pharm m5-7 Flashcards
When prescribing inhalers for exercise induced asthma you teach and direct the patient to use their medication when?
A Take Combivent inhaler with spacer 15 minutes prior to exercise.
B. Two puffs salmeterol 30-60 minutes prior to exercise and two puffs albuterol 15 minutes before exercise
C. Salmeterol prevents exercise induced asthma for 12 hours and albuterol 2 to 3 hours
D. Take salmeterol twice daily and additional dose 30 minutes prior to exercise
When prescribing inhalers for exercise induced asthma you teach and direct the patient to use their medication when?
Take Combivent inhaler with spacer 15 minutes prior to exercise.
Two puffs salmeterol 30-60 minutes prior to exercise and two puffs albuterol 15 minutes before exercise
Salmeterol prevents exercise induced asthma for 12 hours and albuterol 2 to 3 hours
Take salmeterol twice daily and additional dose 30 minutes prior to exercise
A 35-year-old female with asthma is seen in your office for a sick appointment with increased cough, congestion, and shortness of breath, which statement by this patient is the most concerning?
A. “I feel like I get more relief from my Symbicort (Formoterol/Budesonide) inhaler, so I have been taking 2 puffs every 6 hours when I feel short of breath.”
B. “I was around my niece who tested flu + a couple of days ago.”
C. “I have been using my Proair (albuterol) Inhaler 2 puffs every 4-6 hours for the past two days.”
D. “I bought some guaifenesin tablets over the counter to help with my cough.”
A. “I feel like I get more relief from my Symbicort (Formoterol/Budesonide) inhaler, so I have been taking 2 puffs every 6 hours when I feel short of breath.”
Which vaccination(s) cause significant adverse reaction and should not be given to patients who are immunocompromised or on oral corticosteroids > 20mg per day?
A. All attenuated vaccinations
B. Oral Polio vaccine
C. JYNNEOS (monkey and small pox)
D. Diphtheria Tetanus and Pertussis
B. Oral Polio vaccine
Which statement is incorrect regarding the hepatitis B vaccination?
A. Immunosuppressed patients require larger doses to achieve immunity
B. The vaccine is made from genetically modified common baker’s yeast
C. People who are at risk for bodily fluid exposure can have anti HB testing done to confirm sufficient antibodies
D. The one to three dose series needs to be given sequentially 4 weeks apart. Series is restarted if any dose is missed.
D. The one to three dose series needs to be given sequentially 4 weeks apart. Series is restarted if any dose is missed.
A 32 y/o female is prescribed propranolol for migraines. Additional patient education includes all of the following except:
A. Avoid OTC cold medicines with ephedrine
B. Limit Tylenol use due to impact on liver
C. Do not abruptly stop taking medication
D. Additional birth control precautions should be taken as propranolol decreases effectiveness of birth control pill
D. Additional birth control precautions should be taken as propranolol decreases effectiveness of birth control pill
Which medication for seizures does not interact with oral contraceptives?
A. Phenytoin (Dilantin)
B. Levetiracetam (Keppra)
C. Oxcarbazepine (Trileptal)
D. Lamotrigine (Lamictal)
B. Levetiracetam (Keppra)
Which of the following instructions is of most concern for a 35-year-old African American male in terms of asthma management?
A. Take Salmeterol 1 puff BID, 12 hours apart, for short-term relief.
B. Use a spacer device with an MDI (metered-dose inhaler).
C. Pulmonary function and response to inhaler medications will be monitored with a peak flow meter.
D. Take Ipratropium bromide (Atrovent) 2-3 inhalations every 6 hours, with a maximum of 12 puffs/day for maintenance.
a. Salmeterol, formoterol, and arformoterol are long-acting inhaled bronchodilators with a half-life of 10 to 12 hours. Salmeterol is more selective for beta2 receptors than is albuterol and has minor beta1 activity (p.301). Salmeterol is not to be used for short-term bronchospasm relief (p.308). The risks of salmeterol (Serevent) and formoterol (Foradil) outweighed the benefits and that they should not be used singly in asthma for all ages.
Which of the following populations or coexisting conditions should be considered when you are prescribing Tiotropium Handihaler inhalation 18 mcg QID for COPD management?
a. 75-year-old male with benign prostatic hyperplasia
b. Patient with closed-angle glaucoma
c. Pregnant women
d. 4-year-old for long-term control of asthma
e. All of the above
e. All of these populations and conditions require special consideration due to potential contraindications or safety concerns with Tiotropium Handihaler use. The inhaled anticholinergics (aclidinium, ipratropium, and tiotropium) should not be used for the treatment for acute bronchospasm except ipratropium combined with albuterol in ER as a treatment of acute bronchospasm (p.316).
61-year-old patient in your office has not received any pneumococcal vaccine. Which of the following is the most appropriate action?
A. Administer 1 dose of PCV15 or PCV 20 or PCV21
B. Administer 1 dose of PPSV23
C. Ask patient’s preference between PCV13 or PCV 15
D. Tell him it is okay without pneumonia vaccine
For those aged 50 years or older who have not previously received a dose of PCV13, PCV15, PCV20, or PCV21 or whose previous vaccination history is unknown, administer 1 dose PCV15 or 1 dose PCV20 or 1 dose PCV21 (CDC, 2024).
A 54-year-old female patient asks about the shingles vaccine due to a previous painful skin eruption. Which of the following statements is appropriate?
A. “You don’t need a vaccination due to a previous infection.”
B. “A 2-dose series of recombinant zoster vaccine (RZV, Shingrix), given 2–6 months apart, should be administered regardless of previous infection.”
C. “Only one dose is needed because of your previous infection.”
D. “You should return for the zoster vaccine because the influenza vaccine given today interacts with the zoster vaccine.”
B. “A 2-dose series of recombinant zoster vaccine (RZV, Shingrix), given 2–6 months apart, should be administered regardless of previous infection.”
You prescribed tamsulosin 0.4 mg daily for a male patient with benign prostatic hyperplasia. You are aware that this medication is a selective Alpha-1 antagonist causing relaxation of the muscle. Which of the instructions is given correctly for this patient?
a. It’s a once-a-day medication and remember to take it during the day; timing is when you feel comfortable taking it.
b. You can take this medication crushed, mixed with applesauce or yogurt.
c. The most common adverse reaction is hypotension and potential syncopal episodes. Changing positions slowly and avoiding alcohol consumption.
d. It takes 2-3 days for this medication to be effective.
c. The most common adverse reaction is hypotension and potential syncopal episodes. Changing positions slowly and avoiding alcohol consumption.
A 56-year-old female patient with type 2 diabetes mellitus and neuropathic pain is recently diagnosed with major depression. She refuses in-person psychotherapy and prefers to try pharmacological treatment. Which of the following medications is the best choice for this patient?
a. Duloxetine (Cymbalta) 60 mg daily
b. Quetiapine (Seroquel) 25 mg BID on day 1
c. Olanzapine (Zyprexa) 5 mg daily
d. Carbidopa-levodopa (Sinemet) 1 tablet (25 mg carbidopa and 100 mg levodopa) TID
a. Duloxetine (Cymbalta) 60 mg daily
An 11-year-old patient was diagnosed with persistent asthma a year ago and has been using an inhaled corticosteroid but is still experiencing frequent exacerbations. The provider is considering adding a long-acting beta-agonist (LABA) to his treatment. What is the most appropriate recommendation for this patient?
A. Consult a Respiratory Therapist to choose the best treatment for the patient.
B. Discontinue the inhaled corticosteroid and start only an LABA for long-term management.
C. Prescribe a combination of corticosteroid and LABA inhalers.
D. Switch the patient to only a LABA inhaler to achieve better asthma control.
C. Prescribe a combination of corticosteroid and LABA inhalers.
A nurse practitioner is assessing a 2-year-old child with a history of asthma who is experiencing acute bronchospasm. Which one of the following medications is most appropriate for the NP to prescribe?
A. Albuterol
B. Ipratropium
C. Levalbuterol
D. Salmeterol
A. Albuterol
A nurse practitioner is educating a patient on the Ebola vaccine (Ervebo). Which statement is accurate regarding its use?
A. Ervebo is a medication that should be taken PO to decrease the risks of Ebola virus disease.
B. Ervebo is a live attenuated vaccine that was approved to be used in adults ages 18 and older or at high risk of occupational exposure.
C. The Ervebo is a vaccine specifically given to children under 18 in endemic regions.
D. The Ervebo vaccine will provide immediate effect against EVD after administration.
B. Ervebo is a live attenuated vaccine that was approved to be used in adults ages 18 and older or at high risk of occupational exposure.
RA is a 32-year-old male patient who presents for a routine check-up and reports a history of diphtheria infections when he was 8. He is not sure whether he needs further vaccinations due to a previous infection. What is the most appropriate recommendation regarding diphtheria immunization for this patient?
A. “No further vaccination is needed since you were previously infected and that provided you with lifelong immunity”.
B. “It is recommended that you receive a diphtheria booster only when you travel to an endemic area”.
C. “You should receive a diphtheria toxoid booster every 10 years regardless of past infection”.
D. “You should receive a full series of diphtheria vaccines again, even if you were vaccinated previously”.
C. “You should receive a diphtheria toxoid booster every 10 years regardless of past infection”.
An 80-year-old patient has been diagnosed with mild Alzheimer’s disease. The NP is considering prescribing medication to help with cognitive symptoms like donepezil. What is the most appropriate initial dosing and titration plan for the patient?
A. Start with the highest dose possible
B. Start with 5 mg in the morning and increase to 23 mg within one month.
C. Start with 5 mg at bedtime and increase the dose to 10 mg after at least 3 months if tolerated by the patient
D. Start at 10 mg immediately and tartrate every other day by 2.5 mg.
C. Start with 5 mg at bedtime and increase the dose to 10 mg after at least 3 months if tolerated by the patient
Which of the following statements about cough and cold medicine is correct?
A Decongestants like Pseudoephedrine reduce swelling associated with inflammation of the mucous membranes by vasodilation effects
B Antitussives are used to suppress cough for patients with pneumonia
C Expectorants effective for patients thinning respiratory secretions for clearance
D None of the above
C Expectorants effective for patients thinning respiratory secretions for clearance
Leanne is an emergency department nurse practitioner. She is caring for a patient who is in severe status asthmatics. Which of the following medications would you expect Leanne to order for emergency medications?
A Albuterol and Levalbuterol
B Salmeterol and formoterol
C Montelukast and Beclomethasone
D Cromolyn and Budesonide
A Albuterol and Levalbuterol
Melissa is a Nurse Practitioner student who is currently in a clinical rotation at her local primary care office. She is seeing a patient who was prescribed Adalimumab (Humira) for inflammatory bowel disease for 2 years. Which of the following statements indicates that Melissa is educated on biological drugs?
A “It is appropriate to receive the Herpes Zoster vaccine to protect you from Shingles.”
B “There is no indication that you should be taken off any biological agent while you are pregnant.”
C “You have pneumonia; you should stop taking Humira until the infection resolves.”
D None of the above
C “You have pneumonia; you should stop taking Humira until the infection resolves.”
Which of the following statements about the influenza vaccine is true?
A Influenza is recommended annually because influenza viruses are constantly changing, and immunity wanes over time.
B Influenza vaccine imparts immunity by stimulating the production of antibodies that are specific to the disease strain. People are only immune to the strains included in the vaccine for that year.
C The vaccine dose for a child and adult are the same.
D A higher dose vaccine is available for older adults
C The vaccine dose for a child and adult are the same.
Which of the following statements is true about prescribing an Anorexiant?
A It is recommended that a patient is prescribed to use an anorexiant for weight loss regardless of their history of supraventricular tachycardia
B It is recommended to assess a patient for alcohol dependence because anorexics are metabolized by the liver
C Anorexiants are beneficial to patients with difficult to monitor and control diabetes
D Anorexiants are beneficial for blood pressure control
B It is recommended to assess a patient for alcohol dependence because anorexics are metabolized by the liver
Joseph is a nurse practitioner who sees a patient for an annual physical. This patient has a past medical of hypertension and is on 50 mg BID of Metoprolol (Lopressor). Which of the following indicates a nontherapeutic effect caused by this medication?
A Depression
B Constipation
C HR: 41 bpm
D Insomnia
E All of the above
F None of the above
E All of the above
Max is a 6 year old boy who plays soccer. His mother has noticed that he has a hard time sometimes when he runs causing him to cough and have to take a break. This patient is diagnosed with exercise induced asthma with bronchospasm. What is the most appropriate medication prescription for this patient prior to exercise?
A Ipratropium bromide
B Theophylline
C Albuterol
D Indacaterol
C Albuterol
Inhaled corticosteroids are used to treat asthma and allergic rhinitis. The clinician knows they need to educate the patient on possible side effects including all except?
A Oral candidiasis
B Xerostomia
C Bronchospasm
D Gi upset
Gi upset
All are contraindications to revoice the MMR vaccine except?
A Asthma
B Leukemia
C HIV
D untreated TB
A Asthma
Which patient is not a candidate for the rabies vaccine?
A Veterinary technician without current exposure
B 5 y/o with dog bite from unknown dog
C Exterminator who specialized in bats
D 35 y/o bit by feral cat
E All of the above qualify for rabies vaccines
All of the above qualify for rabies vaccines.
A patient is prescribed Benztropine for Parkinson’s disease. The clinician knows that this medication is contraindicated or to be used with caution in patients with all except?
A Acute angle glaucoma
B Benign prostatic hyperplasia
C Myasthenia gravis
D Drug induced EPS
. Drug induced EPS
A patient presents to the clinic for feelings of sadness and anxiety. This patient also has a known history of fibromyalgia. They state that the pain from the fibromyalgia is contributing to their anhedonia. After using standard screenings you diagnose the patient with depression. Of the following, what medication would be beneficial in treating the patients depression and chronic pain?
A Escitalopram
B Bupropion
C Gabapentin
D Duloxetine
D. duloxetine is the correct answer
A 40-year-old male patient makes a sick visit appointment with his primary care provider due to his persistent coughing. The patient states he is “getting over a cold,” and the cough is one of the last symptoms affecting his sleep. The practitioner is considering ordering an antitussive for this patient. Of the following situations, which would be a contraindication for prescribing an antitussive?
A A productive cough that produces mucus.
B A dry, nonproductive cough that is affecting the patient’s sleep.
C A harsh cough that produces throat irritation but no mucus.
D A cough caused by post-nasal drip due to allergies.
A A productive cough that produces mucus.
For patients who are suffering from hypoxia, oxygen therapy is often prescribed to assist with its management. However, the provider must remember several considerations, as oxygen therapy requires careful administration. Which of the following considerations regarding oxygen therapy is false?
A Too high or low oxygen flow rates can lead to adverse effects.
B Patients with hypoxia should receive the highest concentration possible of oxygen to help correct the hypoxia.
C Oxygen is a medication that requires a prescription from a provider.
D Oxygen should be used with caution for patients who are suffering from COPD, as it can suppress their respiratory drive.
B Patients with hypoxia should receive the highest concentration possible of oxygen to help correct the hypoxia.
A parent is bringing in their 5-year-old daughter for a well-child visit. The parent states that her daughter has been healthy with no illnesses for the past several months. The topic of vaccinations is presented, and the parent agrees that their child should be brought up to date with the vaccination schedule. For a 4–6-year-old patient, which vaccinations are recommended per the CDC immunization schedule?
A HPV, Tdap, and Meningococcal vaccinations.
B Hib, PCV13, Hepatitis B, Rotavirus.
C Varicella, MMR, DTaP, IPV.
D HPV, Meningococcal, and Varicella.
C Varicella, MMR, DTaP, IPV.
A patient is speaking with their primary care provider regarding the difference between attenuated vaccinations, such as the annual influenza vaccination, and inactivated vaccinations, such as the annual COVID-19 vaccination. Which of the following statements regarding attenuated and inactivated vaccinations are true?
A Both forms of vaccinations, attenuated and inactivated, contain live pathogens, but the inactivated vaccinations use a weaker strain.
B Inactivated vaccinations contain weakened pathogens, while attenuated vaccinations contain dead pathogens.
C Inactivated vaccinations provide a more durable and stronger immune system response than attenuated vaccinations provide.
D For the immunocompromised population, inactivated vaccinations are recommended, as they are safer than attenuated vaccinations.
D For the immunocompromised population, inactivated vaccinations are recommended, as they are safer than attenuated vaccinations.
A 53-year-old male patient comes to the clinic for the initial evaluation regarding the potential need to initiate monoclonal antibody therapy for his solid tumor malignancies. The clinician carefully takes his health history and comprehensively examines his body systems. After completing this, what is the most crucial consideration before initiating monoclonal antibody therapy for the treatment of his malignancies?
A As monoclonal antibody therapy can trigger severe immune-mediated reactions and other adverse events, careful monitoring for 1 to 2 hours after initiation of treatment is critical.
B Monoclonal antibody therapy does not need specialty training to administer.
C The patient should not receive any vaccinations 90 days before monoclonal antibody therapy initiation.
D Careful monitoring of the patient’s electrolytes and glucose levels is needed, as they are the most susceptible to being affected by monoclonal antibody therapy.
A As monoclonal antibody therapy can trigger severe immune-mediated reactions and other adverse events, careful monitoring for 1 to 2 hours after initiation of treatment is critical.
The 28-year-old female patient’s provider is providing patient education for her upcoming monoclonal antibody treatment. As this treatment option is very specialized and can have side effects, there is a need for the correct information to be given to the patient. Which of the following statements regarding monoclonal antibody treatments is false?
A Monoclonal antibody treatment can treat autoimmune diseases such as inflammatory bowel disease, psoriatic arthritis, and rheumatoid arthritis.
B Monoclonal antibody treatments such as mepolizumab (Nucala) and reslizumab (Cinqair) are used in the treatment of hematological malignancy.
C Monoclonal antibody treatments such as alirocumab (Praluent) and evolocumab Repatha) work to treat hyperlipidemia.
D Not all monoclonal antibody treatments are safe in pregnancy, so careful patient health analysis is required.
B Monoclonal antibody treatments such as mepolizumab (Nucala) and reslizumab (Cinqair) are used in the treatment of hematological malignancy.
Alpha-2 agonists can be used for various conditions, such as hypertension, including clonidine (Catapres) and guanabenz (Wytensin). A practitioner must carefully consider whether to use these medications, however, as while they provide significant therapeutic benefits for the patient, they also can cause considerable side effects. When considering the use of alpha-2 agonists, which of the following statements is false?
A Alpha-2 agonists can cause tachycardia and hypertension as side effects.
B Alpha-2 agonists can cause pruritic rashes.
C Alpha-2 agonists can cause cognitive impairment and should be prescribed with caution in older adults.
D Alpha-2 agonists can include systemic side effects such as drowsiness, dry mouth, and constipation.
A Alpha-2 agonists can cause tachycardia and hypertension as side effects.
Clonidine can be prescribed for various clinical applications due to its mechanism of action. However, it is contraindicated in certain situations for which the provider must be cautious. Which of the following clinical applications is clonidine NOT to be used for?
A Prescribed as part of a treatment plan for ADHD in children.
B Used for treatment of acute heart failure.
C Can be prescribed off-label for the treatment of opioid withdrawal.
D Used as a second-line drug for treating mild to moderate hypertension.
B Used for treatment of acute heart failure.
Due to the ongoing obesity crisis affecting Western countries such as the United States, a class of drugs called anorexiants have grown in popularity due to their ability to assist with weight loss. However, providers must still conduct patient education when prescribing and helping administer these medications. Which of the following statements regarding anorexiants are false?
A Many anorexiants can cause fetal harm and should be discontinued during pregnancy.
B Anorexiants should be carefully prescribed for patients with substance use disorders due to their high risk for dependence and tolerance.
C Anorexiants stimulate satiety centers in two areas of the brain, the hypothalamus and limbic regions.
D Anorexiants’ primary benefit comes from their ability to induce long-term metabolic changes, even after discontinuation of the medication.
D Anorexiants’ primary benefit comes from their ability to induce long-term metabolic changes, even after discontinuation of the medication.
Opioids are a class of medication that has been under tremendous federal and state scrutiny due to its high potential for misuse and abuse. However, they remain a treatment option for patients who cannot find pain relief from nonopioid agents. Before prescribing this class of medication, providers must be mindful of federal and state regulations and use caution. Which of the following statements is false?
A For patients with a head injury, caution is urged when prescribing opioids due to their ability to mask pain and increase cerebrospinal fluid pressure.
B The provider must obtain a complete, accurate health history of the patient before prescribing, as patients with substance use disorders are at higher risk for misuse and abuse of opioids.
C Patients with compromised pulmonary function should not be prescribed opioids due to their depressant effect on the respiratory system.
D Chronic pain patients should be prescribed short-acting opioids as opposed to long-acting opioids, as pain relief is more immediate.
D Chronic pain patients should be prescribed short-acting opioids as opposed to long-acting opioids, as pain relief is more immediate.
A 34-year-old female patient comes to the office with low IgG to MMR and requires a booster to travel abroad. When going over the informed consent you ask if she is pregnant. She informs she is not, however, there is a possibility as she is going through IVF with her husband. Should this patient get this MMR Vaccine?
A Yes, she should get this immediately since she may be pregnant and is vulnerable.
B Yes, she should get this since she is traveling and will be at increased risk.
C No, she will need to get this as soon as she delivers the baby.
D No, pregnancy is contraindication and needs to be avoid for 90 days.
D No, pregnancy is contraindication and needs to be avoid for 90 days.
An 18-year-old patient comes in to receive a PPD placement for school admission after moving to the U.S from Haiti, which of the following would stop the provider from administering.
A She has known syncope with needles and does not tolerate them at all.
B She had pneumonia 3 months ago and was treated with antibiotics.
C She received the MMR vaccine 8 weeks ago.
D When asking if she had the BCG vaccine, she states she has.
D- She was given the BCG Vaccine.
Rationale: the BCG vaccine is administered to those outside of the United States to lower the risk of severe complications of Primary TB in children, she is more likely to have a false positive and a QuantiFERON gold may be recommended instead (Woo & Wright, 2024). All the others would not stop the administration of the TB test.
You are seeing a 53-year-old female patient for an asthma follow up on her Arnuity and Albuterol medications. Which of the following statements would indicate further intervention?
A “I have been using my Albuterol inhaler 30 minutes before physical activity to prevent an asthma exacerbation.”
B “I take my Arnuity in the morning.”
C “I use my Albuterol inhaler everyday”
D “My husband is now smoking outside and I’m using Buspirone now.”
C- “I use my albuterol inhaler every day.”
Rationale: If the patient is using her albuterol every day, that informs the provider that her asthma is not well controlled and that her medications need to be re-evaluated. Use of an albuterol inhaler is an appropriate intervention and recommended guideline for exercised induced asthma exacerbations (UpToDate, 2025).
What side effect would you anticipate a patient reporting with Theophylline?
A GERD
B Urinary Retention
C Extreme Fatigue
D Sialorrhea
A- Gerd
Rationale: Theophylline’s common side effects and adverse reactions include increasing gastric acid secretions, nausea, vomiting, increased urination, insomnia, and dry mouth
A 62-year-old female comes to the office and reports pain on her right side by her bra-strap. After evaluation, you notice a rash consistent with shingles. Which of the following medications would be best for her pain?
A Tylenol 500 mg 1 tab PO QD daily.
B Ibuprofen 600 mg Q6HR
C Ice pack to the area and recommendation not to wear a bra.
C Gabapentin 300 mg 1 tablet PO QHS.
D
Rationale: Gabapentin is a great medication to help with neuralgia which is caused by the shingles virus. Sometimes the pain can linger for months, or may not resolve at all, so Gabapentin is a great medication. Tylenol and Ibuprofen are pain relievers, but may not directly with postherpetic neuralgia which is associated with shingles. Cold temperatures are not recommended as this can exacerbate shingle pain in some patients due to the temperature sensitivities post-infection.
You are prescribing Carbidopa-Levodopa to a patient with Parkinson’s Disease. All the statements listed by the provider below are correct EXCEPT
A “You need to take this medication with a low-protein meal.”
B “You are going to need a referral to a Dermatologist for skin checks.”
C “You can take B6 to help increase energy levels.”
D “You need to avoid hazardous activities if drowsy or dizzy.”
C
Rationale: B6 should be avoided with patients taking Levodopa as it may interfere with the action of this medication (Woo & Wright, 2024).
