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Advanced Pharmacotherapeutics > CS Exam > Flashcards

CS Exam Flashcards

1
Q

List 3 common classes and examples of drugs often prescribed as ADJUNCTIVE first line therapies in combination with analgesics, opioids, and non-opioid for pain

A

Anticonvulsants: Neuropathic pain (gabapentin, pregabalin) * check renal function

Antidepressants: neuropathic pain, co-analgesic for cancer pain, concurrent treatment of depression (TCA-amitriptyline *caution with ederly, cardiac; SSRI- paroxetine; SNRI- Venlafaxine-liver

Local anesthetics: topic/local discomfort, neuropathic pain- lidoderm patch, lidocaine injections

Steroids: inflammatory neuropathic pain, chronic cancer pain; short term only (IE Dexamethasone)

Muscle Relaxants: temporary relief of acute muscle injury

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2
Q

Which DEA schedule has the least potential for abuse?

A

Schedule V

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3
Q

Which DEA schedule has the most potential for abuse?

A

Schedule II

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4
Q

What are the COMMON side effects of opioid medications?

A

constipation, dry mouth, nausea, vomiting, drowsiness, confusion, tolerance, physical dependence, withdrawal symptoms

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5
Q

What is the maximum dose of Lidocaine into a subcutaneous site at one time?

What drug can be added to Lidocaine for subcutaneous injection to potentiate its effects?

A

Lidocaine without epinephrine: 4.5 mg/kg, max 300mg or 30 mL

Lidocaine with epinephrine: 7g/kg, max 500 mg or 50mL of Lidocaine 1%

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6
Q

Can nurse practitioners furnish or prescribe drugs or devices to family members or friends?

A

No

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7
Q

Certified NPs who hold active prescribing or furnishing licenses and valid DEA registration numbers can prescribe or order controlled substances from what schedules?

A

Schedule II-V

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8
Q

What are the criteria for being classified as dangerous controlled substance drugs by the federal Drug Enforcement Agency (DEA)?

A

Substances are placed in their respective schedule based on their relative abuse potential and likelihood of causing dependence when abused

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9
Q
  1. What controlled schedules (I, II, III, IV, V) are the following drugs?

Methylphenidate (Ritalin)
Diazepam (Valium)
Lomotil
Marijuana (THC)
Fentanyl (Duragesic)
Morphine
Guaifenesin/Hydrocodone (Hycotuss)
Acetaminophen/Hydrocodone (Norco, Vicodin)
AndroGel (Testosterone)
Phentermine
Alprazolam (Xanax)
Carisoprodol (Soma)
Zolpidem (Ambien)
Adderall (amphetamine/dextroamphetamine)
Methadone

A

Methylphenidate (Ritalin): II
Diazepam (Valium): IV
Lomotil: V
Marijuana (THC): I
Fentanyl (Duragesic): II
Morphine: II
Guaifenesin/Hydrocodone (Hycotuss): II
Acetaminophen/Hydrocodone (Norco, Vicodin): II
AndroGel (Testosterone): III
Phentermine: IV
Alprazolam (Xanax): IV
Carisoprodol (Soma): IV
Zolpidem (Ambien): IV
Adderall (amphetamine/dextroamphetamine): II
Methadone: II

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10
Q
  1. Vicodin has been changed from a Schedule ? to a Schedule ? drug due to its increased risk of abuse and addiction.
A

Schedule III to a Schedule II

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11
Q
  1. List two (2) different Schedule I substances (of which NPs are not permitted to prescribe).
A
  • Heroin and marijuana
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12
Q
  1. What class of pain medications typically should not be ordered for a renal-impaired patient (GFR < 50 ml/min)?
A
  • NSAIDs
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13
Q

According to the Pharmacotherapeutics for Advanced Practice Providers textbook, among ultra rapid metabolizers who carry copies of the CYP2D6 gene, codeine is unusually effective and has led to ? in some children

A

fatalities

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14
Q
  1. What class of pain medications typically should not be ordered for a moderately hepatic-impaired patient, or must be hepatic dosed adjusted?
A
  • Acetaminophen
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15
Q
  1. According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, pure opioid agonists such as Morphine have the effects such as respiratory depression. From your textbook, list 5 more possible effects of pure opioid agonists.
A

Relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, respiratory depression

  • serotonin syndrome: high body temp., agitation, hyperreflexia, tremor, dilated pupils
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16
Q
  1. Cough medications with codeine or antidiarrheal are what type of Scheduled medication?
A
  • Schedule V
17
Q
  1. Benzodiazepines must be (fill in the blank) when you plan to discontinue them? Here’s your choices- Abruptly stopped, tapered, dosed around the clock to be effective, or have thorough renal and hepatic labs before prescribing.
A
  • Slowly tapered
18
Q
  1. How many refills can a patient have for Methylphenidate (Ritalin)?
A
  • No refills – no prescription schedule II substances may be refilled
19
Q
  1. What are the unique characteristics of Oxycodone (Oxycontin), aside from its potency? What Controlled Drug Schedule is it?
A
  • Time released, Schedule II
20
Q
  1. According to the Pharmacotherapeutics for Advanced Practice Providers textbook, severe toxicity has occurred in ? infants whose mothers are taking codeine.
A

breastfed

21
Q
  1. What are the signs and symptoms of opiate withdrawal?
A

similiar to a severe influenza infection: n/v, sweating, joint aches, agitation, tremor

pulse >120
sweat streaming off face
unable to sit still for more than a few seconds
pupils so dilated
rubbing joints or muscles & unable to sit still because of discomfort
nose constantly running or tears streaming down face
multiple episodes of diarrhea or vomitting
gross tremor or muscle twitching
yawning several times/ minute
irritable and anxious
prominent piloerrection

22
Q
  1. Which DEA Schedule contains drugs that have very high abuse potential and are not usually used as prescribed medications?
A
  • Schedule I
23
Q
  1. According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, about 10% of each dose of codeine in the liver converts to ? .
A

morphine

24
Q
  1. True or false: Using benzodiazepines can lead to a potential for tolerance and dependency.
A
  • True
25
Q
  1. According to the assigned reading handout “OTC Analgesia Checklist”, what indications show that your patient may be at risk if you prescribe NSAIDs? And when should have a risk vs. benefit analysis and/or medication adjustment before prescribing NSAIDs?
A
  • Have increased risk of GI bleeding?
  • Have GERD, dyspepsia, or peptic ulceration or a history of stomach problems?
  • Have kidney disease?
  • Have cardiovascular disease or a history of stroke?
  • Have hypertension?
  • Take aspirin to protect against heart attack or stroke
  • Have liver cirrhosis?
  • Have asthma?
  • Have edema (due to CHF)?
  • Drink 3 or more alcoholic beverages every day?
  • Take prescription meds, such as NSAIDS, antihypertensive agents, diuretics, or anticoagulants?
  • Take OTC medications containing NSAIDs, including cough and cold or allergy products, sleep aids, antipyretics and analgesics?
  • Take steroids or have condition that requires long term steroid use?
  • Is your patient over 60 years old
  • Has your patient ever had an allergic reaction or serious side effects from taking pain relievers
  • Has your patient recently had heart surgery or he/ she about to have heart surgery?
26
Q
  1. According to the assigned reading handout “OTC Analgesia Checklist”, what indications show that your patient may be at risk if you prescribe acetaminophen? And when should your patient have a risk vs. benefit analysis and/or medication adjustment completed by you before prescribing acetaminophen? (Select 4)
A
  • Drink 3 or more alcoholic beverages every day?
  • Have liver disease?
  • Take warfarin?
  • Take prescription medication containing acetaminophen, including acetaminophen containing opiods?
27
Q
  1. What are the criteria for a Nurse Practitioner to be able to prescribe Buprenorphine (Suboxone) for heroin addiction to prevent opiate withdrawal?
A
  • NPs with a furnishing and DEA license may now prescribe Buprenorphine (Suboxone) for heroin addiction to prevent opiate withdrawal

Advanced Pharmacotherapeutics (3 decks)

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