Question 1. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
A need to monitor drugs metabolized by 2D6 for toxicity
Increased dosages needed of drugs metabolized by 2D6, such as the SSRIs
Decreased conversion of codeine to morphine by CYP 2D6
The need for lowered dosages of drugs, such as beta blockers
Question 2. Rifampin is a nonspecific CYP450 inducer that may:
Lead to toxic levels of rifampin and must be monitored closely
Cause toxic levels of drugs, such as oral contraceptives, when co-administered
Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
Cause nonspecific changes in drug metabolism
Question 3. Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
Decreased therapeutic levels of quinidine
Increased therapeutic levels of quinidine
Decreased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
Increased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
Question 4. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
Toxic levels of warfarin building up
Decreased response to warfarin
Increased risk for significant drug interactions with warfarin
Less risk of drug interactions with warfarin
Question 5. Pharmacogenetic testing is required by the Food and Drug Administration (FDA) prior to prescribing:
Erythromycin
Digoxin
Cetuximab
Rifampin
Question 6. Patients who have a poor metabolism phenotype will have:
Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
Accumulation of inactive metabolites of drugs
A need for increased dosages of medications
Increased elimination of an active drug
Question 7. Ultra-rapid metabolizers of drugs may have:
To have dosages of drugs adjusted downward to prevent drug accumulation
Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
Increased elimination of active, nonmetabolized drug
Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
Question 8. When melatonin is used to induce sleep, the recommendation is the patient:
Take 10 mg 30 minutes before bed nightly
Take 1 to 5 mg 30 minutes before bed nightly
Not take melatonin more than three nights a week
Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep
Question 9. Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to:
Cardiac disturbances
Central nervous system depression
Respiratory depression
Skin rashes
Question 10. The standard dosage of St John's Wort for the treatment of mild depression is:
300 mg daily
100 mg three times a day
300 mg three times a day
600 mg three times a day
Question 11. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
Antihypertensives, diuretics, and digoxin
Antidiarrheals, antihistamines, and omeprazole
Penicillin antibiotic class and benzodiazepines
None of the above
Question 12. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
Respiratory depression
Cardiac disturbance
Salicylates poisoning
Life-threatening rashes
Question 13. The role of the NP in the use of herbal medication is to:
Maintain competence in the prescribing of common herbal remedies
Recommend common over-the-counter herbs to patients
Educate patients and guide them to appropriate sources of care
Encourage patients to not use herbal therapy due to the documented dangers
Question 14. According to Traditional Chinese Medicine, if a person who has a fever is given an herb that is cooling in nature, such as golden seal, the patient's illness will:
Get worse
Get better
Not be adequately treated
Need additional herbs to treat the yang
Question 15. Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:
Be safe and labeled for appropriate use
Have a low potential for abuse or misuse
Be taken for a condition the patient can reliably self-diagnose
All of the above
Question 16. In the United States, over-the-counter drugs are regulated by:
No one, there is no oversight for over-the-counter medications
The U.S. Food and Drug Administration Center for Drug Evaluation and Research
The Drug Enforcement Administration
MedWatch
Question 17. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:
Get a new patent for the over-the-counter form of the drug
Lower the costs, since most prescription benefit plans do not cover generics
Market the drug to a whole new population, as they are able to market to patients instead of just providers
Continue to make large profits from their blockbuster brand-name drug
Question 18. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of:
His appropriately only telling you about his regularly prescribed medications
His hiding information regarding his inappropriate use of aspirin from you
A common misconception that intermittently taken over-the counter medications are not an important part of his drug history
A common misuse of over-the-counter aspirin
Question 19. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:
Not to take their regularly prescribed medications while on these antibiotics
Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption
Not to take antacids while on these medications, as the antacid decreases absorption
That there are no drug interactions with these antibiotics
Question 20. Sadie's adult daughter reports that when Sadie (age 84 years) takes Tylenol PM (acetaminophen and diphenhydramine) to help her sleep she has "strange dreams" including wandering and thinking she is at her childhood home. You understand:
This is a sign of early dementia and she should undergo cognitive testing
Sadie is not taking an effective dose to help her stay asleep
Sadie is exhibiting signs of an allergic reaction to the diphenhydramine in the Tylenol PM
Delirium is a common adverse reaction seen when elderly patients take diphenhydramine