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NURS 572 Advanced Pharmacotherapeutics UofA Nursing > Pain and Alcohol/Drug Addiction Meds > Flashcards

Pain and Alcohol/Drug Addiction Meds Flashcards

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1
Q

Which of the following is characteristic of opioid use?

  1. The potential for overdose is decreased after a period of abstinence as tolerance has decreased.
  2. The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal.
  3. Although opioid overdose is a major consequence of opioid use, there has been a sharp decrease in the number of deaths in recent years.
  4. Opioid withdrawal is life-threatening.
A
  1. The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal.
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2
Q

Which medication is indicated for emergency treatment of known or suspected opioid overdose, is carried by first responders, and is prescribed to known opioid users?

  1. Naloxone nasal spray
  2. Flumazenil (Romazicon)
  3. Citalopram (Celexa)
  4. Lofexidine (Lucemyra)
A
  1. Naloxone nasal spray is indicated for emergency treatment of known or suspected opioid overdose, is carried by first responders, and is prescribed to known opioid users. A single spray of naloxone nasal spray is administered to adult or pediatric patients intranasally in one nostril. Additional doses of naloxone nasal spray may be given every 2 to 3 minutes until emergency medical assistance arrives.
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3
Q

Which of the following medications decreases alcohol cravings and reduces the likelihood of returning to drinking?

  1. Disulfiram (Antabuse)
  2. Lithium
  3. Sertraline (Zoloft)
  4. Naltrexone (Revia tablets)
A
  1. Naltrexone (Revia tablets, Vivitrol extended-release injection) decreases alcohol cravings and reduces the likelihood of returning to drinking.
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4
Q

Experts recommend that the use of benzodiazepines be limited to what time frame?

  1. No less than 1 year
  2. Six months
  3. At least 12 weeks
  4. No more than 2 to 4 weeks for most patients
A
  1. Experts recommend that the use of benzodiazepines be limited to no more than 2 to 4 weeks for most patients.
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5
Q

Which of the following is an important prescribing consideration when treating a patient with methadone?

  1. Methadone treatment should be started when the patient is exhibiting signs of sedation or intoxication.
  2. Increasing methadone dose too quickly can lead to respiratory depression and death.
  3. The dosage should be increased quickly to prevent withdrawal symptoms and relapse.
  4. Due to the long half-life, methadone can be tapered rapidly.
A
  1. Increasing methadone dose too quickly can lead to respiratory depression and death. This requires careful titration of the dose and knowledge of the variable half-life of methadone. Methadone treatment is started when there are no signs of sedation or intoxication, and the patient is demonstrating signs of withdrawal. Dosage is gradually increased to suppress cravings, to a dose of 60 to 120 mg per day. Increasing the dose too quickly can place the patient at risk for respiratory depression and death. Weaning from methadone should be done slowly. Tapering should be medically supervised with dosage reductions of less than 10% every 10 to 14 days. Patients should be monitored closely during tapering for relapse.
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6
Q

Which of the following patients should not be prescribed buprenorphine with naloxone (Suboxone)?

  1. Pregnant women
  2. A patient who has a history of diversion
  3. A male who has a history of injectable drug use
  4. A patient with a history of opioid addiction
A
  1. The addition of naloxone acts as a deterrent to diversion and injection of medication and is generally preferable. One exception is with pregnant women, with whom the risk of precipitated withdrawal could be detrimental if the combination is injected.
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7
Q

Which of the following benzodiazepines has the longest duration of action?

  1. Alprazolam (Xanax)
  2. Temazepam (Restoril)
  3. Oxazepam (Serax)
  4. Diazepam (Valium)
A
  1. Valium has a long duration of action. The rest have a short duration.
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8
Q

When possible, the clinician should avoid prescribing what drug for a patient who is taking an opioid pain medication?

  1. Anticonvulsants
  2. Benzodiazepines
  3. Anticholinergics
  4. Corticosteroids
A
  1. Benzos
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9
Q

The United States Preventive Services Task Force (USPSTF) recommends which of the following screening tools for alcohol misuse?

  1. Mini Mental Status Exam (MMSE)
  2. Tolerance, Worried, Eye-opener, Amnesia, K-Cut Down (TWEAK)
  3. Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool
  4. Single Alcohol Screening Question (SASQ)
A
  1. The USPSTF recommends the Alcohol Use Disorders Identification Test (AUDIT-C) and SASQ as screening tools. The CRAFFT screening tool can be used to screen alcohol use in adolescents. TWEAK can be used as a screening tool for alcohol use in pregnant women.
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10
Q

Which of the following is a symptom that can be associated with opioid withdrawal?

  1. Constipation
  2. Pupil constriction
  3. Lacrimation
  4. Cough
A
  1. Symptoms of opioid withdrawal include dysphoria, nausea, vomiting, stomach cramping, diarrhea, myalgia, rhinorrhea, lacrimation, pupil dilation, diaphoresis, piloerection, yawning, fever, and insomnia. Constipation and pupil constriction are associated with opioid use.
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11
Q

A patient who is presently using heroin presents to the clinician’s clinical setting. He has asked when withdrawal symptoms can be expected after the last dose of this drug. What should your response be?

  1. “Typically, symptoms develop around 24 hours after the last dose.”
  2. “Symptoms start in 1 to 3 days and gradually subside over a week.”
  3. “Symptoms start 1 hour before the next expected dose.”
  4. “Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin.”
A
  1. Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin, and up to a few days later with long-acting opioids such as methadone. Symptoms peak over 1 to 3 days and gradually subside over a week.
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12
Q

According to the Centers for Disease Control (CDC) Recommendations for Prescribing Opioids for Chronic Pain Outside of Active Cancer, Palliative, and End-of-Life Care, use of opioids for acute pain beyond which time frame is noted to be rarely needed?

  1. Four weeks
  2. Seven days
  3. Two months
  4. Six months
A
  1. According to the CDC recommendations, 3 days or less will often be sufficient; more than 7 days will rarely be needed.
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13
Q

Which of the following is a consideration when planning initiation of buprenorphine in a patient with opioid use disorder?

  1. Treatment beyond 9 months is not recommended.
  2. Patients who are not stable on low-to-moderate doses should be initiated on a subdermal buprenorphine implant.
  3. Tapering of dose should occur over 3 to 6 months if long-term maintenance is not desired.
  4. Buprenorphine can trigger withdrawal; symptom-triggered dosing and titration are required for induction.
A
  1. Because buprenorphine can trigger withdrawal, symptom-triggered dosing and titration are required for induction, which is generally started 8 to 24 hours after the last opioid dose (24 to 36 hours after long-acting opioid or methadone). Tapering of dose can occur over 3 to 7 days if long-term maintenance is not desired.
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14
Q

Which of the following is a treatment specific for benzodiazepine intoxication?

  1. Methadone (Dolophine)
  2. Naloxone (Revia)
  3. Topiramate (Topamax)
  4. Flumazenil (Romazicon)
A
  1. Flumazenil (Romazicon) is the treatment for benzodiazepine intoxication.
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15
Q

Which drug class has been shown to be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant to other commonly used treatments?

  1. Anticonvulsants
  2. Norepinephrine-dopamine reuptake inhibitors
  3. Monoamine oxidase inhibitors (MAOIs)
  4. Angiotensin receptor blockers
A
  1. Benzodiazepines are the medication of choice for treating alcohol withdrawal, but evidence has shown that anticonvulsants can be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant of benzodiazepines.
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16
Q

A patient presents to the clinician’s clinical setting today and states that she wants to stop the benzodiazepine that she has taken for several years. You should educate the patient regarding which of the following?

  1. “You should not discontinue a benzodiazepine abruptly because it can cause serious complications including seizures and death.”
  2. “You can stop the medication today.”
  3. “You must continue taking the medication since you have taken it long-term.”
  4. “You must taper over 3 days to avoid withdrawal symptoms from occurring before you stop the medication.”
A
  1. Withdrawing abruptly from benzodiazepines can cause not only discomfort and anxiety, but also confusion, psychosis, seizures, and death. It is recommended that gradual tapering should be instituted for long-term users.
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16
Q

Which action should the clinician consider when treating a patient with opioids for chronic pain?

  1. When starting opioid therapy, prescribe extended-release/long-acting (ER/LA) opioids instead of immediate-release opioids.
  2. Start at the highest dose expected to control the patient’s pain.
  3. Provide a quantity of the drug for at least 30 days for acute pain to ensure continuity of pain control is maintained.
  4. When opioids are started, clinicians should prescribe the lowest effective dosage.
A
  1. When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage.
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17
Q

Which receptor is thought to be responsible for the reward effect of opioids?

  1. Mu
  2. Delta
  3. Kappa
  4. Phi
A
  1. The mu receptor is thought to be responsible for the reward effects of opioids.
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18
Q

During treatment with naltrexone, patients should be monitored for which of the following?

  1. Complete blood count (CBC)
  2. Comprehensive metabolic profile (CMP)
  3. Vitamin D level
  4. Urine drug testing
A
  1. During treatment with naltrexone, patients should be monitored for illicit drug use via urine drug testing.
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19
Q

How often should the clinician evaluate benefits and harms with patients when starting opioid therapy for chronic pain or at dose escalation?

  1. Within 3 days
  2. Within 1 to 4 weeks
  3. After 6 weeks
  4. Within 9 weeks
A
  1. Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or at dose escalation.
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20
Q

Relief of inflammation that causes increased intracranial pressure is best achieved with which drug?

  1. Methylprednisolone
  2. Triamcinolone
  3. Betamethasone
  4. Dexamethasone
A
  1. Dexamethasone is the drug of choice for inflammation that causes increased intracranial pressure because it has extremely low mineralocorticoid activity and limited effects on blood pressure, thus minimizing the risk for inadvertently increasing intracranial pressure.
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21
Q

Treatment of acute rheumatic fever includes a combination of antimicrobials and which drug?

  1. Ibuprofen
  2. Acetaminophen
  3. Prednisone
  4. Aspirin
A
  1. Acute rheumatic fever is treated with antimicrobials, but the inflammatory manifestations are treated with aspirin.
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22
Q

Patients taking glucocorticoids for longer than 3 months should be prescribed which medication?

  1. An antihypertensive agent
  2. A hypoglycemic agent
  3. A bisphosphonate
  4. An antibiotic
A
  1. The American College of Rheumatology recommends treating patients on long-term (3 months or longer) glucocorticoid therapy with the bisphosphonates alendronate (Fosamax) or risedronate (Actonel) based on a risk assessment algorithm.
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23
Q

Glucocorticoids increase blood glucose by which mechanism of action?

  1. Simulating gluconeogenesis in the liver
  2. Increasing uptake of glucose into adipose cells
  3. Stimulating protein catabolism in the muscle
  4. Increasing uptake of amino acids into hepatic cells
A
  1. Glucocorticoids increase blood glucose concentration by stimulating gluconeogenesis in the liver (synthesis of glucose from nonhexose substrates, such as amino acids and lipids) and by decreasing uptake of glucose into muscle, lymphatic, and adipose cells.
24
Q

When oral corticosteroid therapy is required during pregnancy, which of these is the drug of choice?

  1. Prednisone
  2. Dexamethasone
  3. Triamcinolone
  4. Hydrocortisone
A
  1. Corticosteroids cross the placenta (prednisone has the slowest transport rate) and may be used cautiously when needed in pregnancy.
25
Q

Which laboratory finding is consistent with long-term corticosteroid therapy?

  1. Increased serum calcium levels
  2. Increased serum phosphorus levels
  3. Decreased serum sodium levels
  4. Decreased serum potassium levels
A
  1. Average and large doses of drugs with high relative mineralocorticoid potency (e.g., cortisone and hydrocortisone) can cause increased excretion of potassium, leading to decreased serum potassium levels. Potassium supplementation may be necessary.
26
Q

A patient who is breastfeeding asks for advice on how she should take her prednisone to minimize the amount excreted in the breast milk. Which advice from the APN is most appropriate?

  1. As long as she is taking less than 40 mg of prednisone per day, the amount excreted in the breast milk is negligible.
  2. She should discontinue the prednisone and ask for an alternative corticosteroid.
  3. She should take the prednisone with a full glass of milk or food to minimize absorption.
  4. She should wait 3 to 4 hours after taking the prednisone before she nurses.
A
  1. For mothers who want to nurse, waiting 3 to 4 hours after taking prednisone (with a dose of less than 20 mg per day) should be advised to minimize excretion in the breast milk.
27
Q

Which dose of salicylates is acutely lethal in children?

  1. 3 gm
  2. 6 gm
  3. 10 gm
  4. 30 gm
A
  1. The acute lethal dose of salicylates in adults is 10 to 30 grams, and in children it is 3 gm.
28
Q

Increased salicylate excretion is best achieved by which mechanism?

  1. Performing gastric lavage
  2. Ingesting activated charcoal
  3. Correcting electrolyte imbalances
  4. Forcing alkaline diuresis
A
  1. Forced alkaline diuresis by administering sodium bicarbonate increases salicylate excretion. Ingesting activated charcoal diminishes salicylate absorption if it is given within 2 hours of ingestion, but it does not increase salicylate excretion. Performing mechanical gastric lavage will remove unabsorbed drugs from the stomach, but it does not increase salicylate excretion. Monitoring and correcting electrolyte imbalance is important but won’t increase excretion.
29
Q

Which NSAID is the most appropriate choice for a patient who is actively vomiting?

  1. Naproxen sodium (Naprosyn)
  2. Ketorolac (Toradol)
  3. Meloxicam (Mobic)
  4. Diclofenac potassium (Cataflam)
A
  1. Ketorolac (Toradol) is the only NSAID available in an intramuscular route, making it the best option for a patient who is actively vomiting.
30
Q

Which pain reliever has the lowest anti-inflammatory effect?

  1. A corticosteroid
  2. An NSAID
  3. Acetaminophen
  4. Aspirin
A
  1. Acetaminophen, although not an anti-inflammatory drug by chemistry, is often used to treat pain and fever. It is an analgesic and antipyretic with limited anti-inflammatory activity.
31
Q

In a patient who is taking aspirin, which drug level should be monitored to decrease risk for toxicity?

  1. Cephalexin
  2. Phenytoin
  3. Prednisone
  4. Metoprolol
A
  1. All salicylates, such as aspirin, may enhance the activity of penicillins, phenytoin, methotrexate, valproic acid, sulfonylureas, and sulfonamides. The clinician should be aware of this effect and monitor drug levels as well as signs of toxicity.
32
Q

How frequently should older adults on corticosteroid therapy have their blood glucose and electrolyte levels checked?

  1. Every month
  2. Every 6 months
  3. Every 12 months
  4. Every 24 months
A
  1. Older adults on corticosteroid therapy should have their blood glucose and electrolyte levels checked every 6 months.
33
Q

Glucocorticoids promote lipolysis in which part of the body?

  1. The extremities
  2. The face
  3. The abdomen
  4. The cervical area
A
  1. Glucocorticoids promote lipolysis in the extremities. Glucocorticoids promote fat deposits in the face, abdomen, and cervical area.
34
Q

When prescribing oral ketorolac (Toradol), the APN should include which information in the instructions?

  1. Do not exceed 30 mg per day. Do not take for more than 5 days.
  2. Do not exceed 30 mg per day. Do not take for more than 10 days.
  3. Do not exceed 40 mg per day. Do not take for more than 5 days.
  4. Do not exceed 40 mg per day. Do not take for more than 10 days.
A
  1. Oral ketorolac (Toradol) dosing should not exceed 40 mg per day and should not be taken for more than 5 days.
35
Q

Which salicylate is preferred for inhibition of platelet aggregation?

  1. Aspirin
  2. Salsalate
  3. Choline magnesium trisalicylate
  4. Choline salicylate
A
  1. Aspirin irreversibly inhibits platelet aggregation, making it the drug of choice. The nonacetylated salicylates (salsalate [Disalcid], choline magnesium trisalicylate [Arthropan], diflunisal [Dolobid]) are salicylic acid derivatives not metabolized to salicylic acid, are not as potent as aspirin, and do not have the same degree of antiplatelet activity.
36
Q

When advising a mother on treatment of fever in a 3-month-old, the APN should recommend which medication?

  1. Ibuprofen
  2. Acetaminophen
  3. Aspirin
  4. Naproxen
A
  1. Acetaminophen is used for children younger than 6 months and patients who do not tolerate ibuprofen. Aspirin should not be used in children with acute febrile illness due to risk of Reye syndrome. Additionally, children with dehydration appear more at risk for salicylate toxicity. Ibuprofen is the NSAID of choice for fever in children older than 6 months and adults.
37
Q

If rapid analgesia is desired, which NSAID is most appropriate for the APN to prescribe?

  1. Acetaminophen (Tylenol)
  2. Naproxen sodium (Naprosyn)
  3. Diclofenac sodium (Voltaren)
  4. Rofecoxib (Vioxx)
A
  1. Naproxen sodium (Naprosyn) is a rapidly absorbed NSAID and is used when rapid analgesia is desired. Diclofenac sodium (Voltaren) is released in the higher pH environment of the duodenum and takes more time to effect than many of the other NSAIDs.
38
Q

When tapering a patient off a 60-mg dose of prednisone, which regimen is most appropriate?

  1. Week 1: 60 mg per day. Week 2: 50 mg per day. Week 3: 40 mg per day. Week 4: 30 mg per day. Week 5: 20 mg per day Week 6: 10 mg per day
  2. Week 1: 60 mg per day Week 2: 50 mg per day Week 3: 45 mg per day Week 4: 40 mg per day Week 5: 35 mg per day Week 6: 30 mg per day
  3. Week 1: 60 mg per day Week 2: 50 mg per day Week 3: 40 mg per day Week 4: 35 mg per day Week 5: 30 mg per day Week 6: 25 mg per day
  4. Week 1: 60 mg per day Week 2: 40 mg per day Week 3: 20 mg per day Week 4: 10 mg per day Week 5: 5 mg per day Week 6: 0 mg per day
A
  1. Tapering schedule for prednisone: for doses greater than 40 mg, decrease by 10 mg every 1 to 3 weeks. Doses below 40 mg require reductions of 5 mg every 1 to 3 weeks. Once the physiological dose is reached (5 to 7.5 mg/day), then reduce by 1 mg weekly or biweekly (this is not illustrated here).
39
Q

A patient who is on a regimen of indomethacin (Indocin) 25 mg twice daily calls the office because he missed his morning dose. Which advice would be most appropriate for the APN to provide?

  1. “Do not take the regularly scheduled morning dose and take the regularly scheduled evening dose.”
  2. “Do not take the regularly scheduled morning dose and double the regularly scheduled evening dose.”
  3. “Take the morning dose as soon as possible and take the regularly scheduled evening dose.”
  4. “Double the morning dose and take as soon as possible, but do not take the regularly scheduled evening dose.”
A
  1. Drugs should be taken exactly as prescribed. A missed dose should be taken as soon as the patient remembers unless it is almost time for the next dose. For drugs taken more than once daily, ideally the missed dose should be taken within 1 to 2 hours of the time it was scheduled. Doses should not be doubled.
40
Q

A mother who is breastfeeding asks which medication she can safely take for headaches. Which drug is the drug of choice for this patient?

  1. Ibuprofen
  2. Naproxen
  3. Ketorolac
  4. Diclofenac
A
  1. Of the NSAIDs, ibuprofen is the safest during breastfeeding. At doses of 400 mg bid and 400 mg every 6 hours, ibuprofen is not detected in breast milk.
41
Q

In patients with elevated liver enzymes who are receiving corticosteroid therapy for post-transplant immunosuppression, which of these is the drug of choice?

  1. Prednisolone
  2. Cortisone
  3. Betamethasone
  4. Dexamethasone
A
  1. Prednisolone, the active hepatic metabolite of prednisone, is used for post-transplant immunosuppression in patients with hepatic dysfunction.
42
Q

Patients with elevated salicylate levels should be advised to avoid which spice?

  1. Salt
  2. Thyme
  3. Paprika
  4. Cumin
A
  1. Foods and spices high in salicylate include curry, paprika, licorice, Benedictine liqueur, prunes, raisins, tea, and gherkins. These should be avoided in patients with elevated salicylate levels.
43
Q

In patients on salicylate therapy, which foods might result in increased serum levels?

  1. Plums and peas
  2. Cheese and fish
  3. Chocolate and beef
  4. Prunes and milk
A
  1. Cheeses, cranberries, eggs, fish, grains, meats, plums, poultry, and prunes acidify the urine, which decreases excretion of salicylate, resulting in increased serum levels.
44
Q

Which of these is the earliest sign of salicylate toxicity?

  1. Tinnitus
  2. Vomiting
  3. Tarry stools
  4. Dizziness
A
  1. The earliest manifestation of salicylate toxicity is tinnitus or mild deafness. Dizziness and vomiting are associated with salicylate toxicity but occurs later. Tarry stools occur as an adverse effect rather than as a sign of toxicity (although it could be a later sign).
45
Q

Although indomethacin is not approved for use in children, it has shown clinical benefit for which condition in neonates?

  1. Patent ductus arteriosus
  2. Coarctation of the aorta
  3. Tetralogy of Fallot
  4. Hypoplastic left heart syndrome
A
  1. Indomethacin is not approved for use in children younger than 14 years, although it is used in neonates to close a patent ductus arteriosus.
46
Q

A 35-year-old patient has been taking a trial regimen of 3 g of aspirin daily for 6 days. She has no complaints of adverse effects but states she does not feel like it has helped with the inflammation. Her salicylate level is 15 mg/dL. Her plan of care should include which next step?

  1. Discontinuing the aspirin because it does not appear to be effective
  2. Continuing the aspirin at the same dose and reevaluating her response in 1 week
  3. Increasing the dose of aspirin to 650 mg per day and reevaluating her response in 1 week
  4. Adding 600 mg per day of ibuprofen to the current aspirin therapy and reevaluating her response in 1 week
A
  1. With all patients, a therapy trial of 3 to 4 g per day for 4 to 6 days is recommended (2 to 3 g per day in older adults). If the response and adherence have been good, a salicylate level should be drawn before discontinuing and/or changing the drug. If the drug level is not within therapeutic parameters (20 to 25 mg/dL in adults; 15 to 20 mg/dL in older adults) and the patient tolerates the aspirin, the dose should be increased by 325 mg to 650 mg until the desired anti-inflammatory effect is achieved. Adding ibuprofen will only increase the patient’s risk for gastrointestinal (GI) adverse effects.
47
Q

When prescribing ketorolac (Toradol), an alternative NSAID might be considered if the clinician is notified of which laboratory value?

  1. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
  2. Elevated creatinine
  3. Decreased serum calcium
  4. Decreased serum potassium
A
  1. The only relative contraindications for NSAIDs are for ketorolac, mefenamic acid, flurbiprofen, and nabumetone in the presence of preexisting renal impairment. Thus, the clinician should consider an alternative NSAID if creatinine is elevated. Although NSAIDs are extensively metabolized in the liver, elevated liver enzymes (liver dysfunction) are not considered a contraindication; however, the clinician may want to consider a lower dose when prescribing and use NSAIDs cautiously in these patients.
48
Q

A 76-year-old patient is requesting medication for treatment of pain caused by osteoarthritis. His labs are normal except for moderately elevated liver enzymes. Which medication is most appropriate for this patient?

  1. A trial of acetaminophen
  2. A trial of oral NSAIDs
  3. A trial of aspirin
  4. A trial of topical NSAIDs
A
  1. The American College of Rheumatology recommends use of topical rather than oral NSAIDs in patients ages 75 years and older.
49
Q

Which dose of aspirin is recommended for primary prevention of cardiovascular disease in a 55-year-old patient?

  1. 75 to 100 mg daily
  2. 75 to 100 mg twice daily
  3. 325 mg daily
  4. 325 mg twice daily
A
  1. The American College of Chest Physicians Guidelines for Primary and Secondary Prevention of Cardiovascular Disease recommend low-dose aspirin (75 to 100 mg daily) in patients (ages 40 to 59 with a risk factor of 10% or higher) with established coronary artery disease, patients with coronary stenosis greater than 50%, and those with evidence of cardiac ischemia.
50
Q

Before initiation of long-term NSAID therapy, the APN reviews a patient’s laboratory values and notes that the hemoglobin is 9 g/dL and the hematocrit is 34%. Which action is most appropriate?

  1. These are extremely low values, and NSAID therapy should not be initiated. A blood transfusion should be ordered.
  2. These are low values, and NSAID therapy should not be initiated. Initiate iron supplementation.
  3. These are extremely low values. Initiate NSAID therapy and monitor values throughout treatment.
  4. These are normal values, and nothing further needs to occur. Initiate NSAID therapy.
A
  1. These values are low, and in patients with initial hemoglobin levels below 10 g/dL who are to receive long-term therapy, values should be monitored throughout treatment. The labs are not a contraindication for initiation of NSAID therapy. They also do not require a blood transfusion. Iron supplementation may be warranted.
51
Q

Which advantage does aspirin have in treatment of rheumatoid arthritis compared with nonacetylated salicylates?

  1. The low incidence of gastrointestinal (GI) intolerance
  2. The convenience of taking it only once or twice daily
  3. The potent anti-inflammatory effect
  4. The short interval in which the drug becomes effective
A
  1. An advantage to using aspirin is its potent anti-inflammatory effect. Nonacetylated salicylates are less potent anti-inflammatory agents, but they have fewer adverse reactions than aspirin.
52
Q

A lower dose of corticosteroid therapy may be needed in patients taking which drug(s)?

  1. Oral contraceptives
  2. Antiepileptic drugs
  3. Ephedrine
  4. Rifampin
A
  1. Oral contraceptives decrease the metabolism of corticosteroids, resulting in increased levels in the blood, which may necessitate a lower dose.
53
Q

When prescribing NSAIDs, how would the APN advise the patient to achieve optimal pain control?

  1. Take the drug with food.
  2. Take the drug only when pain is present.
  3. Take the drug around the clock.
  4. Take the drug at its highest dose.
A
  1. Taking NSAIDs for mild to moderate pain around the clock, rather than as necessary, is most effective.
54
Q

Gastrointestinal adverse reactions from NSAIDs are caused by inhibition of which action?

  1. Leukotriene synthesis
  2. Cyclooxygenase activity
  3. Neutrophil aggregation
  4. Lysosomal enzyme release
A
  1. NSAIDs inhibit leukotriene synthesis, cyclooxygenase activity, neutrophil aggregation, and lysosomal enzyme release. However, it is the inhibition of cyclo-oxygenase activity (more specifically COX-1 as opposed to COX-2), which results in gastrointestinal (GI) adverse effects. COX-1 has a large role in gastric acid secretion and production or protective mucous, especially in the stomach. COX-2 does have some synthesis in the GI tract.
55
Q

Which patient is an INAPPROPRIATE candidate for analgesia with acetaminophen?

  1. A patient with a history of renal stones
  2. A patient with a history of psychosis
  3. A patient who reports drinking five alcoholic drinks per night
  4. A patient who reports smoking one pack of cigarettes per day
A
  1. In a patient who reports drinking five alcoholic drinks per night, the clinician should be suspicious of alcoholism and consider an alternative to acetaminophen. For patients with chronic alcoholism, no safe dose has been determined, and acetaminophen should not be used for these patients.
56
Q

A patient on aspirin therapy calls the office complaining of impaired hearing. Which information is most appropriate for the APN to provide?

  1. The impaired hearing is permanent, and he should continue taking his aspirin as prescribed.
  2. The impaired hearing is permanent, and he should discontinue the aspirin immediately to avoid other complications.
  3. The impaired hearing loss is temporary, and he should continue taking his aspirin as prescribed.
  4. The impaired hearing loss is temporary, and he should discontinue the aspirin immediately to avoid other complications.
A
  1. Salicylates, such as aspirin, are ototoxic at increased blood levels. They should be discontinued if dizziness, tinnitus, or impaired hearing develops. The hearing loss is temporary and will resolve gradually once the drug is stopped.
57
Q

A patient with suspected acetaminophen overdose arrives at the emergency department (ED). Serum levels indicate 100 mg/mL. Which treatment option should the APN prescribe?

  1. Administer intravenous N-acetylcysteine.
  2. Administer dialysis.
  3. Initiate seizure precautions.
  4. Use supportive care.
A
  1. Oral or intravenous N-acetylcysteine is a specific antidote for acetaminophen toxicity.

NURS 572 Advanced Pharmacotherapeutics UofA Nursing (19 decks)

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