chap 18: Drugs affecting the Hematopoietic system

Question 1

1. Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:
2. Ibuprofen 400 mg three times a day
3. Acetaminophen, not to exceed 4 grams per day
4. Prescribe acetaminophen with codeine
5. Aspirin 640 mg three times a day

Answer 1

2. Acetaminophen, not to exceed 4 grams per day

Question 2

2. Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
3. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case.
4. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
5. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission.
6. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.

Answer 2

2. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.

Question 3

3. The safest drug to use to treat pregnant women who require anticoagulant therapy is:
4. Low-molecular-weight heparin
5. Warfarin
6. Aspirin
7. Heparin

Answer 3

4. Heparin

Question 4

4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?
5. Pregnant women
6. Elderly men
7. Overweight or obese patients
8. Patients with multiple comorbidities

Answer 4

3. Overweight or obese patients

Question 5

5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be:
6. Administer one dose of low-molecular weight heparin 24 hours before travel.
7. Prescribe one dose of warfarin to be taken the day of travel.
8. Consult with a hematologist regarding a treatment plan for Cecil.
9. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

Answer 5

4. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

Question 6

6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?
7. He has arthritis and this will help with the inflammation and pain.
8. Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
9. Aspirin acidifies the urine and he needs this for prostrate health.
10. He has a history of GI bleed, and one aspirin a day is a safe dosage.

Answer 6

2. Aspirin has anti-platelet activity and prevents clots that cause heart attacks.

Question 7

7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated?
8. Tinnitus
9. Diarrhea
10. Hearing loss
11. Photosensitivity

Answer 7

1. Tinnitus

Question 8

8. Patient education when prescribing clopidogrel includes:
9. Do not take any herbal products without discussing it with the provider.
10. Monitor urine output closely and contact the provider if it decreases.
11. Clopidogrel can be constipating, use a stool softener if needed.
12. The patient will need regular anticoagulant studies while on clopidogrel.

Answer 8

1. Do not take any herbal products without discussing it with the provider.

Question 9

9. For patients taking warfarin, INRs are best drawn:
10. Monthly throughout therapy
11. Three times a week throughout therapy
12. Two hours after the last dose of warfarin to get an accurate peak level
13. In the morning if the patient takes their warfarin at night

Answer 9

4. In the morning if the patient takes their warfarin at night

Question 10

10. Patients receiving heparin therapy require monitoring of:
11. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
12. Electrolytes for elevated potassium levels in the first 24 hours of therapy
13. INR throughout therapy to stay within the range of 2.0
14. Blood pressure for hypertension that may occur in the first 2 days of treatment

Answer 10

1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy

Question 11

11. The routine monitoring recommended for low molecular weight heparin is:
12. INR every 2 days until stable, then weekly
13. aPTT every week while on therapy
14. Factor Xa levels if the patient is pregnant
15. White blood cell count every 2 weeks

Answer 11

3. Factor Xa levels if the patient is pregnant

Question 12

12. When writing a prescription for warfarin it is common to write _________ on the prescription.
13. OK to substitute for generic
14. The brand name of warfarin and Do Not Substitute
15. PRN refills
16. Refills for 1 year

Answer 12

2. The brand name of warfarin and Do Not Substitute

Question 13

13. Education of patients who are taking warfarin includes discussing their diet. Instructions include:
14. Avoiding all vitamin K-containing foods
15. Avoiding high-vitamin K-containing foods
16. Increasing intake of iron-containing foods
17. Making sure they eat 35 grams of fiber daily

Answer 13

2. Avoiding high-vitamin K-containing foods

Question 14

14. Patients who are being treated with epoetin alfa need to be monitored for the development of:
15. Thrombocytopenia
16. Neutropenia
17. Hypertension
18. Gout

Answer 14

1. Thrombocytopenia

Question 15

15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:
16. ESAs no longer be prescribed to patients with chronic renal failure
17. The risk of tumor development be explained to cancer patients on ESA therapy
18. Patients should no longer receive ESA therapy to prepare for allogenic transfusions
19. ESAs be prescribed only to patients younger than age 60 years

Answer 15

2. The risk of tumor development be explained to cancer patients on ESA therapy

Question 16

16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:
17. 6 weeks if they are a cancer patient
18. 1 week if they have chronic renal failure
19. 2 weeks if they are taking it for allogenic transfusion
20. Each week throughout therapy

Answer 16

1. 6 weeks if they are a cancer patient

Question 17

17. Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:
18. Folic acid to prevent megaloblastic anemia
19. Iron, to start when the epogen starts
20. An antihypertensive to counter the adverse effects of epogen
21. Vitamin B12 to prevent pernicious anemia

Answer 17

2. Iron, to start when the epogen starts

Question 18

18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
19. Reticulocyte count 1 week after therapy is started
20. Complete blood count every 2 weeks throughout therapy
21. Hemoglobin level at 1 week of therapy
22. INR weekly throughout therapy

Answer 18

1. Reticulocyte count 1 week after therapy is started

Question 19

19. Patient education regarding taking iron replacements includes:
20. Doubling the dose if they miss a dose to maintain therapeutic levels
21. Taking the iron with milk or crackers if it upsets their stomach
22. Iron is best taken on an empty stomach with juice
23. Antacids such as Tums may help the upset stomach caused by iron therapy

Answer 19

3. Iron is best taken on an empty stomach with juice

Question 20

20. Patients with pernicious anemia require treatment with:
21. Iron
22. Folic acid
23. Epogen alpha
24. Vitamin B12

Answer 20

4. Vitamin B12

Question 21

21. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
22. Hematocrit levels start to rise
23. Hemoglobin levels return to normal
24. Reticulocyte count begins to rise
25. Vitamin B12 levels return to normal

Answer 21

2. Hemoglobin levels return to normal

Question 22

22. Patients who are beginning therapy with vitamin B12 need to be monitored for:
23. Hypertensive crisis that may occur in the first 36 hours
24. Hypokalemia that occurs in the first 48 hours
25. Leukopenia that occurs at 1 to 3 weeks of therapy
26. Thrombocytopenia that may occur at any time in therapy

Answer 22

3. Leukopenia that occurs at 1 to 3 weeks of therapy