Pharm Exam 6

Front 1

Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John’s Wort due to:

Back 1

The risk of serotonin syndrome

Front 2

Caution when prescribing phentermine to an actively drinking alcoholic should be taken b/c it can cause:

Back 2

Depression, paranoia, or psychosis

Front 3

Caution when prescribing phentermine to a pt with a hx of alcohol or drug dependence should be taken b/c there is a risk of:

Back 3

Cross-tolerance

Front 4

Use of phentermine should be limited to how many months?

Back 4

6 months

Front 5

phentermine is contraindicated in pts who abuse cocaine, methamphetamine, or phenylcyclidine b/c

Back 5

potential for excessive adrenergic stimulation

Front 6

What is the length of time anorexiants should be prescribed?

Back 6

6 months

Front 7

What is rectal diazepam (Diastat) used to treat

Back 7

refractory seizures in pts 2 yrs and older

Front 8

What are the symptoms of phenytoin hypersensitivity syndrome

Back 8

fever, skin rash, and lymphadenopathy

Front 9

When does phenytoin hypersensitivity syndrome usually occur?

Back 9

3-8 weeks of treatment

Front 10

what unique metabolism ability does Carbamazepine have?

Back 10

auto-metabolism

Front 11

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:

Back 11

Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance

Front 12

What is the Black Box Warning of carbamazepine?

Back 12

Regarding serious dermatological reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis) and the risk of developing aplastic anemia, thrombocytopenia and agranulocytosis

Front 13

Carbamazepine has a Black Box warning due to life-threatening:

Back 13

Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis

Front 14

What blood values should be monitored with carbamazepine?

Back 14

CBC, liver fx, TSH and serum level of the drug

Front 15

long term monitoring of pts who are taking carbamazepine includes, CBC every ____ months

Back 15

3-4

Front 16

Carbamazepine (Tegretol) exerts it effect by depressing transmission in the

Back 16

nucleus ventralis anterior of the thalamus

Front 17

the nucleus ventralis anterior of the thalamus is the area associated with

Back 17

spread of seizure discharge

Front 18

carbamazepine is absorbed in the

Back 18

stomach

Front 19

What's the most common adverse effect of ethosuximide (Zarontin)?

Back 19

GI distress (can be relieved taking it with food or milk)

Front 20

Prior to treatment with ethosuximide (Zarontin), what labs should be done?

Back 20

CBC and liver fx

Front 21

during treatment with ethosuximide (Zarontin), what labs should be done?

Back 21

serum med level, liver panel, renal panel, and hematological studies

Front 22

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:

Back 22

Assess for suicidal ideation

Front 23

Monitoring of a patient's seizures while on gabapentin to treat seizures includes:

Back 23

Recording seizure frequency, duration, and severity

Front 24

How will you monitor patients for suicidal ideations when prescribing central nervous system medications?

Back 24

Monitor for emergence or worsening of depression, suicidal thoughts, or changes in behavior.

Front 25

Topiramate will cause weight loss. What patient teaching will you provide?

Back 25

To monitor weight frequently and report any changes

-has the side effect of anorexia

Front 26

What should families be taught regarding the monitoring of seizure activity

Back 26

-Monitor frequency, duration, and severity

- You should know that you may continue to have seizures during your treatment

-You may need to avoid activities such as swimming, driving, and climbing so that you will not harm yourself or others if you lose consciousness during a seizure

Front 27

What electrolyte imbalance is noted with the administration of topiramate?

Back 27

Decreased serum bicarbonate concentrations

Front 28

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:

Back 28

Reassure her that this is a normal side effect of topiramate and continue to monitor her weight

Front 29

Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes

Back 29

He should monitor his temperature and ability to sweat in the heat while playing

Front 30

Why doesn't levetiracetam interact with other meds

Back 30

mostly unbound and does not use CYP450 enzymes for metabolism, thereby decreasing the likelihood

Front 31

Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her to not abruptly discontinue levetiracetam due to risk for

Back 31

withdrawal seizures

Front 32

Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Back 32

Ruling out a hypersensitivity reaction that may lead to multi-organ failure

Front 33

Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause:

Back 33

Reduced lamotrigine levels, requiring doubling the dose of lamotrigine

Front 34

What is the pregnancy category for valproate?

Back 34

D

Front 35

Valoroate should not be administered during pregnancy especially during the 1st trimester d/t risk of

Back 35

spina bifida

Front 36

Most significant risk while taking tricyclic antidepressants is

Back 36

cardiac conduction disorder

Front 37

Conduction disorders caused by tricyclic antidepressants include:

Back 37

depolarization leading to prolonged QRS, PR/QT

Front 38

Caution should be taken with TCA use in pts with glaucoma, prostatic hypertrophy, and urinary incontinence b/c of the

Back 38

acetycholine blocking effect

Front 39

TCA is pregnancy category

Back 39

C

Front 40

What are the cautions and contraindications with Phenelzine (Nardil)?

Back 40

Liver or kidney disease, hypersensitivity,CHF, arterioschlerotic disease, and over age 60

Front 41

Phenelzine (Nardil) is a pregnancy category

Back 41

C

Front 42

Phenelzine (Nardil) should not be prescribed to impulsive or cognitively impaired pts b/c

Back 42

they may be unable to follow instructions such as dietary restrictions

Front 43

MAOIs prevents breakdown of

Back 43

Tyramine

Front 44

The inhibition of metabolism of norepinephrine by MAOI's increases the change of

Back 44

hypertensive crisis

Front 45

MAOI's are indicated for

Back 45

treatment resistant unipolar depression, panic disorder, and atypical depression associated with borderline personality disorder

Front 46

How is Phenelzine (Nardil) used to treat recalcitrant depression?

Back 46

They irreversiblyinactivate the enzymes that metabolize norepinephrine, serotonin, and dopamine,thereby increasing their bioavailability

Front 47

What are the symptoms of hypertensive crisis?

Back 47

HA, heart palpitations,stiff or sore neck, chest tightness, tachycardia, sweating, and dilated pupils

Front 48

How long does it take for selective serotoninreuptake inhibitors to produce an effect in patients with depression?

Back 48

3-4 weeks

Front 49

all of the serotonin-norepinephrine reuptake inhibitors are administered for what disorders

Back 49

depression with lack of motivation, major depressive disorder, and bipolar mood disorder

Front 50

names of drugs in the serotonin-norepinephrine reuptake inhibitors class

Back 50

venlafaxine (effexor), duloxetine (Cymbalta), and Desvenlafaxine (Pristiq)

Front 51

What are the symptoms of EPS

Back 51

akathisia, dystonia, psuedoparkinsonism, dyskinesia,

Front 52

Measures the presence and severity of EPS

Back 52

abnormal involuntary movement scale

Front 53

Jake, a 45-year-old patient with schizophrenia, was recentlyhospitalized for acute psychosis due to medication noncompliance. He wastreated with IM long-acting haloperidol. Besides monitoring his schizophreniasymptoms, the patient should be assessed by his primary care provider:

Back 53

With the Abnormal Involuntary Movement Scale(AIMS) for EPS symptoms

Front 54

Anticholinergic agents, such as benztropine(Cogentin), may be given with a phenothiazine to:

Back 54

Reduce the chance of tardive dyskinesia

Front 55

When administeringolanzapine (Zyprexa) what should the nurse practitioner monitor?

Back 55

-metabolic syndrome (abdobesity, HTN, high cholesterol levels, and insulin resistance) d/t weight gain

-increased risk for DM

Front 56

What are the adverse effects of risperidone?

Back 56

Seizures,weight gain, diabetes, hyperprolactinemia, dizziness, orthostatic hypotension,tachycardia, sleep disturbance, constipation, and rhinitis.

Front 57

How is the dosing increased with risperidone?

Back 57

initial dose: 1mg BID,increase every 24 hr by 1 mg per dose to target dose of 4-8mg per day

Front 58

Which benzodiazepam has the greatest risk fordeveloping dependence?

Back 58

Alprazolam (Xanax) andlorazepam (Ativan)

Front 59

Patients should be instructed regarding the rapid onset of zolpidem(Ambien) because:

Back 59

Zolpidem should be taken just before going tobed

Front 60

Why is buspirone (Buspar) and an SSRI combined?

Back 60

Combined intreatment-resistant depression b/c of the combined serotonergic mechanisms,that is, postsynaptic reuptake inhibition and receptor agonism.

Front 61

What type of diet is recommended with theadministration of lithium?

Back 61

Diet with adequate saltintake and to stay hydrated

Front 62

Tom is taking lithium for bipolar disorder. He should be taught what about his diet

Back 62

Eat a diet with consistent levels of salt(sodium)

Front 63

valproate is what pregnancy category

Back 63

D

Front 64

Cynthia is taking valproate (Depakote) for seizures and would liketo get pregnant. What advice would you give her?

Back 64

Valproate is a known teratogen, but may be takenafter the first trimester if necessary

Front 65

Kirk sprained his ankle and is asking for pain medication for hismild-to-moderate pain. The appropriate first line medication would be:

Back 65

ibuprofen

Front 66

Monitoring for a child on methylphenidate forADHD includes

Back 66

ADHD symptoms, Routine height and weight checks, and Amount of methylphenidate being used

Front 67

When prescribing Adderall (amphetamine and dextroamphetamine) toadults with ADHD the nurse practitioner will need to monitor:

Back 67

BP

Front 68

What is the most commonadverse effect when prescribing calcium carbonate antacids?

Back 68

constipation

Front 69

The ____ scale measures the presence and severity of EPS.

Back 69

The Abnormal Involuntary Movement Scale (AIMS)

Front 70

Extrapyramidal symptoms (EPSs), can be problematic for pts receiving what 2 classes/types of meds.

Back 70

dopamine-blocking agents

Front 71

EPS symptoms include:

Back 71

akathisia, dystonia, psuedoparkinsonism, anddyskinesia

Front 72

Jake, a45-year-old patient with schizophrenia, was recently hospitalized for acutepsychosis due to medication noncompliance. He was treated with IM long-actinghaloperidol. Besides monitoring his schizophrenia symptoms, the patient shouldbe assessed by his primary care provider using the:

Back 72

the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms

Front 73

Benztropinebelongs to a class of medication called

Back 73

anticholinergics

Front 74

There is a balance between what two types ofneurotransmitters in the body?

Back 74

dopamine and acetylcholine

Front 75

Antipsychotic meds artificially reduce dopamine levelswhich automatically shifts the level of acetylcholine as being _____in the body

Back 75

higher

Front 76

Anticholinergic agents, such as benztropine (Cogentin), may begiven with a phenothiazine to:

Back 76

Reduce the chance of tardive dyskinesia

Front 77

Beforestarting a patient on any of the atypical antipsychotics, which includeolanzapine, patient’s should be assessed for

Back 77

waistcircumference, body mass index (BMI), blood pressure, fasting plasma glucose,and lipid profile.

Front 78

Adverseeffects of risperidone include:

Back 78

orthostatichypotension, bradykinesia, akathisia, agitation and elevation of prolactinlevels

Front 79

Which benzodiazepam has the greatest risk for developing dependence?

Back 79

xanax (alprazolam)

Front 80

In choosing a benzodiazepam to treat anxiety the prescriber needsto be aware of the possibility of dependence. The benzodiazepam with thegreatest likelihood of rapidly developing dependence is:

Back 80

xanax (alprazolam)

Front 81

Temazepam should not be used more than ____ a week for less than _____.

Back 81

three times; 3 months

Front 82

Patients should be instructed regarding the rapid onset of zolpidem(Ambien) because:

Back 82

Zolpidem should be taken just before going to bed

Front 83

Why is buspirone (Buspar)and an SSRI combined?

Back 83

To treat resistantdepression

Front 84

What type of diet is recommended with theadministration of lithium?

Back 84

consistent levels of salt and increased fluids

Front 85

One major drug used to treat bipolar disease is lithium. Becauselithium has a narrow therapeutic range, it is important to recognizesymptoms of toxicity, such as:

Back 85

Drowsiness and nausea

Front 86

Can valproatebe administered in the first trimester of pregnancy? and what category is it?

Back 86

it should be restricted to cases in which the womans life would beendangered without them and then only beyond the first trimester ; D

Front 87

Cynthia is taking valproate (Depakote) for seizures and would liketo get pregnant. What advice would you give her?

Back 87

Valproate is a known teratogen, but may be takenafter the first trimester if necessary

Front 88

Kirk sprained his ankle and is asking for pain medication for hismild-to-moderate pain. The appropriate first line medication would be:

Back 88

Ibu (Advil)

Front 89

What is the most commonadverse effect when prescribing calcium carbonate antacids?

Back 89

constipation

Front 90

Many patientsself-medicate with antacids. Which patients should be counseled to not takecalcium carbonate antacids without discussing with their provider or apharmacist first?

Back 90

patients with kidney stones

Front 91

Calcium-basedantacids should not be administered with of food containing large amounts of what two acids?

Back 91

oxalicacid and phyticacids

Front 92

Takingcalcium-based antacids with foods that contain phosphorous (dairy products) maylead to

Back 92

milk-alkalisyndrome

Front 93

Patients taking antacids should be educated that these drugs should be separated from other medications by __ hour

Back 93

one

Front 94

Loperamidebinds with the ___ receptors of the intestinal wall leading to slowedgastric motility

Back 94

opiate

Front 95

Kelly has diarrhea and is wondering if she can take loperamide(Imodium) for the diarrhea. Loperamide:

Back 95

Slows gastric motility and reduces fluid andelectrolyte loss from diarrhea

Front 96

Josie is a 5 year old who presents to the clinic with a 48-hourhistory of nausea, vomiting, and some diarrhea. She is unable to keep fluidsdown and her weight is 4 pounds less than her last recorded weight. Besides IVfluids, her exam warrants the use of an antinausea medication. Which of thefollowing would be the appropriate drug to order for Josie?

Back 96

Ondansetron (Zofran)

Front 97

Patients who are on chronic long-term proton pump inhibitor therapyrequire monitoring for:

Back 97

Iron deficiency anemia, vitamin B12 and calciumdeficiency

Front 98

Patrick is a 10 year old who presents with constipation. Along withdiet changes, a laxative is ordered to provide more rapid relief ofconstipation. An appropriate choice of medication for a 10 year old would be:

Back 98

PEG 3350 (Miralax)

Front 99

Mainadverse effect of bismuth subsalicylate is

Back 99

reboundconstipation

Front 100

Bismuth subsalicylate may lead to toxicity if taken with:

Back 100

Aspirin

Front 101

Bismuth subsalicylate is contraindicated in children with_____ illness

Back 101

flu-like

Front 102

Bismuth subsalicylate has antimicrobial effects against ______ and ______.

Back 102

bacterial and viral enteropathogens

Front 103

Hannah will be traveling to Mexico with herchurch group over Spring Break to build houses. She is concerned she maydevelop traveler's diarrhea. Advice includes normal food and waterprecautions as well as

Back 103

Bismuth subsalicylate with each meal and bedtime

Front 104

What lab values should be monitored with long-term administration ofproton pump inhibitors?

Back 104

Iron, Vitamin B12 and calcium

Front 105

Why is osteoporosis a risk when taking omeprazole?

Back 105

Iron, Vitamin B12 and calcium all need an acidic environment foroptimal absorption.

Front 106

Sadie is a 72year old who takes omeprazole for her chronic GERD. Chronic long-termomeprazole use places her at increased risk for:

Back 106

Osteoporosis

Front 107

What is the most actinglaxative?

Back 107

Sulfate salts

Front 108

How does metoclopramide (Reglan) improveGERD?

Back 108

Increases lower esophagealsphincter (LES) tone.

Front 109

Antacids treat GERD by:

Back 109

Increasing gastric pH

Front 110

Infants with reflux are initially treated with:

Back 110

Anti-reflux maneuvers (elevate head of bed)

Front 111

When treating patients using the “Step-Down” approach the patientwith GERD is started on ____ first.

Back 111

Proton pump inhibitors

Front 112

If sx are relieved for __ wks using the step-down approach, after the first step, then step down to a ____ to control sx

Back 112

4; H2RA

Front 113

If sx are not relieved after the first step of the step down approach, step 2 should be initiated. Step 2 is:

Back 113

increasing PPI to BID x 4-8 weeks

Front 114

If sx are relieved for __ wks using the step-down approach, after the 2nd step, then step back up to _____ therapy which is ___ ____ and reassess in _______ mo.

Back 114

step 1; PPI QD: 6-12

Front 115

If sx are not relieved after using step 2 of the step-down approach:

Back 115

refer to gastroenterologist

Front 116

Step one of the step-up process is:

Back 116

lifestyle modification and antacids

Front 117

if sx relieved after step 1 of the step up process

Back 117

continue with lifestyle modifications and antacids prn

Front 118

If sx unrelieved after step 1 of the step-up process proceed to step 2 which is:

Back 118

H2RAs and continue lifestyle modifications x 4-8 wks.

Front 119

if sx relieved with step 2 of the step up process then

Back 119

continue for 8-12 wks and then attempt reduction or w/d of H2RA.

Front 120

if sx relieved with step 2 of the step up process and tx was continude for 8-12 wks and then attempt reduction or w/d of H2RA and sx returned then

Back 120

step 2 with continuous H2RA therapy

Front 121

if sx are unrelieved with step 2 of the step up process then proceed to step 3 which is

Back 121

change to PPI x 4-8 wks

Front 122

if sx relieved by step 3 of the step up process then

Back 122

trial step down to H2RA

Front 123

if sx return by trial step down to H2RA (relief following step 3) then ________. Pt should be reassessed in _ to _ mo and attempted to wean.

Back 123

return to PPI and continue even if sx are relieved eventually; 6-12

Front 124

If sx are not relieved by step 3 of the step up approach then refer to

Back 124

gastroenterologist

Front 125

Which bone is likely to befractured with long-term proton pump inhibitor therapy?

Back 125

hip

Front 126

What is the first line of therapy of triple therapy for peptic ulcer disease with positive H. pylori?

Back 126

PPI BID, clarithromycin 500mg BID or Metronidazole 500mg BID, and Amox 1g BID x 10-14 d

Front 127

What is the first line of therapy of triple therapy for peptic ulcer disease with positive H. pylori for pts allergic to PCN?

Back 127

PPI BID, clarithromycin 500mg BID, and Metronidazole 500mg BID x 7-14 d

Front 128

What is the second line of therapy for pts that fail the first line for peptic ulcer disease with positive H. pylori?

Back 128

PPI BID or Ranitidine 150mg BID, metronidazole 250mg QID, Tetracycline 500mg QID, and bismuth subsalicylate 525mg QID x 10-14 d

Front 129

what is the levoflaxacin based triple therapy for second line therapy or rescue therapy for peptic ulcer disease with positive H. pylori?

Back 129

PPI BID, levofloxacin 250-500mg BID and amox 1gm BID

Front 130

Treatment failure in patients with peptic ulcer disease associatedwith H. pylori may be due to:

Back 130

Antimicrobial resistance

Front 131

Henry presents to clinic with a significantly swollen painful greattoe and is diagnosed with gout. Of the following, which would be the besttreatment for Henry?

Back 131

Low-dose colchicine

Front 132

Whatlab values should be monitored with gout?

Back 132

uric acid level

Front 133

Larry is taking allopurinol to prevent gout. Monitoring of apatient who is taking allopurinol includes:

Back 133

BUN, creatinine, and creatinine clearance

Front 134

What are the adverseeffects of corticosteroids if administered for 6months or more?

Back 134

immunosuppressionand can mask s/s of infection

Front 135

Jane has been taking 10 mg per day of prednisone for the past 6months. She should be assessed for:

Back 135

Osteoporosis

Front 136

Patients whose total dose of prednisone will exceed 1 gram willmost likely need a second prescription for:

Back 136

Omeprazole, a proton pump inhibitor to preventpeptic ulcer disease

Front 137

Daniel has been on 60 mg of prednisone for 10 days to treat asevere asthma exacerbation. It is time to discontinue the prednisone. How isprednisone discontinued?

Back 137

Develop a tapering schedule to slowly weanDaniel off the prednisone

Front 138

Patients with rheumatoid arthritis who are on chronic low-doseprednisone will need co-treatment with which medications to prevent furtheradverse effects?

Back 138

A bisphosphonate, Calcium supplementation and Vitamin D

Front 139

Why is it important totaper the corticosteroid?

Back 139

Adrenalinsufficiency may result when the drug is stopped immediately

Front 140

What are the blackbox warnings on NSAIDS?

Back 140

cardiovascular risk and GI bleeding risk

Front 141

What are the signs ofaspirin toxicity?

Back 141

Respiratory Alkalosis isseen initially; hypernea and tachypnea occurrs a result of increase CO2.

Front 142

The trial period to determine effective anti-inflammatory activitywhen starting a patient on aspirin for rheumatoid arthritis is:

Back 142

4 to 6 days

Front 143

Patients prescribed aspirin therapy require education regarding thesigns of aspirin toxicity. An early sign of aspirin toxicity is:

Back 143

Tinnitus

Front 144

Monitoring a patient on a high dose aspirin level includes:

Back 144

Salicylate level, CBC, and urine pH

Front 145

Patients who are on long-term aspirin therapy should have ____annually.

Back 145

CBC

Front 146

Henry is 82 years old and takes two aspirin every morning to treatthe arthritis pain in his back. He states the aspirin helps him to “get going”each day. Lately he has had some heartburn from the aspirin. After ruling outan acute GI bleed, what would be an appropriate course of treatment for Henry?

Back 146

Add an H2 blocker such as ranitidine to his therapy