Mod 1-4 Flashcards
- When working with a patient to create a treatment plan, it is important to ask your patient questions regarding personal, financial, and health system factors that impact their overall health in order to:
A. Obtain past medical history
B. Determine predictors of adherence
C. Gather history on medication compliance
D. Screen for drug abuse
B. Determine predictors of adherence
In regards to controlled substances, the following statements are all true except:
A. Registration for a DEA number is required for all who manufactures, distributes, prescribes, procures or dispenses any controlled substance.
B. All practitioners who regularly purchase, dispense/distribute and administer controlled substances must maintain and keep on file accurate records for 2 years.
C. A fax prescription for a Schedule II controlled substance is acceptable if the patient resides in a nursing home.
D. State laws are not allowed differences in the scheduling of controlled substances and must follow federal laws.
D. State laws are not allowed— because they are allowed to have differences, they can be more strict but not less
Tommy, a 5 year old pediatric patient, was prescribed a therapeutic range dose of amoxicillin for strep throat. The mother of the patient denies any known drug allergies and states the patient was on amoxicillin for the first time 2 months ago for strep and tolerated it without any adverse drug reactions. After taking the first dose at home later that evening, Tommy developed hives, itching, and mild respiratory distress. He was transferred by ambulance to the emergency department for treatment. Which classification of adverse drug reaction would this be considered?
A First dose reaction
B. Type I
C. Type A
D. Early Reaction
B–Type I
is an immune mediated response often caused by re-exposure to a specific source, in this case amoxicillin. Type I reactions can range from mild (hives, allergic rhinitis) to severe (angioedema and anaphylaxis). Education to patient and caregiver about potential for allergic reaction should always be given at time of treatment counseling.
When treating a patient with new onset seizures, which racial group is at risk for developing carbamazepine-induced Stevens Johnson syndrome and requires pharmacogenomic testing ?
A. Caucasian
B. African American
C. Hispanic
D. Asian
D –Asian - Asian ancestry is at risk of developing carbamazepine induced Stevens Johnson syndrome. They should undergo pharmacogenomic testing for the HLA-B*1502 allele as this increases the frequency 10 fold (Wood & Wright, p. 67, 2024).
Which pediatric medication administration technique is not correct?
A. Administer liquid medications in the buccal pouch in 1mL increments in infants.
B. Assist parent/teen relationships in medication compliance and self- administration
C. Prescribe liquid medication for young school aged children to increase compliance.
D. Choose antibiotics with single or twice daily dosing for toddlers.
C- prescribing liquid medicaton for young shhcool aged children— you should ask their preference to mom or dad, some can start to swallow pills
A patient is prescribed verapamil for hypertension control, which statement by the patient requires more education?
A. “I will need to increase fiber in my diet”
B. “I will talk to you about adverse drug reactions before stopping the medication”
C. “Even with my osteoporosis, I should stop taking my calcium and vitamin D supplement”
D. “I will buy orange juice instead of grapefruit”
C-
calcium can continue to be taken without impacting CCB
Beta Blockers are contraindicated in patients with which disorder?
A. Myocardial Infarction
B. Atrial Fibrillation
C. Migraines
D. Asthma
D. asthma or COPD, no cardiac specific and can cause bronchial constriction
PDE-5 Inhibitors like tildalafil should not be taken concurrently with:
A. Nitrates
B. Class III Antiarrhythmics
C. Grapefruit Juice
D. All of the Above
D–All of the above
Collaboration is a key component to an effective health-care team. This collaboration could include all of the following professions, except:
A. Nurses
B Medical Doctors/DO
C Pharmacists
D All of the above
D. All of the above, No single member of the health-care team can provide high-quality care without collaborating with other team members and this includes a multitude of healthcare professionals as well as ancillary services involved in the patient’s care
The Institute for Safe Medication Practice’s (ISMP’s) List of Error-Prone Abbreviations, Symbols, and Dose Designations suggest which of the following to provide a complete, safe prescription?
A Abbreviations are allowed as long as they are standardly used and easy to interpret
B. Do no need to indicate a general indication for the use
C. Indicate a safety cap is not required, as medications will be dispensed with them by default
D Do no need “Dispense as Written” because the pharmacist will determine if the generic is a better option for the patient
C–Indicate a safety cap is not required, as medications will be dispensed with them by default
The provider should indicate if a safety cap is not required only for patients that have dexteritiy concerns and can ensure that the medications could still be stored safely.
An adverse drug reaction that occurs during or immediately after the administration of a medication or treatment is called?
A. First-dose reaction
B. Rapid reaction
C. Early reaction
D. Instant reaction
B–Rapid reaction
A rapid reaction is one that occurs during or immediately after the administration of a medication or treatment. The generally occurs when a medication is incorrectly administered, such as an IV push medication that is pushed too rapidly.
Distractors: A first-dose reaction occurs after the first dose of a medication is administered, as the name implies. An example would be orthostatic hypotension occuring after starting a new blood pressure medication. This generally does not occur with repeat doses.
An early reaction usually occurs early into treatment and generally resolves with continued treatments as tolerance develops. An example would be GI upset after starting Metformin that resolves after continuance of treatment.
Instant reaction is not listed as a type of ADR in the reading and is a distractor due to the similarity of the words instant and rapid only.
The process of rational drug prescribing involves several steps in a systematic process that is used every time a prescription is written. Step 2 involves specifying the therapeutic objective which is defined as?
A. Determining if the goal of therapy is curative, symptom relieving, or preventative.
B. Formulating a diagnosis and differential care plan including early screening and effective drug therapy regimen.
C. Monitoring the drug therapy’s effectiveness through monitoring, detection, and evaluation.
D. Involving the patient in the treatment plan decisions and providing education as to why the medication should be chosen.
A–Specifying the therapeutic objective involves determining if the goal of therapy is to cure the disease, relieve the symptoms of disease, replace deficiencies, prevent long-term disease, or treat the combination of two conditions such as pain and inflammation.
Which of the following is the first-line therapy for women with mild to moderate pain related to endometriosis?
A. Opioid pain relievers
B. NSAIDs and continuous hormonal contraceptives
C. Progestin therapy
D. SSRIs
B. NSAIDs and continuous hormonal contraceptives
NSAIDs and continuous hormonal contraceptives are listed as the first-line therapy for mild to moderate pain related to endometriosis. Continuous hormonal contraceptives such as Estrogen-progestin containing 20mcg of ethinyl estradiol help suppress ovarian function and may slow disease progression.
Blood flow, body fat, body water composition, and plasma protein binding are the main factors of geriatric pharmacokinetics that effect which of the following?
A. Absorption
B. Drug Distribution
C. Metabolism
D. All of the above
D. all of the above
The factors listed affect all of the pharmacokinetics involved in the geriatric patient demographic.
Which medication class is found to produce more coronary artery vasodilation and reduce vasospasms in Vasospastic Angina?
A. ACE Inhibitors
B. Calcium Channel Blockers
C. Angiotensin II Receptor Antagonists
D. Cardiac Glycosides
B–Calcium Channel Blockers (CCB) block the influx of calcium at the onset of excitation-contraction process to depolarize the membrane which results in coronary artery vasodilation and reduces vasospasms.
Which of the following medications is used to treat atherosclerosis?
A. Antihypertensives
B. Antiemetics
C. Antilipidemics
D. Beta Blockers
C–Antilipidemics are used to treat atherosclerosis, the major cause of CVD.
What are some patient barriers that may contribute to medication non-adherence?
A. Patient is a construction worker with poor health insurance coverage.
B. Patient has two children and is a single parent
C. Patient had to drop out of school in the 6th grade to take care of family
D. All of the above.
D– all of the above
What control substance tier would Vyvanse fall under if you were told they could not have any refills, no telephone orders, unless there was a true emergency, and electronic prescriptions, are alright with proper software and scripts?
A. Teir 1
B. Teir 2
C. Teir 3
D. Teir 4
E. Teir 5
B. Teir 2
A patient was just prescribed Penicillin and came back to the office with concerns of severe pruritus and urticaria. What of the following reactions would you suspect the patient is having?
A. Type 1 reaction
B. Type 2 Reaction
C. Type 3 reaction
D. Type 4 Reaction
A. Type 1 reaction
What metabolic phase is responsible for 59% of adverse reactions?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
A. Phase I
Phase I metabolism enzymes are responsible for approximately 59% of ADRs due to the creation of reactive metabolites through oxidation reaction catalyzed by Cytochrome P450 enzymes, which can potentially bind to the cellular endoplasmic reticulum and mitochondria and cause toxicity, especially in individuals with genetic variations affecting their enzyme activity (Page 61 and chart 6-1).
A parent brings their child into the office and is prescribed Amoxicillin oral solution, before discharge, you are educating the parents about administration of this medication. Which of the following provided is FALSE:
A. You only want to administer small amounts at a time (1mL) into the inner buccal space.
B. Parents should report any hives, rashes, or wheezing to the office immediately.
C. If your baby is not taking the syringe, its ok to mix it with formula to ensure they get the right dose
D. Breastfed babies often sputter and choke the first time you administer medication using a syringe.
C. If your baby is not taking the syringe, its ok to mix it with formula to ensure they get the right dose
Which medication is considered an Angiotensin II receptor Blocker?
A. Lisinopril
B. Hydrochlorothiazide
C. Losartan
D. Metoprolol
C. Losartan
A 47-year-old African American female comes into the office with hypertension with a history of severe asthma, current smoking, hyperlipidemia, and hyperthyroidism. Which medication would you NOT consider prescribing?
A. Hydrochlorothiazide 12.5mg 1 tablet by mouth daily
B. Metoprolol 25mg 1 tablet by mouth daily
C. Losartan Potassium 50 mg 1 tablet by mouth daily
D. Amlodipine 5mg 1 tablet by mouth daily
B. Metoprolol 25mg 1 tablet by mouth daily
Metoprolol is a beta blocker which is contraindicated in those with severe asthma and COPD.
The provider is assessing the patient during a routine primary care examination and is looking to determine the patient’s adherence to the prescribed drug regimen. What is the most reliable method for assessing adherence?
A. Ask the patient about any barriers to taking their medications and discuss options to alleviate them.
B. Patient’s report of taking medication as prescribed.
C. Administering a medication adherence scale.
D. Examine the patient’s lab work to determine compliance.
A. Ask the patient about any barriers to taking their medications and discuss options to alleviate them.
When prescribing medications in the older population, a provider should always consider which of the following:
A. Adherence
B. Liver and Kidney function
C. Polypharmacy
D. Risk for falls
E. All of the above
E. All of the above
A provider must consider all of the above when prescribing to the older population. Adherence can be influenced by multiple factors such as financial status, multiple medications (being on “too many”), side effects, etc. Liver and Kidney function will dictate what dose the provider can prescribe and monitor, such as liver and kidney functions (liver panel & BMP). Polypharmacy should be considered due to certain medications interacting with each other or increasing side effects and ADRs. Fall risk should always be considered when prescribing to older adults, as medications can cause increased cognitive impairment, drops in blood pressure, dizziness, etc. (Page 1357).
When a new drug is being developed, the FDA closely monitors the clinical tests using the drug. These tests are divided into three separate and distinct phases to evaluate the new drug’s efficacy and safety. Which of the following statements regarding the phases of the FDA clinical trials for a new drug is false?
A. Phase III evaluates the efficacy and safety of the drug in a large, diverse population.
B. Phase II examines the long-term side effects in a small group of healthy individuals.
C. Phase II evaluates the safety of the new drug in patients and its effectiveness.
D. Phase I examines the safety of the new drug in a small group of healthy individuals.
B. Phase II examines the long-term side effects in a small group of healthy individuals.
Phase II trials are designed to focus on actual patients suffering from the illness the drug is being developed for, not healthy individuals. It also does not focus on the long-term side effects of the new drug but assesses the short-term side effects
Adverse drug reactions (ADRs) can be medical emergencies, as more severe reactions can lead to hospitalization or even the patient’s death. The practitioner must be aware of two different types of ADRs, namely, pharmacological and idiosyncratic ADRs. Which of the following correctly distinguishes between the two different adverse drug reactions?
A. Pharmacological ADRs only occur with toxic doses of medications, while idiosyncratic reactions happen with therapeutic medication doses.
B. The immune system causes Pharmacological ADRs, while drug-drug interactions cause idiosyncratic reactions.
C. Pharmacological ADRs are dose-dependent, with idiosyncratic ADRs being not dose-dependent and unpredictable.
D. Pharmacological ADRs only affect a single body organ, while idiosyncratic ADRs affect the entire body’s organ systems.
C. Pharmacological ADRs are dose-dependent, with idiosyncratic ADRs being not dose-dependent and unpredictable.
ADRs can range from mild to life-threatening, with upwards of 6% of all annual hospitalizations due to an ADR, with high costs nationwide due to these reactions (Woo & Wright, 2024, p. 48). As such, providers must always be vigilant regarding these reactions in their patients. Pharmacological reactions are the body’s exaggerated response to a drug and can be eliminated by reducing the dose or removing the drug entirely (Woo & Wright, 2024, pp. 48-49). On the other hand, Idiosyncratic ADRs are much more unpredictable, can be caused by various sources, such as the immune system or drug-drug interactions, and are often not dose-dependent.
A patient comes in for a standard wellness check with their primary care provider. The patient has an established history of chronic kidney disease, and requires new medication to be prescribed. With this patient’s health history in mind, which of the following is the most important to consider when prescribing a new medication?
A. The medication’s cost.
B. The medication’s route of administration.
C. The medication’s availability.
D The medication’s elimination pathways.
D The medication’s elimination pathways.
A parent brings their child, aged 3 years old and female, into the clinic for a well-child examination. The child shows signs and symptoms of a skin infection and will need topical medication. The provider remembers that they must be mindful of how drug absorption differs for the pediatric population compared to adults. Which of the following factors best explains this difference?
A. Children absorb topical medications at a higher rate than adults.
B. Children absorb topical medications at a lower rate than adults.
C. Medications administered via a patch work better with children.
D. There are no drug absorption differences between children and adults.
A. Children absorb topical medications at a higher rate than adults.
Children have a larger body surface area than their size, which affects the topical absorption of various medicines (Woo & Wright, 2024, p. 1324). Due to this, children absorb topical medications at a higher rate than adults, and this factor can lead to systemic toxicity when topical medications are misapplied.
As people age, many changes affect their bodies and systems. One example is that the geriatric population experiences changes in drug distribution when taking their medications. Which of the following statements regarding these changes in the geriatric population is true?
A. Increased total body water can lead to higher water-soluble drug plasma concentrations.
B. Lower serum albumin levels lead to less binding of drugs to protein molecules, producing higher levels of free drug and chance for toxicity.
C. Increased lean body mass levels allow for better drug distribution.
D A lower level of body fat can cause a prolonged half-life of lipophilic medications, leading to a more intense immediate effect.
B. Lower serum albumin levels lead to less binding of drugs to protein molecules, producing higher levels of free drug and chance for toxicity.
In the geriatric population, plasma albumin levels typically decrease, which leads to higher free drug concentrations (Woo & Wright, 2024, p. 1355). Due to this, the drug’s effects are heightened and can lead to toxicity.
Providers must be mindful of the systemic effects of heart failure that can negatively affect a patient’s health. When initiating drug therapy for a patient with chronic heart failure, which of the following statements is the most accurate?
A. Start low and go slow, which can give therapeutic effects while minimizing side effects.
B Start with a high dose initially, with a planned taper to follow.
C Start with a standard dose for every patient.
D Start with and keep the maximum drug dose due to the patient’s urgent medical needs.
A. Start low and go slow, which can give therapeutic effects while minimizing side effects.
For chronic therapy, “start low and go slow” are the recommended steps when a provider is looking to start medication for the treatment of heart failure (Woo & Wright, 2024, p. 276). Typically, the doses are advanced over a week or two, leading to the desired therapeutic effect without significant side effects, such as orthostasis and headache.
The provider meets with their patient during a scheduled primary care visit regarding increased edema in their lower extremities. The provider prepares to order a diuretic for the patient, but the provider remembers that diuretics can have different effects on different patient populations. Which of the following statements regarding using diuretics in specific patient populations is false?
A. Glucose intolerance is an issue with all diuretics.
B. Thiazide and loop diuretics are the drugs of choice for patients taking lithium.
C. Patients suffering from gout may have exacerbations due to diuretic use, leading to heightened levels of uric acid.
D. The geriatric population can experience an increased risk of electrolyte imbalances and hypotension.
B. Thiazide and loop diuretics are the drugs of choice for patients taking lithium.
For patients who take lithium, taking thiazide and loop diuretics can lead to lithium toxicity, as these drugs lead to a reduction in renal lithium excretion (Woo & Wright, 2024, p. 292). These drugs can also affect other medications as well, such as insulin and warfarin.
