Foundations 2 Flashcards
A pt brings in an Rx for orlistat. Which of the following vitamins should the pharmacist recommend the pt take while on this med?
a. Vitamin A
b. Vitamin B6
c. Vitamin D
d. Vitamin E
e. Vitamin K
a, c, d, e
Fat-soluble vitamins should be supplemented in pts on orlistat.
A pt used a natural product for a cold and then lost his ability to smell. He was likely using this product, which the FDA has recommended against using d/t the risk of anosmia:
a. Echinacea
b. Zinc nasal spray
c. Elderberry
d. Vitamin C
e. Zinc lozenges
b
Zinc nasal sprays and swabs should not be recommended. Zinc lozenges may provide benefit, but the pt needs to use enough. They have a metallic taste.
The pediatrician has told a couple that their 3-month-old infant requires vitamin D and iron supplementation. Which supplement would be a suitable product?
a. Fer-In-Sol
b. Feosol
c. Flintstones Chewable Multi-Vitamins
d. Slow-Fe
e. Poly-Vi-Sol with iron
e
-Fer-In-Sol and Feosol contain iron but not vitamin D.
-An infant can’t use a chewable; they need the liquid drops that can be squirted into the side of the mouth, mixed into formula, or pumped breast milk.
Which natural product can be useful for UTI prophylaxis?
a. Ginger
b. Cranberry
c. Feverfew
d. Saw palmetto
e. Magnesium
b
A pt has depression. Which natural product might be useful for this condition?
a. Ginseng
b. SAMe
c. DHEA
d. Glucosamine
e. Chondroitin
b
St. John’s wort, SAMe, Valerian, and 5-HTP can be used for depression.
A 73 y/o male was given an Rx for tamsulosin but wishes tp use a natural product instead. Which product has claimed benefit for this indication?
a. Ginger
b. Cranberry
c. Feverfew
d. Saw palmetto
e. Magnesium
d
-An older male who wishes to self-treat enlarged prostate should be seen by a Dr first to make sure the condition is benign. It could cover up symptoms of prostate cancer. Saw palmetto is touted for BPH, but most evidence states it is likely not effective for symptoms.
-Lycopene is available in supplements and is used for prostate cancer prevention.
A pt brings the pharmacist a bottle of “natural pain pills” that he ordered off a late-night TV show. The name of the manufacturer listed on the bottle is “Magic Cure-All.” Choose the correct statement regarding this product.
a. The manufacturer is responsible for proving efficacy.
b. The FDA is responsible for proving the product is safe.
c. The manufacturer doesn’t have to prove efficacy prior to sale.
d. The product label can claim to treat pain.
e. This product was obtained illegally.
c
A dietary supplement manufacturer is responsible for the supplement’s safety, but it doesn’t have to prove safety and effectiveness to the FDA before it’s marketed. Supplements can’t claim to treat or cure a condition.
A pt asks if there’s a natural product that can be used for constipation. The pharmacist could recommend this product:
a. Glucosamine
b.Psyllium
c. Butterbur
d. Fish oil
e. Feverfew
b
Psyllium is a fiber found in barley, oat bran, and Metamucil.
HPI: MS is a 39 y/o female who recently became involved in a sexual relationship and went to clinic to get advice on birth control measures and safe sex practices. Specifically, she wants to know whether she and her partner should be screened for STDs before becoming intimate. MS has some documented chronic health conditions but believes in natural healing and takes a handful of supplements daily, although she didn’t bring her meds to clinic, so there are limited details on dosing and manufacturer brands she’s using.
PMH: T2DM, dyslipidemia, osteoarthritis
Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep
Which natural product is putting MS at a health risk, in particular CVD risk, for no known benefit?
a. Kava
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. Vitamin E
e
It’s unusual to have a vit. E deficiency, since it’s present in many foods. Vit. E in foods is considered healthy, but excess intake in supplements is considered a health risk (particularly CVD risk). Patients should not exceed 400 IU daily.
HPI: MS is a 39 y/o female who recently became involved in a sexual relationship and went to clinic to get advice on birth control measures and safe sex practices. Specifically, she wants to know whether she and her partner should be screened for STDs before becoming intimate. MS has some documented chronic health conditions but believes in natural healing and takes a handful of supplements daily, although she didn’t bring her meds to clinic, so there are limited details on dosing and manufacturer brands she’s using.
PMH: T2DM, dyslipidemia, osteoarthritis
Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep
Which natural product is putting MS at risk for hepatotoxicity?
a. Kava
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. Vitamin E
a
HPI: MS is a 39 y/o female who recently became involved in a sexual relationship and went to clinic to get advice on birth control measures and safe sex practices. Specifically, she wants to know whether she and her partner should be screened for STDs before becoming intimate. MS has some documented chronic health conditions but believes in natural healing and takes a handful of supplements daily, although she didn’t bring her meds to clinic, so there are limited details on dosing and manufacturer brands she’s using.
PMH: T2DM, dyslipidemia, osteoarthritis
Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep
Despite strict adherence to her birth control pill regimen, MS became pregnant. What was the most likely cause of the pregnancy?
a. Fish oils
b. St. John’s wort
c. Lactobacillus
d. Melatonin
e. High-dose vitamin E
b
SJW is a potent inducer of hepatic enzymes. It can’t be used with PO contraceptives, transplant drugs, warfarin, and others, as it induces CYP3A4 and other isoenzymes.
HPI: MS is a 39 y/o female who recently became involved in a sexual relationship and went to clinic to get advice on birth control measures and safe sex practices. Specifically, she wants to know whether she and her partner should be screened for STDs before becoming intimate. MS has some documented chronic health conditions but believes in natural healing and takes a handful of supplements daily, although she didn’t bring her meds to clinic, so there are limited details on dosing and manufacturer brands she’s using.
PMH: T2DM, dyslipidemia, osteoarthritis
Meds:
Loestrin Fe 1/20 1 tab QD
Fish oil 1000 mg QD
B vit. complex 1 tab QD
MVI QD
Vit. E 400 IU 2 caps QD
St. John’s Wort QD
Kava QD
Probiotic QD
Melatonin PRN for sleep
Which of the following medical problems is MS potentially self-treating without a documented indication?
a. Depression
b. Migraines
c. Dyspepsia
d. Anxiety
e. Weight loss
a, d
-SJW is a common supplement used in depression and anxiety.
-Kava is used in anxiety.
MO is having night sweats and can’t get a good night’s sleep. She has been told by her Dr. that she’s perimenopausal. What natural product may offer some benefit?
a. Dong quai
b. Saw palmetto
c. L-lysine
d. Glucosamine
e. Guarana
a
Others: Black cohosh, evening primrose oil, soy, red clover
Which pt may benefit from use of pyridoxine?
a. A pt with morning sickness
b. A pt who suffers from migraines
c. A pt with insomnia
d. A pt with depression
e. A pt with cold sores
a
A pt with scurvy is deficient in which of the following?
a. Vitamin A
b. Vitamin B6
c. Vitamin C
d. Vitamin D
e. Vitamin E
c
A pharmacist is reviewing the medical profile for a pt and notes that the pt take turmeric, glucosamine, and SAMe. Which condition listed in the pt’s PMH would be consistent with the use of these products?
a. Osteoarthritis
b. Menopause
c. Benign prostatic hyperplasia
d. Dementia
e. Erectile dysfunction
a
ME is a pt at the pharmacy who’s planning to take a cruise to the Bahamas. She explains that she gets really bad motion sickness and doesn’t want to take Dramamine d/t sedation. She has tried this before and doesn’t wish to sleep through her vacation. Which OTC product is best recommended to ME for nausea from motion sickness?
a. Diphenhydramine
b. Aloe vera
c. Cinnamon
d. Dimenhydrinate
e. Ginger
e
Peppermint may also help.
A pt with recently diagnosed active TB was prescribed isoniazid (INH), rifampin, pyrazinamide, and ethambutol. Which vitamin supplement is recommended with this regimen?
a. Vitamin B1
b. Vitamin B12
c. Vitamin B2
d. Vitamin B3
e. Vitamin B6
e
Pyridoxine (vitamin B6) is used to reduce the risk of INH-induced peripheral neuropathy.
JD is an elementary school teacher. She suffers from frequent bouts of osteoarthritis pain during the school day and only gets relief when she sits down to rest. This isn’t always possible. To get by, JD has been taking 5-6 tabs of Extra Strength Tylenol throughout the day. JD heard a news report about using excessive acetaminophen and became frightened. She’s at the pharmacy counter asking if there’s anything “natural” that might help arthritis pain. What supplement might provide a mild benefit?
a. Feverfew
b. Hawthorn
c. Chromium
d. Evening primrose oil
e. SAMe
e
Others: Glucosamine, chondroitin, and turmeric
AS had a stent placed in a coronary artery. She has been using the following meds for many months: Clopidogrel, aspirin, rosuvastatin, amlodipine, atenolol, and the natural products arginine, coenzyme Q10, and cinnamon. AS has felt confused lately and couldn’t remember where she put her house keys. A friend recommended that she begin to use some “brain booster” natural products. About a month ago, after speaking with her friend, AS began to use gingko biloba and huperzine A. It was wintertime, and for the first time ever in the dry, indoor heat, AS began to have chronic, bothersome nosebleeds. Her husband came into the pharmacy to ask for advice. The pharmacist should recommend the following:
a. She shouldn’t be using ginkgo biloba; it’s unsafe with the rest of her meds.
b. She should switch to St. John’s wort.
c. She should consider vitamin E instead of ginkgo.
d. She should be using warfarin instead of clopidogrel.
e. She should be using warfarin instead of aspirin.
a
Gingko and vitamin E (both can help with memory) increase bleeding risk.
MP is a pharmacist in LA who has made it a priority to increase folic acid intake among women of child-bearing age. What is MP’s motivation for this important work?
a. To reduce the risk of low bone density in young women
b. To reduce the risk of serious birth defects in children born to women with low folic acid intake
c. To reduce the risk of ovarian cancer in young women
d. To reduce the risk of endometrial cancer in young women
e. To make money for the manufacturer of folic acid
b
Needs to be taken at least one month before pregnancy
MO has decided to use black cohosh for menopausal symptoms. Choose the correct statement concerning this popular product:
a. Can be hepatotoxic
b. More effective than estrogen for improving vasomotor symptoms
c. Available as prescription only
d. Should be combine with hormone replacement therapy
e. Contraindicated in women over the age of 50
a
JF has self-treated acne for the past 3 years. She has tried spot treatments, facial scrubs, and exfoliation kits that contain either benzoyl peroxide or salicylic acid to help clear her skin. These are useful but leave her skin dry and sore. She’s asking for something more lubricating and “natural.” What OTC supplements might provide benefit?
a. Hawthorn
b. Milk thistle
c. Ipriflavone
d. Tea tree oil
e. Pygeum
d
How many daily mcg of dietary folate equivalents (DFE) are recommended for a pregnant female?
a. 200
b. 300
c. 600
d. 800
e. 1000
c
All women of childbearing age should obtain 400 mcg/day.
JB gets cold sores (herpes simplex labialis) whenever he is under stress. Which agent is sometimes recommended to help reduce this occurrence?
a. Lycopene
b. Lysine
c. Red yeast rice
d. Plant stanols/sterols
e. Fish oils
b
JB has high cholesterol. Which of the following agents can help improve cholesterol values?
a. St. John’s wort
b. Plant stanols/sterols
c. Ginseng
d. Statins
e. Red yeast rice
b, d, e
A pt diagnosed with microcytic anemia would likely require tx with which supplement?
a. Ferrous sulfate
b. Vitamin D
c. Folic acid
d. Vitamin B12
e. Pyridoxine
a
-Microcytic anemia (when the MCV is low) is typically caused by iron deficiency.
-Macrocytic anemia - treated with vitamin B12 and/or folate
A pharmacist recently switched jobs as a result of a med error that he made. He has supportive management who will support him as he identifies similar situations that led to the previous dispensing error and implements approaches that can help reduce errors. What is the name of the analysis done prospectively that can identify pathways that lead to errors and find ways to help prevent future errors?
a. Root Cause Analysis
b. Prospective Error Search (PES)
c. Safety-First Approach
d. Failure Mode and Effects Analysis (FMEA)
e. Prevention and Safety Analysis
d
FMEA is a step-by-step approach for identifying all possible ways in which something might fall. In pharmacy, it’s used to reduce med errors.
The Emergency Department has had 3 errors in the past 4 months involving hypertonic saline for traumatic brain injury (TBI). What measures can the hospital take to improve the use of this high-risk med?
a. Move all hypertonic saline to the ADC in the ED.
b. Develop a protocol for the use of hypertonic saline in TBI.
c. Stock only premixed IV products.
d. Allow the ED staff to prepare the hypertonic saline since they are most familiar with its safe use.
e. Stock the minimum number of product options/strengths.
a, b, e
SP, a hospital pharmacist, just finished lunch and went to the restroom. Place the following hand washing steps in the correct order.
a. Wet both sides of hands
b. Dry hands with a paper towel and use the towel to turn off the water
c. Apply soap
d. Rinse hands thoroughly
e. Rub hands together for at least 15 slow seconds
a - c - e - d - b
One of the largest causes of bloodborne infections is d/t the use of glucose meters in healthcare settings that are used to test many patients. Another cause is the use of medication vials, such as insulin, in more than one patient. Choose the correct statement/s.
a. If a glucose meter travels from room-to-room, the nursing staff must replace the lancet tip before testing each patient.
b. If the same injection vial will be used for multiple patients, it’s imperative never to re-insert a used needle into the vial.
c. It’s preferable to avoid the use of multiple-dose vials in different patients; it’s preferable to label the multiple-dose vial with one patient’s name only.
d. The ISMP recommends using insulin pens to avoid contamination from insulin in multiple patients.
e. Glucose meter shouldn’t be used in the hospital; blood sugar can be tested with the daily labs.
a, b, c
A pharmacist dispensed the wrong drug to a patient. His pharmacy manager screamed at him in front of the staff. The pharmacist got scared and quit. What is the preferred approach when a med error has occurred?
a. Conducting a behavioral intervention with the staff
b. Hiring more technicians to perform double checks on all prescriptions
c. Conducting a Failure Mode and Effects Analysis
d. Punishing everyone involved with demotion or firings
e. Conducting a root cause analysis
e
Which of the following are benefits of patient counseling?
a. Counseling ensures that the drug will cure the patient’s condition
b. Counseling can ensure that the patient is aware of the monitoring required for the drug
c. Counseling can ensure the patient is aware of safety concerns with the use of the drug
d. Counseling makes the patient aware of treatment goals
e. Counseling can ensure that the patient is getting a drug for their condition (and not for a wrong indication, or for a wrong patient)
b, c, d, e
A pharmacist works in a small city hospital that has a medical Dr. who’s an orthopedist. He does several hip replacements and several knee replacements at this hospital per month. The pharmacist hopes to implement patient-controlled analgesia (PCA) devices for orthopedic patients. However, the medical staff at the hospital is overburdened, and the head of the nursing team isn’t interested in changing to a new system. Communication between the healthcare professionals is lacking. Choose the primary reason why PCA devices may not be appropriate in this setting:
a. PCAs can’t be used in small hospitals.
b. PCAs require an educated, coordinated healthcare team.
c. PCAs aren’t used in orthopedic surgeries d/t a higher-than-normal DVT risk.
d. PCAs are only used in outpatient clinics.
e. The use of a PCA would increase costs too much for a small hospital to manage.
b
A nurse is overwhelmed with responsibility for 4 ICU patients. She provides an injection and proceeds to the red sharps container to dispose of the syringe. The sharps container is filled to the surface. She finds a large textbook and carefully uses it to press down the contents of the container to make more room. She removes the needle since the sharps container is now nearly filled, and she’s concerned about the needle being close to the top of the container. Choose the correct statement:
a. This isn’t an acceptable practice.
b. This is an acceptable practice since she compressed the contents of the sharps container.
c. This is an acceptable practice since she removed the needle tip, which can transmit infection.
d. This is an acceptable practice, but she should have used gloved hands to compress the contents of the sharps container.
e. This is an acceptable practice, but she should have asked the pharmacist to do this.
a
In a healthcare setting, soap and water (as opposed to alcohol-based rubs) must be used to wash hands in the following situations:
a. When hands are visibly dirty
b. After caring for a patient with a C. difficile infection
c. Before using the restroom
d. After caring for a patient with irritable bowel syndrome
e. After caring for a patient with a Pseudomonas infection
a, b
A prescriber wrote an Rx for “MS 1 gram IV” for a patient. He wanted the patient to receive magnesium sulfate, but the patient received a fatal dose of morphine. Select the correct method to reduce this error in the future:
a. For morphine sulfate, do not write MS of MS04, write out morphine sulfate.
b. For magnesium sulfate, do not write MS or MgS04, write out magnesium sulfate.
c. Institute a tech check tech policy in the pharmacy.
d. Avoid abbreviations whenever possible.
e. If abbreviations are used, they must be on an approved list at your institution.
a, b, d, e
NC, an 82 y/o female, entered the hospital for orthopedic surgery. Before the surgery, NC used warfarin 3 mg daily. The warfarin was stopped, and she was bridge with enoxaparin. The day after the surgery, “warfarin 10 mg PO each evening” was ordered for NC. The pt had complications post-surgery and stayed in the hospital for ten more days. During this time, the INR was not checked, and she experienced severe bleeding. Which of the following are appropriate measures to avoid this situation?
a. A baseline INR and regular (current) INR should be available for all pts receiving warfarin.
b. Develop a warfarin prescribing protocol that includes an appropriate starting dose.
c. Remove warfarin from the hospital formulary.
d. Don’t permit adjustments to the pt’s home warfarin dose during the hospitalization.
e. A CPOE system could have alerted the prescriber or pharmacist that the dose was high or that an INR wasn’t performed.
a, b, e
Which of the following categories are considered high-alert meds?
a. Anticoagulants
b. Loop diuretics
c. Insulin
d. Sedatives
e. Opioids
a, c, d, e
Which of the following procedures can help reduce med errors associated with heparin?
a. Don’t use the color of the syringe or packaging to verify the dose
b. Provide in-services that review heparin safety
c. If possible, outsource the preparation of heparin flushes
d. Make sure unit nurses prepare the heparin doses
e. Implement protocols to initiate and manage therapy
a, b, c, e
The Joint Commission identifies areas where significant lapses in pt safety exist and then implements National Patient Safety Goals (NPSGs). These recommend specific measures that would reduce risk and improve safety. The Joint Commission has NPSGs in which of the following areas?
a. Improving the way antithrombotics are used
b. Improving the use of patient identifiers
c. Improving med labeling in perioperative settings
d. Improving the timely reporting of critical lab results
e. Compliance with CDC hand hygiene guidelines
a, b, c, d, e
When DN was an inpatient, the nursing student have her 1 dose of PO morphine that should have been administered to the pt in the room beside her. Which of the following med error-reduction programs would most likely have helped avoid the problem of administering the med to the wrong person?
a. Barcoding
b. CPOE
c. Med Rec
d. High-Risk Drug Protocols
e. Staff In-services
a
What is meant by the Joint Commission recommendation to use “2 pt identifiers” when providing care?
a. 2 nurses, or other healthcare professionals, should identify each pt before administering medication or conducting a procedure.
b. 2 cognitive individuals should provide identification for a pt when they are admitted to prevent a pt from being admitted under someone else’s name.
c. 2 pt identifiers, such as name and pt ID number, should be checked before the administration of any drug or procedure.
d. Pts should be identified by 2 physical parameters, such as eye color and hair color, or by primary language.
e. The same pt should be identified twice at different times.
c
CO had been using carbamazepine 400 mg BID for several months. After the pharmacist dispensed a refill last month, CO developed agranulocytosis from the use of carbamazepine and almost died from a severe infection. When he recovered, he was switched to a different med. Choose the correct statement that best describes CO’s experience with carbamazepine:
a. It was a med error to dispense carbamazepine to this pt
b. This pt had an adverse drug reaction to carbamazepine
c. The pharmacist should be dismissed for dispensing the carbamazepine
d. The physician should be disciplined for prescribing carbamazepine for this pt
e. This pt must have taken more than the prescribed dose
b
A pharmacy in a hospital uses mostly unit-dose meds for the general floor pts. The unit dose meds have “barcodes” on the packaging. The pharmacy has replaced the cassettes on the floor with automated dispensing cabinets (ADCs), manufactured by ScriptPro. The ADC has barcodes on the shelves that are scanned to make sure that the correct drug is placed into the correct place in the cabinet. Before the nursing staff can administer a medication that has been removed from the ADC, the nurse scans the medication removed from the ADC and scans the pt’s wristband to make sure that the correct pt is receiving the correct med. Choose the correct statement/s:
a. Barcodes may be the most important med error reduction tool we currently have.
b. Barcode technology isn’t cost-effective for most small and medium hospitals.
c. Barcodes are also used on pumps an with IV infusions.
d. Barcodes are only useful in the inpatient setting.
e. Barcodes follow drugs through the medication use process.
a, c, e
A pharmacist has entered a pt’s room to check on the volume left in the PN bag. Upon leaving the room, she uses an alcohol-based hand rub. Which of the following statements are true concerning alcohol-based hand rubs?
a. They should be avoided in healthcare settings.
b. They are germicidal against many G (+) and G (-) bacteria, including MRSA.
c. They do not kill or remove C. difficile.
d. They are preferred when caring for pts with food allergies.
e. They should not be used more than BID.
b, c
