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Chapter 1: The Role of the Nurse Practitioner as Prescriber

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Nurse practitioner prescriptive authority is regulated by:

A.

The National Council of State Boards of Nursing

B.

The U.S. Drug Enforcement Administration

C.

The State Board of Nursing for each state

D.

The State Board of Pharmacy

 

 

____    2.   Physician Assistant (PA) prescriptive authority is regulated by:

A.

The National Council of State Boards of Nursing

B.

The U.S. Drug Enforcement Administration

C.

The State Board of Nursing

D.

The State Board of Medical Examiners

 

 

____    3.   Clinical judgment in prescribing includes:

A.

Factoring in the cost to the patient of the medication prescribed

B.

Always prescribing the newest medication available for the disease process

C.

Handing out drug samples to poor patients

D.

Prescribing all generic medications to cut costs

 

 

____    4.   Criteria for choosing an effective drug for a disorder include:

A.

Asking the patient what drug they think would work best for them

B.

Consulting nationally recognized guidelines for disease management

C.

Prescribing medications that are available as samples before writing a prescription

D.

Following U.S. Drug Enforcement Administration (DEA) guidelines for prescribing

 

 

____    5.   Nurse practitioner practice may thrive under health-care reform due to:

A.

The demonstrated ability of nurse practitioners to control costs and improve patient outcomes

B.

The fact that nurse practitioners will be able to practice independently

C.

The fact that nurse practitioners will have full reimbursement under health-care reform

D.

The ability to shift accountability for Medicaid to the state level

 

 

 

 

Chapter 2: Review of Basic Principles of Pharmacology

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to prescribing because:

A.

Distribution of drugs to target tissue may be affected

B.

The solubility of the drug will not match the site of absorption

C.

There will be less free drug available to generate an effect

D.

Drugs bound to albumin are readily excreted by the kidney

 

 

____    2.   Drugs that have a significant first-pass effect:

A.

Must be given by the enteral (oral) route only

B.

Bypass the hepatic circulation

C.

Are rapidly metabolized by the liver and may have little if any desired action

D.

Are converted by the liver to more active and fat-soluble forms

 

 

____    3.   The route of excretion of a volatile drug will likely be:

A.

The kidneys

B.

The lungs

C.

The bile and feces

D.

The skin

 

 

____    4.   Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the drug. Storage reservoirs:

A.

Assure that the drug will reach its intended target tissue

B.

Are the reason for giving loading doses

C.

Increase the length of time a drug is available and active

D.

Are most common in collagen tissues

 

 

____    5.   The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:

A.

Propensity to go to the target receptor

B.

Biological half-life

C.

Pharmacodynamics

D.

Safety and side effects

 

 

____    6.   Azithromycin dosing requires the first day’s dose be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

A.

Rapidly achieves drug levels in the therapeutic range

B.

Requires four to five half-lives to attain

C.

Is influenced by renal function

D.

Is directly related to the drug circulating to the target tissues

 

 

____    7.   The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:

A.

Minimum adverse effect level

B.

Peak of action

C.

Onset of action

D.

Therapeutic range

 

 

____    8.   Phenytoin requires a trough level be drawn. Peak and trough levels are done:

A.

When the drug has a wide therapeutic range

B.

When the drug will be administered for a short time only

C.

When there is a high correlation between the dose and saturation of receptor sites

D.

To determine if a drug is in the therapeutic range

 

 

____    9.   A laboratory result indicates the peak level for a drug is above the minimum toxic concentration. This means that the:

A.

Concentration will produce therapeutic effects

B.

Concentration will produce an adverse response

C.

Time between doses must be shortened

D.

Duration of action of the drug is too long

 

 

____  10.   Drugs that are receptor agonists may demonstrate what property?

A.

Irreversible binding to the drug receptor site

B.

Up-regulation with chronic use

C.

Desensitization or down-regulation with continuous use

D.

Inverse relationship between drug concentration and drug action

 

 

____  11.   Drugs that are receptor antagonists, such as beta blockers, may cause:

A.

Down-regulation of the drug receptor

B.

An exaggerated response if abruptly discontinued

C.

Partial blockade of the effects of agonist drugs

D.

An exaggerated response to competitive drug agonists

 

 

____  12.   Factors that affect gastric drug absorption include:

A.

Liver enzyme activity

B.

Protein-binding properties of the drug molecule

C.

Lipid solubility of the drug

D.

Ability to chew and swallow

 

 

____  13.   Drugs administered via intravenous (IV) route:

A.

Need to be lipid soluble in order to be easily absorbed

B.

Begin distribution into the body immediately

C.

Are easily absorbed if they are nonionized

D.

May use pinocytosis to be absorbed

 

 

____  14.   When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:

A.

The sum of the effects of each drug individually

B.

Greater than the sum of the effects of each drug individually

C.

Less than the effect of each drug individually

D.

Not predictable, as it varies with each individual

 

 

____  15.   Which of the following statements about bioavailability is true?

A.

Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained release mechanisms.

B.

All brands of a drug have the same bioavailability.

C.

Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.

D.

Combining an active drug with an inert substance does not affect bioavailability.

 

 

____  16.   Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

A.

Water soluble and ionized drugs cross these barriers rapidly.

B.

The blood-brain barrier slows the entry of many drugs into and from brain cells.

C.

The fetal-placental barrier protects the fetus from drugs taken by the mother.

D.

Lipid soluble drugs do not pass these barriers and are safe for pregnant women.

 

 

____  17.   Drugs are metabolized mainly by the liver via Phase I or Phase II reactions. The purpose of both of these types of reactions is to:

A.

Inactivate prodrugs before they can be activated by target tissues

B.

Change the drugs so they can cross plasma membranes

C.

Change drug molecules to a form that an excretory organ can excrete

D.

Make these drugs more ionized and polar to facilitate excretion

 

 

____  18.   Once they have been metabolized by the liver, the metabolites may be:

A.

More active than the parent drug

B.

Less active than the parent drug

C.

Totally “deactivated” so that they are excreted without any effect

D.

All of the above

 

 

____  19.   All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by:

A.

Reduced circulation and perfusion of the kidney

B.

Chronic renal disease

C.

Competition for a transport site by another drug

D.

Unbinding a nonvolatile drug from plasma proteins

 

 

____  20.   Steady state is:

A.

The point on the drug concentration curve when absorption exceeds excretion

B.

When the amount of drug in the body remains constant

C.

When the amount of drug in the body stays below the MTC

D.

All of the above

 

 

____  21.   Two different pain meds are given together for pain relief. The drug-drug interaction is:

A.

Synergistic

B.

Antagonistic

C.

Potentiative

D.

Additive

 

 

____  22.   Actions taken to reduce drug-drug interaction problems include all of the following  EXCEPT:

A.

Reducing the dose of one of the drugs

B.

Scheduling their administration at different times

C.

Prescribing a third drug to counteract the adverse reaction of the combination

D.

Reducing the dosage of both drugs

 

 

____  23.   Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?

A.

Protein malnutrition

B.

Iron deficiency anemia

C.

Both A and B

D.

Neither A nor B

 

 

____  24.   The time required for the amount of drug in the body to decrease by 50% is called:

A.

Steady state

B.

Half-life

C.

Phase II metabolism

D.

Reduced bioavailability time

 

 

____  25.   An agonist activates a receptor and stimulates a response. When given frequently over time the body may:

A.

Up-regulate the total number of receptors

B.

Block the receptor with a partial agonist

C.

Alter the drug’s metabolism

D.

Down-regulate the numbers of that specific receptor

 

 

____  26.   Drug antagonism is best defined as an effect of a drug that:

A.

Leads to major physiologic psychological dependence

B.

Is modified by the concurrent administration of another drug

C.

Cannot be metabolized before another dose is administered

D.

Leads to a decreased physiologic response when combined with another drug

 

 

____  27.   Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?

A.

“Avoid any other oral medicines while taking this drug.”

B.

“If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”

C.

“The tablet may be crushed if you have any difficultly taking it.”

D.

“To achieve best effect, take the tablet with at least 8 ounces of fluid.”

 

 

____  28.   The major reason for not crushing a sustained release capsule is that, if crushed, the coated beads of the drugs could possibly result in:

A.

Disintegration

B.

Toxicity

C.

Malabsorption

D.

Deterioration

 

 

____  29.   Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?

A.

Sodium bicarbonate

B.

Ascorbic acid

C.

Salicylic acid

D.

Glucose

 

 

____  30.   Which of the following variables is a factor in drug absorption?

A.

The smaller the surface area for absorption, the more rapidly the drug is absorbed.

B.

A rich blood supply to the area of absorption leads to better absorption.

C.

The less soluble the drug, the more easily it is absorbed.

D.

Ionized drugs are easily absorbed across the cell membrane.

 

 

____  31.   An advantage of prescribing a sublingual medication is that the medication is:

A.

Absorbed rapidly

B.

Excreted rapidly

C.

Metabolized minimally

D.

Distributed equally

 

 

____  32.   Drugs that use CYP 3A4 isoenzymes for metabolism may:

A.

Induce the metabolism of another drug

B.

Inhibit the metabolism of another drug

C.

Both A and B

D.

Neither A nor B

 

 

____  33.   Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:

A.

After the second dose

B.

After four to five half-lives

C.

When the patient feels the full effect of the drug

D.

One hour after IV administration

 

 

____  34.   Up-regulation or hypersensitization may lead to:

A.

Increased response to a drug

B.

Decreased response to a drug

C.

An exaggerated response if the drug is withdrawn

D.

Refractoriness or complete lack of response

 

 

 

 

 

Chapter 3: Rational Drug Selection

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   An NP would prescribe the liquid form of ibuprofen for a 6 year old because:

A.

Drugs given in liquid form are less irritating to the stomach

B.

A 6 year old may have problems swallowing a pill

C.

Liquid forms of medication eliminate the concern for first-pass effect

D.

Liquid ibuprofen does not have to be dosed as often as tablet form

 

 

____    2.   In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it:

A.

Has serious side effects and it is not being used for a life-threatening condition

B.

Will be taken twice daily and will be taken at home

C.

Is expensive, and is not covered by health insurance

D.

None of these are important in choosing a drug

 

 

____    3.   A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women?

A.

Body temperature varies between men and women

B.

Muscle mass is greater in women

C.

Percentage of fat differs between genders

D.

Proven subjective factors exist between the genders

 

 

____    4.   The first step in the prescribing process according to the World Health Organization is:

A.

Choosing the treatment

B.

Educating the patient about the medication

C.

Diagnosing the patient’s problem

D.

Starting the treatment

 

 

____    5.   Treatment goals in prescribing should:

A.

Always be curative

B.

Be patient-centered

C.

Be convenient for the provider

D.

Focus on the cost of therapy

 

 

____    6.   The therapeutic goals when prescribing include(s):

A.

Curative

B.

Palliative

C.

Preventive

D.

All of the above

 

 

____    7.   When determining drug treatment the NP prescriber should:

A.

Always use evidence-based guidelines

B.

Individualize the drug choice for the specific patient

C.

Rely on his or her experience when prescribing for complex patients

D.

Use the newest drug on the market for the condition being treated

 

 

____    8.   Patient education regarding prescribed medication includes:

A.

Instructions written at the high school reading level

B.

Discussion of expected adverse drug reactions

C.

How to store leftover medication such as antibiotics

D.

Verbal instructions always in English

 

 

____    9.   Passive monitoring of drug effectiveness includes:

A.

Therapeutic drug levels

B.

Adding or subtracting medications from the treatment regimen

C.

Ongoing provider visits

D.

Instructing the patient to report if the drug is not effective

 

 

____  10.   Pharmacokinetic factors that affect prescribing include:

A.

Therapeutic index

B.

Minimum effective concentration

C.

Bioavailability

D.

Ease of titration

 

 

____  11.   Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine:

A.

Conflicts of interest and financial relationships should be disclosed by those providing education.

B.

Providers should ban all pharmaceutical representatives from their office setting.

C.

Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication.

D.

Providers should only accept low-value gifts, such as pens and pads of paper, from the pharmaceutical representative.

 

 

 

Chapter 4: Legal and Professional Issues in Prescribing

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The U.S. Food and Drug Administration (FDA) regulates:

A.

Prescribing of drugs by MDs and NPs

B.

The official labeling for all prescription and over-the-counter drugs

C.

Off-label recommendations for prescribing

D.

Pharmaceutical educational offerings

 

 

____    2.   The U.S. Food and Drug Administration (FDA) approval is required for:

A.

Medical devices, including artificial joints

B.

Over-the-counter vitamins

C.

Herbal products, such as St John’s Wort

D.

Dietary supplements, such as Ensure

 

 

____    3.   An Investigational New Drug (IND) is filed with the FDA:

A.

When the manufacturer has completed Phase III trials

B.

When a new drug is discovered

C.

Prior to animal testing of any new drug entity

D.

Prior to human testing of any new drug entity

 

 

____    4.   Phase IV clinical trials in the United States are also known as:

A.

Human bioavailability trials

B.

Post-marketing research

C.

Human safety and efficacy studies

D.

The last stage of animal trials before the human trials begin

 

 

____    5.   Off-label prescribing is:

A.

Regulated by the FDA

B.

Illegal by NPs in all states (provinces)

C.

Legal if there is scientific evidence for the use

D.

Regulated by the Drug Enforcement Administration (DEA)

 

 

____    6.   The U.S. Drug Enforcement Administration (DEA):

A.

Registers manufacturers and prescribers of controlled substances

B.

Regulates NP prescribing at the state level

C.

Sanctions providers who prescribe drugs off-label

D.

Provides prescribers with a number they can use for insurance billing

 

 

____    7.   Drugs that are designated Schedule II by the DEA:

A.

Are known teratogens during pregnancy

B.

May not be refilled; a new prescription must be written

C.

Have a low abuse potential

D.

May be dispensed without a prescription unless regulated by the state

 

 

____    8.   Precautions that should be taken when prescribing controlled substances include:

A.

Faxing the prescription for a Schedule II drug directly to the pharmacy

B.

Using tamper-proof paper for all prescriptions written for controlled drugs

C.

Keeping any pre-signed prescription pads in a locked drawer in the clinic

D.

Using only numbers to indicate the amount of drug to be prescribed

 

 

____    9.   Strategies prescribers can use to prevent misuse of controlled prescription drugs include:

A.

Use of chemical dependency screening tools

B.

Firm limit-setting regarding prescribing controlled substances

C.

Practicing “just say no” to deal with patients who are pushing the provider to prescribe controlled substances

D.

All of the above

 

 

____  10.   Behaviors predictive of addiction to controlled substances include:

A.

Stealing or borrowing another patient’s drugs

B.

Requiring increasing doses of opiates for pain associated with malignancy

C.

Receiving refills of a Schedule II prescription on a regular basis

D.

Requesting that only their own primary care provider prescribe for them

 

 

____  11.   Medication agreements or “Pain Medication Contracts” are recommended to be used:

A.

Universally for all prescribing for chronic pain

B.

For patients who have repeated requests for pain medication

C.

When you suspect a patient is exhibiting drug-seeking behavior

D.

For patients with pain associated with malignancy

 

 

____  12.   A prescription needs to be written for:

A.

Legend drugs

B.

Most controlled drugs

C.

Medical devices

D.

All of the above

 

 

 

 

Chapter 5: Adverse Drug Reactions

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):

A.

A 32-year-old male

B.

A 22-year-old female

C.

A 3-month-old female

D.

A 48-year-old male

 

 

____    2.   Infants and young children are at higher risk of ADRs due to:

A.

Immature renal function in school-age children

B.

Lack of safety and efficacy studies in the pediatric population

C.

Children’s skin being thicker than adults, requiring higher dosages of topical medication

D.

Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution

 

 

____    3.   The elderly are at high risk of ADRs due to:

A.

Having greater muscle mass than younger adults, leading to higher volume of distribution

B.

The extensive studies that have been conducted on drug safety in this age group

C.

The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect

D.

Age-related decrease in renal function

 

 

____    4.   The type of adverse drug reaction that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic doses is

A.

Type A

B.

Type B

C.

Type C

D.

Type D

 

 

____    5.   Digoxin may cause a Type A adverse drug reaction due to:

A.

Idiosyncratic effects

B.

Its narrow therapeutic index

C.

Being a teratogen

D.

Being a carcinogen

 

 

____    6.   Changes in the individual pharmacokinetic parameters of adsorption, distribution, or elimination may result in high concentrations of the drug in the body, leading to which type of adverse drug reaction?

A.

Type A

B.

Type C

C.

Type D

D.

Type E

 

 

____    7.   According to the World Health Organization Classification, Type B adverse reactions are:

A.

When a drug is a teratogen

B.

When a drug is carcinogenic

C.

A delayed ADR, such as renal failure

D.

An allergic or idiosyncratic response

 

 

____    8.   Sarah developed a rash after using a topical medication. This is a Type __ allergic drug reaction.

A.

I

B.

II

C.

III

D.

IV

 

 

____    9.   A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n):

A.

Cytotoxic hypersensitivity reaction

B.

Immune complex hypersensitivity

C.

Immediate hypersensitivity reaction

D.

Delayed hypersensitivity reaction

 

 

____  10.   Anaphylactic shock is a:

A.

Type I reaction, called immediate hypersensitivity reaction

B.

Type II reaction, called cytotoxic hypersensitivity reaction

C.

Type III allergic reaction, called immune complex hypersensitivity

D.

Type IV allergic reaction, called delayed hypersensitivity reaction

 

 

____  11.   James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction?

A.

Type B

B.

Type C

C.

Type E

D.

Type F

 

 

____  12.   The treatment for a patient who experiences hypothalamic-pituitary-adrenal axis suppression while taking the corticosteroid prednisone, a Type C adverse drug reaction, is to:

A.

Immediately discontinue the prednisone

B.

Administer epinephrine

C.

Slowly taper the patient off of the prednisone

D.

Monitor for long-term effects, such as cancer

 

 

____  13.   The ACE inhibitor lisinopril is a known teratogen. Teratogens cause Type ____ adverse drug reaction.

A.

A

B.

B

C.

C

D.

D

 

 

____  14.   Cardiac defects are a known Type D adverse drug reaction to lithium. Lithium causes a Type D adverse drug reaction because it is:

A.

An immunosuppressant

B.

A carcinogen

C.

A teratogen

D.

An antiseizure medication

 

 

____  15.   Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a Type D reaction because they are known:

A.

Teratogens

B.

Carcinogens

C.

To cause hypersensitivity reactions

D.

Hypothalamus-pituitary-adrenal (HPA) axis suppressants

 

 

____  16.   A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type __ adverse drug reaction when he no longer requires the opioids.

A.

A

B.

C

C.

E

D.

G

 

 

____  17.   Drugs that may cause a Type E adverse drug reaction include:

A.

Beta blockers

B.

Immunomodulators

C.

Antibiotics

D.

Oral contraceptives

 

 

____  18.   Unexpected failure of drug therapy is a Type __ adverse drug reaction, commonly caused by____.

A.

B; cytotoxic hypersensitivity

B.

B; idiosyncratic response

C.

C; cumulative effects of drug

D.

F; drug-drug interaction

 

 

____  19.   Clopidogrel treatment failure may occur when it is co-administered with omeprazole, known as a Type __ adverse drug reaction.

A.

A

B.

C

C.

E

D.

F

 

 

 

Chapter 6: Factors that Foster Positive Outcomes

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment?

A.

Financial status

B.

Mobility

C.

Social support

D.

Sexual practices

 

 

____    2.   Elena Vasquez’ primary language is Spanish and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?

A.

Use correct medical terminology since Spanish has a Latin base

B.

Use a family member who speaks more English to act as interpreter

C.

Use a professional interpreter or a reliable staff member who can interpret

D.

Use careful, detailed explanations

 

 

____    3.   Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?

A.

Stand facing him and speak slowly and clearly

B.

Speak in low tones or find a provider who has a lower voice

C.

Write down the instructions as well as speaking them

D.

If he reads lips, exaggerate lips movements when pronouncing the vowel sounds

 

 

____    4.   Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?

A.

Complexity of the drug regimen

B.

Patient perception of the potential adverse effects of the drugs

C.

Both A and B

D.

Neither A nor B

 

 

____    5.   The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier?

A.

Increasing copayments for care

B.

Unrestricted formularies for drugs including brand names

C.

Increasing the number of people who have access to care

D.

Treating a wider range of disorders

 

 

____    6.   Adverse drug reactions and patients’ perceptions of them are likely to produce non-adherence. Which of the following ADRs are least likely to produce non-adherence?

A.

Severe hypotension and anaphylaxis

B.

Constipation and diarrhea

C.

Headache and dizziness

D.

Nausea and vomiting

 

 

____    7.   Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent?

A.

Ralph states that he always takes the drug “when I feel my pressure is going up.”

B.

Ralph contacts his NP to discuss the need to increase the dose.

C.

Ralph consistently keeps his follow-up appointments to check his blood pressure.

D.

All of the above show that he is adherent to the drug regimen.

 

 

____    8.   Non-adherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of non-adherence to these drugs is to prescribe a drug that:

A.

Has a short half-life so that missing one dose has limited effect

B.

Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down.

C.

Has a tolerability profile with less of the adverse effects that are considered “irritating,” such as nausea and dizziness.

D.

Must be taken no more than twice a day.

 

 

____    9.   Factors in chronic conditions that contribute to non-adherence include:

A.

The complexity of the treatment regimen

B.

The length of time over which it must be taken

C.

Breaks in the usual daily routine, such as vacations and weekends

D.

All of the above

 

 

____  10.   While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when:

A.

The provider spent a lot of time discussing the drugs with them

B.

Their concerns and specific area of knowledge deficit were addressed

C.

They were given written material, such as pamphlets, about the drugs

D.

The provider used appropriate medical and pharmacologic terms

 

 

____  11.   Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:

A.

With a longer half-life so that missed doses produce a longer taper on the drug curve

B.

In oral formulations that are more easily taken

C.

That do not require frequent monitoring

D.

Combined with patient education about the need to adhere even when symptoms are absent

 

 

____  12.   Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?

A.

Have the patient purchase a pill container with compartments for daily or multiple times per day dosing.

B.

Match the clinic appointment to the next time the drug is to be refilled.

C.

Write prescriptions for new drugs with shorter times between refills.

D.

Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.

 

 

____  13.   Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:

A.

Older adults and those on fixed incomes

B.

Patients with chronic illnesses

C.

Patients with copayments for drugs on their insurance

D.

Patients on public assistance

 

 

____  14.   Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who:

A.

Are well-educated and affluent

B.

Have chronic conditions

C.

Self-monitor drug effects on their symptoms

D.

None of the above guarantee adherence

 

 

____  15.   Monitoring adherence can take several forms, including:

A.

Patient reports from data in a drug diary

B.

Pill counts

C.

Lab reports and other diagnostic markers

D.

All of the above

 

 

 

Chapter 7: Cultural and Ethnic Influences in Pharmacotherapeutics

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Cultural factors that must be taken into account when prescribing include(s):

A.

Who is the decision maker in the family regarding health-care decisions

B.

The patient’s view of health and illness

C.

Attitudes regarding the use of drugs to treat illness

D.

All of the above

 

 

____    2.   Ethnic differences have been found in drug:

A.

Absorption

B.

Hepatic metabolism

C.

Filtration at the glomerulus

D.

Passive tubular reabsorption

 

 

____    3.   The National Standards of Culturally and Linguistically Appropriate Services (CLAS) are required to be implemented in all:

A.

Hospitals

B.

Clinics that serve the poor

C.

Organizations that receive federal funds

D.

Clinics that serve ethnic minorities

 

 

____    4.   According to the National Standards of Culturally and Linguistically Appropriate Services (CLAS), interpreters for health care:

A.

May be a bilingual family member

B.

May be a bilingual nurse or other health-care provider

C.

Must be a professionally trained medical interpreter

D.

Must be an employee of the organization

 

 

____    5.   According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

A.

The belief among African Americans that prayer is more powerful than drugs

B.

Poor compliance on the part of the African-American patient

C.

The genetic predisposition for illness found among African Americans

D.

Discrimination, cultural barriers, and lack of access to health care

 

 

____    6.   The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:

A.

Increased CYP 2D6 activity, leading to rapid metabolism of some drugs

B.

Largely unknown due to lack of studies of this population

C.

Rapid metabolism of alcohol, leading to increased tolerance

D.

Decreased elimination of opioids, leading to increased risk for addiction

 

 

____    7.   Pharmacokinetics among Asians are universal to all the Asian ethnic groups.

A.

True

B.

False

 

 

____    8.   Alterations in drug metabolism among Asians may lead to:

A.

Slower metabolism of antidepressants, requiring lower doses

B.

Faster metabolism of neuroleptics, requiring higher doses

C.

Altered metabolism of omeprazole, requiring higher doses

D.

Slower metabolism of alcohol, requiring higher doses

 

 

____    9.   Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:

A.

Require acetylization in order to metabolize drugs

B.

Are unable to tolerate higher doses of some drugs that require acetylization

C.

May have a toxic reaction to drugs that require acetylization

D.

Require higher doses of drugs metabolized by acetylization to achieve efficacy

 

 

____  10.   Hispanic native healers (curanderas):

A.

Are not heavily utilized by Hispanics who immigrate to the United States

B.

Use herbs and teas in their treatment of illness

C.

Provide unsafe advice to Hispanics and should not be trusted

D.

Need to be licensed in their home country in order to practice in the United States

 

 

 

Chapter 8: Pharmacogenomics

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Genetic polymorphisms account for differences in metabolism, including:

A.

Poor metabolizers (PMs) who lack a working enzyme

B.

Intermediate metabolizers (IMs) who have one working, wild-type allele and one mutant allele

C.

Extensive metabolizers (EMs), with two normally functioning alleles

D.

All of the above

 

 

____    2.   Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

A.

A need to monitor drugs metabolized by 2D6 for toxicity

B.

Increased dosages needed of drugs metabolized by 2D6, such as the SSRIs

C.

Decreased conversion of codeine to morphine by CYP 2D6

D.

The need for lowered dosages of drugs, such as beta blockers

 

 

____    3.   Rifampin is a nonspecific CYP450 inducer that may:

A.

Lead to toxic levels of rifampin and must be monitored closely

B.

Cause toxic levels of drugs, such as oral contraceptives, when co-administered

C.

Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure

D.

Cause nonspecific changes in drug metabolism

 

 

____    4.   Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

A.

Decreased therapeutic levels of quinidine

B.

Increased therapeutic levels of quinidine

C.

Decreased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

D.

Increased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

 

 

____    5.   Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

A.

Toxic levels of warfarin building up

B.

Decreased response to warfarin

C.

Increased risk for significant drug interactions with warfarin

D.

Less risk of drug interactions with warfarin

 

 

____    6.   Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.

A.

True

B.

False

 

 

____    7.   Pharmacogenetic testing is required by the Food and Drug Administration (FDA) prior to prescribing:

A.

Erythromycin

B.

Digoxin

C.

Cetuximab

D.

Rifampin

 

 

____    8.   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:

A.

Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele

B.

Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele

C.

Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele

D.

Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine

 

 

____    9.   A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

A.

Decreased effectiveness of irinotecan in the treatment of cancer

B.

Increased adverse drug reactions, such as neutropenia

C.

Delayed metabolism of the prodrugirinotecan into the active metabolite SN-38

D.

Increased concerns for irinotecan being carcinogenic

 

 

____  10.   Patients who have a poor metabolism phenotype will have:

A.

Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug

B.

Accumulation of inactive metabolites of drugs

C.

A need for increased dosages of medications

D.

Increased elimination of an active drug

 

 

____  11.   Ultra-rapid metabolizers of drugs may have:

A.

To have dosages of drugs adjusted downward to prevent drug accumulation

B.

Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure

C.

Increased elimination of active, nonmetabolized drug

D.

Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug

 

 

____  12.   A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

A.

Ensure the patient will not have increased adverse drug reactions to the tamoxifen

B.

Identify potential drug-drug interactions that may occur with tamoxifen

C.

Reduce the likelihood of therapeutic failure with tamoxifen treatment

D.

Identify

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