
3. Compatibility between systems
4. Patient confidentiality risks
EHRs:
1. Are being discouraged by the Centers for Medicare and Medicaid Services due to cost issues
2. Allow for all patient data to be centralized in one location for access by multiple providers
3. Use macros and templates to individualize care
4. Use standardized software to facilitate interoperability between systems
Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:
1. Designing software so that only those who need the information can gain access
2. Requiring providers to log off at the end of the clinical day
3. Keeping a file of the login and password information for each provider in a secure place
4. Having patients sign informed consent documents to have their data on an EHR
Decision support systems often provide medication alerts that tell the prescriber:
1. Patient history data with a summary of their diagnoses
2. The usual dosage for the drug being prescribed
3. The patient's latest laboratory values, such as potassium levels
4. Potential drug-to-drug interactions with other medications the patient is taking
Prescribers have been shown to override a medication alert about a patient's allergies when:
1. The history showed that the patient had tolerated the medication in the past
2. The benefit outweighed the risk
3. The medication was therapeutically appropriate and needed
4. All of the above
The use of information technology for quality improvement in pharmacotherapeutics includes:
1. Incorporating the use of "apps" into all patient encounters
2. Tracking data trends within the practice via the electronic health record database
3. Informing patients that they have access to their medication list via the Internet
4. Using macros for individualizing patient care management
The advantage of using information technology for patient education includes:
1. The ability to track the number of times you have given the patient the same instructions regarding their medication
2. Standardized and individualized patient education that is simultaneously recorded into the patient record
3. Easy access to private patient information specific to populations with a similar diagnosis
4. The ability to download and interpret patient information in multiple languages, easily and accurately
One barrier to use of the Internet for both prescribing and for patient teaching is:
1. Lack of free public access to the Internet
2. Age, with older adults rarely understanding how to use a computer
3. Web pages and hyperlinks may change, be deleted, or be replaced
4. Few Web sites with information about drugs are free
Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to:
1. Prioritize what is needed information and avoid spending time reading "interesting" information not central to the problem at hand
2. Integrate professional and personal searching so that the same browser does not need to be accessed repeatedly
3. Check e-mail frequently so that patient questions can be addressed promptly
4. Check for viruses, spyware, and malware
Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review:
1. The patient's current diagnosis and history
2. Drugs the patient is currently taking
3. Any recent previous encounter for the same problem as this visit and what was done
4. All of the above
Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true?
1. Patients feel the provider does not care about them if they are not seen in a face-to-
face encounter.
2. Data collected from patients between encounters via IT is less accurate and complete.
3. Collecting data between encounters via IT may mean a more efficient face-to-face encounter.
4. Between encounters is a good time to collect screening data.
Discharge summaries using information technology have several advantages. They can:
1. Replace the need for oral instruction because the patient has printed material to read at home
2. Be filed with the patient's chart to document patient teaching
3. Both 1 and 2
4. Neither 1 nor 2
Information technology can also be used for patient teaching during the encounter and after it. The provider can help patients and their families become savvy consumers of health-care information by:
1. Warning them about the questionable quality of health information online
2. Identifying easily used "apps" that patients can use to manage their medications
3. Teaching them how to identify high-quality Web sites and "red flags" signaling inaccurate content
4. All of the above
Incorporating information technology (IT) into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:
1. Turning the screen around so the patient can see material being recorded
2. Not placing the computer screen between the provider and the patient
3. Both 1 and 2
4. Neither 1 nor 2
Pharmacoeconomics is:
1. The study of the part of the U.S. economy devoted to drug use
2. The study of the impact of prescription drug costs on the overall economy
3. The analysis of the costs and consequences of any health-care-related treatment or service
4. The analysis of the clinical efficacy of the drug
The direct costs of drug therapy include:
1. The actual cost of acquiring the medication
2. The loss of income due to illness
3. Pain and suffering due to inadequate drug therapy
4. The cost of a funeral associated with premature death
Indirect costs associated with drug therapy include:
1. The cost of diagnostic tests to monitor therapeutic levels
2. Health-care provider time to prescribe and educate the patient
3. Child-care expenses incurred while receiving therapy
4. Loss of wages while undergoing drug therapy
The intangible costs of drug therapy include:
1. Loss of wages while undergoing therapy
2. Inconvenience, pain, and suffering incurred with therapy
3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels
4. Cost of prescription drug coverage, such as Medicare Part D
When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as:
1. Cost-minimization analysis
2. Cost-of-illness analysis
3. Cost-effectiveness analysis
4. Cost-benefit analysis
Cost-effectiveness analysis compares two or more treatments or programs that are:
1. Not necessarily therapeutically equivalent
2. Considered equal in efficacy
3. Compared with the dollar value of the benefit received
4. Expressed in terms of patient preference or quality-adjusted life years
When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as:
1. Cost-minimization analysis
2. Cost-of-illness analysis
3. Cost-effectiveness analysis
4. Cost-benefit analysis
Mary has a two-tiered prescription benefit plan, which means:
1. She can receive differing levels of care based on whether she chooses an "in-plan" provider or not.
2. She is eligible for the new Medicare Part D "donut hole" reduction of costs program.
3. She pays a higher copay for brand-name drugs than for generic drugs.
4. She must always choose to be treated with generic drugs first.
Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists:
1. Increases the complexity of the Pharmacoeconomics of prescribing for the individual patient
2. Increases compliance by reducing the financial burden of drug costs to the patient
3. Is not sound prescribing practice due to the inferiority of the generic products
4. Will increase the overall cost of drugs to the system due to the ease of overprescribing less-expensive drugs
James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:
1. Order cognitive testing to determine the source of his confusion.
2. Sit down with him and explain the whole Medicare Part D process.
3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him.
4. Request his son come to the next appointment so you can explain the benefit to him.
The "donut hole" in Medicare Part D:
1. Will be totally eliminated with the federal health-care reform enacted in 2010
2. Refers to the period of time when annual individual drug costs are between $250 and $2,250 per year and drug costs are covered 75%
3. Refers to the period between when the annual individual drug costs are $2,970 and $4,750 and the patient pays 52.5% of the costs of brand name drugs (2013)
4. Has no effect on whether patients continue to fill their prescriptions during the coverage gap.
Research has shown that when patients who are covered by Medicare Part D reach the "donut hole" in coverage they:
1. Ask for extra refills of medication to get them through the months of no coverage
2. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin
3. Fill their critical medications, but hold off on filling less-critical medications
4. Demonstrate no change in their prescription filling pattern
The factor that has the greatest effect on males developing male sexual characteristics is:
1. Cultural beliefs
2. Effective male role models
3. Adequate intake of testosterone in the diet
4. Androgen production
When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn:
1. Without regard to time of day
2. First thing in the morning
3. Late afternoon
4. In the evening
Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?
1. Age-related decrease in cognitive functioning
2. Metabolic syndrome
3. Decreased muscle mass in aging men
4. All of the above
The goal of testosterone replacement therapy is:
1. Absence of all hypogonadism symptoms
2. Testosterone levels in the mid-normal range 1 week after an injection
3. Testosterone levels in the mid-normal range just prior to the next injection
4. Avoidance of high serum testosterone levels during therapy
While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:
1. Hemoglobin 14 g/dl or hematocrit 39%
2. Hemoglobin 11.5 g/dl or hematocrit 31%
3. Hemoglobin 13 g/dl or hematocrit 38%
4. Hemoglobin 17.5 g/dl or hematocrit 54%
Monitoring of an older male patient on testosterone replacement includes:
1. Oxygen saturation levels at every visit
2. Serum cholesterol and lipid profile every 3 to 6 months
3. Digital rectal prostate screening exam at 3 and 6 months after starting therapy
4. Bone mineral density at 3 months and 6 months after starting therapy
When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of:
1. Statins
2. Nitrates
3. Insulin
4. Opioids
Men who are prescribed phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction should be educated regarding the adverse effects of the drug which include:
1. Hearing loss
2. Hypotension
3. Delayed ejaculation
4. Dizziness
Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include:
1. Diabetics
2. Those who have had an acute myocardial infarction in the past 6 months
3. Patients who are deaf
4. Patients under age 60 years of age
Monitoring of male patients who are using phosphodiesterase type 5 (PDE-5) inhibitors includes:
1. Serum fasting glucose levels
2. Cholesterol and lipid levels
3. Blood pressure
4. Complete blood count
The Pediatric Research Equity Acts requires:
1. All children be provided equal access to drug research trials
2. Children to be included in the planning phase of new drug development
3. That pediatric drug trials guarantee children of multiple ethnic groups are included
4. All applications for new active ingredients, new indications, new dosage forms, or new routes of administration require pediatric studies
The Best Pharmaceuticals for Children Act:
1. Includes a pediatric exclusivity rule which extends the patent on drugs studied in children
2. Establishes a committee that writes guidelines for pediatric prescribing
3. Provides funding for new drug development aimed at children
4. Encourages manufacturers specifically to develop pediatric formulations
The developmental variation in Phase I enzymes has what impact on pediatric prescribing?
1. None, Phase I enzymes are stable throughout childhood.
2. Children should always be prescribed lower than adult doses per weight due to low enzyme activity until puberty.
3. Children should always be prescribed higher than adult doses per weight due to high enzyme activity.
4. Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and other times higher than adult doses based on the age of the child.
Developmental variation in renal function has what impact on prescribing for infants and children?
1. Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months.
2. Higher doses of water-soluble drugs may need to be prescribed because of increased renal excretion.
3. Renal excretion rates have no impact on prescribing.
4. Parents need to be instructed on whether drugs are renally excreted or not.
Topical corticosteroids are prescribed cautiously in young children because:
1. They may cause an intense hypersensitivity reaction
2. Of hypothalamic-pituitary-adrenal axis suppression
3. Corticosteroids are less effective in young children
4. Young children may accumulate corticosteroids, leading to toxic levels
Liza is breastfeeding her 2-month-old son and has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant?
1. Maternal drug levels
2. Half-life
3. Lipid-solubility
4. All of the above
Drugs that are absolutely contraindicated in lactating women include:
1. Selective serotonin reuptake inhibitors
2. Antiepileptic drugs such as carbamazepine
3. Antineoplastic drugs such as methotrexate
4. All of the above
Zia is a 4-month-old patient with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes:
1. How to administer an oral drug using a medication syringe
2. Mixing the medication with a couple of ounces of formula and putting it in a bottle
3. Discontinuing the antibiotic if diarrhea occurs
4. Calling for an antibiotic change if the infant chokes and sputters during administration
To increase adherence in pediatric patients a prescription medication should:
1. Have a short half-life
2. Be the best tasting of the effective drugs
3. Be the least concentrated form of the medication
4. Be administered 3 or 4 times a day
Janie is a 5-month-old breastfed infant with a fever. Treatment for her fever may include:
1. "Baby" aspirin
2. Acetaminophen suppository
3. Ibuprofen suppository
4. Alternating acetaminophen and ibuprofen
Principles of prescribing for older adults include:
1. Avoiding prescribing any newer high-cost medications
2. Starting at a low dose and increasing the dose slowly
3. Keeping the total dose at a lower therapeutic range
4. All of the above
Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?
1. Increased volume of distribution
2. Decreased lipid solubility
3. Decreased plasma proteins
4. Increased muscle-to-fat ratio
Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?
1. Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs.
2. Decreased tubular secretion of medication will require dosage adjustments.
3. Thin skin will cause increased elimination via sweat.
4. Decreased lung capacity will lead to measurable decreases in lung excretion of drugs.
A medication review of an elderly person's medications involves:
1. Asking the patient to bring a list of current prescription medications to the visit
2. Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit
3. Asking what other providers are writing prescriptions for them
4. All of the above
Steps to avoid polypharmacy include:
1. Prescribing two or fewer drugs from each drug class
2. Reviewing a complete drug history every 12 to 18 months
3. Encouraging the elderly patient to coordinate their care with all of their providers
4. Evaluating for duplications in drug therapy and discontinuing any duplications
Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including:
1. Use of another person's medications
2. Hoarding medications
3. Changing his medication regimen without telling his provider
4. All of the above
To improve positive outcomes when prescribing for the elderly the nurse practitioner should:
1. Assess cognitive functioning in the elder
2. Encourage the patient to take a weekly "drug holiday" to keep drug costs down
3. Encourage the patient to cut drugs in half with a knife to lower costs
4. All of the above
When an elderly diabetic patient is constipated the best treatment options include:
1. Mineral oil
2. Bulk-forming laxatives such as psyllium
3. Stimulant laxatives such as senna
4. Stool softeners such as docusate
Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?
1. Keep the dose of oxycodone low to prevent development of tolerance.
2. Acetaminophen is the first-line drug of choice.
3. Avoid prescribing NSAIDs.
4. Add in a short-acting benzodiazepine for a synergistic effect on pain.
Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:
1. Diuretics
2. Trazodone
3. Clonazepam
4. Levodopa
The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft Gault formula are:
1. 25ml/ min and 133 mL/min respectively
2. 25 mL/min and 103 mL/min respectively
3. 22 ml/min and 133 mL/min respectively
4. 22 ml/min and 103 mL/min respectively
In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?
1. A lipid-soluble medication will be eliminated more quickly and not work as well.
2. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.
3. Absorption of lipid-soluble drugs is impaired in older adults.
4. The bioavailability of the lipid-soluble drug will be increased in older adults.
All of the following statements about the Beer's List are true except:
1. It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.
2. It is derived from the expert opinion of one geriatrician and is not evidence-based.
3. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.
4. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.
You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased and the most common cause of these problems in older adults?
1. Body fat content
2. Liver function
3. Renal function/clearance
4. Plasma albumin levels
Which of the following is not consistent with the rules for geriatric prescribing:
1. Half-life will be longer in older adults
2. Steady state is reached more quickly in the older adult
3. Reduce the number of drugs in the patient's regimen whenever possible
4. Adverse drug responses present atypically in the older adult [Show Less]