24 Jan 3. Rinsing their mouth

Chapter 21. Drugs Affecting the Endocrine System

1. Both men & women experience bone loss with aging. The bones most likely to demonstrate significant loss are:

1. Cortical bones

2. Femoral neck bones

3. Cervical vertebrae

4. Pelvic bones

2. Bisphosphonates treat or prevent osteoporosis by:

1. Inhibiting osteoclastic activity

2. Fostering bone resorption

3. Enhancing calcium uptake in the bone

4. Strengthening the osteoclastic proton pump

3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

1. Selective estrogen receptor modulators

2. Aspirin

3. Glucocorticoids

4. Calcium supplements

4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, & amylase components, but the drug is prescribed in units of:

1. Lipase

2. Protease

3. Amylase

4. Pancreatin

5. Brands of pancreatic enzyme replacement drugs are:

1. Bioequivalent

2. About the same in cost per unit of lipase across brands

3. Able to be interchanged between generic & brand-name products to reduce cost

4. None of the above

6. When given subcutaneously, how long until neutral protamine Hagedorninsulin begins to take effect (onset of action) after administration?

1. 15 to 30 minutes

2. 60 to 90 minutes

3. 3 to 4 hours

4. 6 to 8 hours

7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs & symptoms of hypoglycemia include:

1. “Fruity” breath odor & rapid respiration

2. Diarrhea, abdominal pain, weight loss, & hypertension

3. Dizziness, confusion, diaphoresis, & tachycardia

4. Easy bruising, palpitations, cardiac dysrhythmias, & coma

8. Nonselective beta blockers & alcohol create serious drug interactions with insulin because they:

1. Increase blood glucose levels

2. Produce unexplained diaphoresis

3. Interfere with the ability of the body to metabolize glucose

4. Mask the signs & symptoms of altered glucose levels

9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?

1. Optimal time of prepr&ial injection is 15 minutes.

2. Duration of action is increased when the dose is increased.

3. It is compatible with neutral protamine Hagedorn insulin.

4. It has no pronounced peak.

10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:

1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.

2. The initial dose of glargine is 2 to 10 units per day.

3. Patients who have been on high doses of NPH will need tests for insulin antibodies.

4. Obese patients may require more than 100 units per day.

11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose & limit complication risks. Which of the following statements is accurate based on research?

1. Premixed insulin analogues are better at lowering HbA1C & have less risk for hypoglycemia.

2. Premixed insulin analogues & the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.

3. Newer premixed insulins are better at lowering HbA1C & postpr&ial glucose levels than long-acting insulins.

4. Patients who are not controlled on oral agents & have postpr&ial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.

12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:

1. Substitutes for insulin usually secreted by the pancreas

2. Decreases glycogenolysis by the liver

3. Increases the release of insulin from beta cells

4. Decreases peripheral glucose utilization

13. Prior to prescribing metformin, the provider should:

1. Draw a serum creatinine to assess renal function

2. Try the patient on insulin

3. Tell the patient to increase iodine intake

4. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions

14. The action of “gliptins” is different from other antidiabetic agents because they:

1. Have a low risk for hypoglycemia

2. Are not associated with weight gain

3. Close ATP-dependent potassium channels in the beta cell

4. Act on the incretin system to indirectly increase insulin production

15. Sitagliptin has been approved for:

1. Monotherapy in once-daily doses

2. Combination therapy with metformin

3. Both 1 & 2

4. Neither 1 nor 2

Chapter 22. Drugs Affecting the Reproductive System

1. Men who use transdermal testosterone gel (&roGel) should be advised to avoid:

1. Washing their h&s after applying the gel

2. Wearing occlusive clothing while using the gel

3. Exposure to estrogens while using the gel

4. Skin-to-skin contact with pregnant women while using the gel

2. Education when prescribing &rogens to male patients includes advising that:

1. Short-term use places the patient at risk for hepatocellular carcinoma.

2. Cholestatic hepatitis & jaundice may occur with low doses of &rogens.

3. Gynecomastia is a rare occurrence with the use of &rogens.

4. Low sperm levels only occur with long-term use of &rogens.

3. Patients who are prescribed exogenous &rogens need to be warned that decreased libido:

1. Is an unusual side effect of &rogens & should be reported to the provider

2. Is treated with increased doses of &rogens, so the patient should let the provider know if he is having problems

3. May be a sign of early prostate cancer & he should make an appointment for a prostate screening exam

4. May occur with &rogen therapy

4. The U.S. Food & Drug Administration warns that &rogens may cause:

1. Peliosishepatis

2. Orthostatic hypotension

3. Menstrual irregularities

4. Acne

5. Monitoring for a patient who is using &rogens includes evaluation of:

1. Complete blood count & C-reactive protein levels

2. Lipid levels & liver function tests

3. Serum potassium & magnesium levels

4. Urine protein & potassium levels

6. Male patients require __ before & during &rogen therapy.

1. A digital prostate exam

2. A Doppler exam of testicular blood flow

3. Urine analysis for proteinuria

4. Serial orthostatic blood pressures

7. Absolute contraindications to estrogen therapy include:

1. History of any type of cancer

2. Clotting disorders

3. History of tension headaches

4. Orthostatic hypotension

8. Postmenopausal women with an intact uterus should not be prescribed:

1. Estrogen/progesterone combination

2. IM medroxyprogesterone (Depo Provera)

3. Estrogen alone

4. &rogens

9. Women who have migraines with an aura should not be prescribed estrogen because of:

1. The interaction between triptans & estrogen, limiting migraine therapy choices

2. An increased incidence of migraines with the use of estrogen

3. An increased risk of stroke occurring with estrogen use

4. Patients with migraines may be prescribed estrogen without any concerns

10. A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes:

1. Counseling regarding decreasing or not smoking while taking oral contraceptives

2. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive

3. Advising that she may miss two pills in a row & not be concerned about pregnancy

4. Recommending that her next follow-up visit is in 1 year for a refill & annual exam

11. A 19-year-old female is a nasal Staph aureus carrier & is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?

1. Separate the oral ingestion of the rifampin & oral contraceptive by at least an hour.

2. Both medications are best tolerated if taken on an empty stomach.

3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack.

4. If she gets nauseated with the medications she should call the office for an antiemetic prescription.

12. A 56-year-old woman is complaining of vaginal dryness & dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed:

1. Low-dose oral estrogen

2. A low-dose estrogen/progesterone combination

3. A vaginal estradiol ring

4. Vaginal progesterone cream

13. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:

1. Depression

2. Hypertension

3. Weight loss

4. Cataracts

14. When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects:

1. Hypertension & dysuria

2. Depression & weight gain

3. Abdominal pain & constipation

4. Orthostatic hypotension & dermatitis

15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to:

1. The potential development of significant hypertension

2. Increased risk of strokes

3. Decreased bone density

4. The risk of a life-threatening rash such as Stevens-Johnson

Chapter 23. Drugs Affecting the Integumentary System

1. Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances & request the least expensive-treatment. Which medication would be the best choice for treatment?

1. Mupirocin (Bactroban)

2. Bacitracin & polymixin B (generic double antibiotic ointment)

3. Retapamulin (Altabax)

4. Oral cephalexin (Keflex)

2. Juakeem is a nasal methicillin resistant staphylococcus aureus(MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:

1. Take the oral medication exactly as prescribed.

2. Insert one-half of the dose in each nostril twice a day.

3. Alternate treating one nare in the morning & the other in the evening.

4. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients.

3. Instructions for applying a topical antibiotic or antiviral ointment include:

1. Apply thickly to the infected area, spreading the medication well past the borders of the infection.

2. If the rash worsens, apply a thicker layer of medication to settle down the infection.

3. Wash h&s before & after application of topical antimicrobials.

4. None of the above

4. When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam?

1. Miconazole (Micatin) powder

2. Ketoconazole (Nizoral) cream

3. Terbinafine (Lamisil) cream

4. Griseofulvin (Grifulvin V) suspension

5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:

1. Mix the griseofulvin with ice cream before administering

2. Take the griseofulvin until the tinea clears, in approximately 4 to 5 weeks

3. Shampoo with baby shampoo daily while taking the griseofulvin

4. Griseofulvin is best absorbed if ingested with a high-fat food.

6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

1. OTC topical azole (clotrimazole, miconazole)

2. Oral terbinafine

3. Oral griseofulvinmicrosize

4. Nystatin cream or ointment

7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:

1. Spread penciclovir liberally all over lips & area surrounding lips.

2. Penciclovir therapy is started at the first sign of a cold sore outbreak.

3. Skin irritation is normal with penciclovir & it should resolve.

4. The penciclovir should be used a minimum of 2 weeks to prevent recurrence.

8. Erika has been prescribed isotretinoin (Accutane) by her dermatologist & is presenting to her primary care provider with symptoms of sadness & depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point?

1. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant

2. Refer her to a mental health therapist

3. Contact her dermatologist about discontinuing the isotretinoin

4. Reassure her that mood swings are normal & schedule follow up in a week

9. Drew is a 17-year-old competitive runner who presents with complaint of pain in his hip that occurred after he fell while running. His only medical problem is severe acne for which he takes isotretinoin (Accutane). With this history what would you be concerned for?

1. He may have pulled a muscle & needs to rest to recover.

2. He is at risk for bone injuries & needs to be evaluated for fracture.

3. Isotretinoin interacts with ibuprofen which is the pain medication of choice.

4. Teen athletes are at risk for repetitive stress injuries.

10. Catherine calls the clinic with concerns that her acne is worse 1 week after starting topical tretinoin. What would be the appropriate care for her?

1. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.

2. Switch her to an oral antibiotic to treat her acne.

3. Advise her to apply an oil-based lotion to her face to soothe the redness.

4. Reassure her that the worsening of acne is normal & it should improve with continued use.

11. Li is a 6-month-old infant with severe eczema. She would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:

1. Apply liberally to all areas with eczema.

2. Double the frequency of application when the eczema is severe.

3. Apply sparingly to eczema areas.

4. Cover the eczema area with an occlusive dressing after applying a corticosteroid.

12. Jose has had eczema for many years & reports that he thinks his corticosteroid cream is not working as well as it was previously. He may be experiencing tolerance to the corticosteroid. Treatment options include:

1. Increase the potency of the corticosteroid cream.

2. Recommend an interrupted or cyclic schedule of application.

3. Increase the frequency of dosing of the corticosteroid.

4. Discontinue the corticosteroid because it isn’t working any longer .

13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:

1. Tacrolimus is the most effective if it is used continuously for 4 to 6 months.

2. Tacrolimus should be spread generously over the affected area.

3. The FDA has issued a Black Box warning about the use of tacrolimus & the development of cancer in animals & humans.

4. The FDA recommends patients be screened for cancer before prescribing tacrolimus.

14. Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:

1. High vitamin D levels

2. Hyperkalemia

3. Hypercalcemia

4. Hyperuricemia

15. Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them:

1. That tazarotene is applied in a thin film to the psoriasis plaque lesions

2. To apply it liberally to all psoriatic lesions

3. To apply tazarotene to nonaffected areas to prevent breakout

4. That tazarotene may cause hypercalcemia if it is overused

Chapter 24. Drugs Used in Treating Infectious Diseases

1. Factors that place a patient at risk of developing an antimicrobial-resistant organism include:

1. Age over 50 years

2. School attendance

3. Travel within the U.S.

4. Inappropriate use of antimicrobials

2. Infants & young children are at higher risk of developing antibiotic-resistant infections due to:

1. Developmental differences in pharmacokinetics of the antibiotics in children

2. The fact that children this age are more likely to be in daycare & exposed to pathogens from other children

3. Parents of young children insisting on preventive antibiotics so they don’t miss work when their child is sick

4. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

3. Providers should use an antibiogram when prescribing. An antibiogram is:

1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics

2. An algorithm used for prescribing antibiotics for certain infections

3. The reference also known as the Pink Book, published by the Centers for Disease Control

4. A chart of the local resistance patterns to antibiotics developed by laboratories

4. There is often cross-sensitivity & cross-resistance between penicillins & cephalosporins because:

1. Renal excretion is similar in both classes of drugs.

2. When these drug classes are metabolized in the liver they both produce resistant enzymes.

3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

4. There is not an issue with cross-resistance between the penicillins & cephalosporins.

5. Jonathan has been diagnosed with strep throat & needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:

1. Penicillin VK, because his rash does not sound like a serious rash

2. Amoxicillin

3. Cefadroxil (Duricef)

4. Azithromycin

6. Sarah is a 25-year-old female who is 8 weeks pregnant & has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?

1. Ciprofloxacin (Cipro)

2. Amoxicillin (Trimox)

3. Doxycycline

4. Trimethoprim-sulfamethoxazole (Septra)

7. Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic & say he has developed diarrhea. The appropriate action would be to:

1. Advise the parents that some diarrhea is normal with amoxicillin & recommend probiotics daily.

2. Change the antibiotic to one that is less of a gastrointestinal irritant.

3. Order stool cultures for suspected viral pathogens not treated by the amoxicillin.

4. Recommend increased fluids & fiber in his diet.

8. Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, & rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be:

1. Amoxicillin

2. Amoxicillin/clavulanate

3. TMP/SMZ (Septra)

4. None

9. Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old & has no residual cardiac problems. She is now 28 & is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology & American Heart Association guidelines is:

1. None, no antibiotic is required for dental procedures

2. Amoxicillin 2 grams 1 hour before the procedure

3. Ampicillin 2 grams IM or IV 30 minutes before the procedure

4. Azithromycin 1 gram 1 hour before the procedure

10. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of:

1. Urinary tract infections in young women

2. Upper respiratory infections in adults

3. Skin & soft tissue infections in adults

4. Community-acquired pneumonia in patients with comorbidities

11. Fluoroquinolones have a Black Box Warning regarding even months after treatment.

1. Renal dysfunction

2. Hepatic toxicity

3. Tendon rupture

4. Development of glaucoma

12. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

1. Encourage increased fluids & fiber.

2. Assess her for pseudomembranous colitis.

3. Advise her to eat yogurt daily to help restore her gut bacteria.

4. Start her on an antidiarrheal medication.

13. Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?

1. Azithromycin (Zithromax)

2. Clarithromycin (Biaxin)

3. Erythromycin (E-mycin)

4. None of the above

14. Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) & requires an antibiotic. Which class of antibiotics should be avoided in this patient?

1. Penicillins

2. Macrolides

3. Cephalosporins

4. Sulfonamides

15. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:

1. Loop diuretics

2. Sulfonylureas

3. Thiazide diuretics

4. All of the above

Chapter 25. Drugs Used in Treating Inflammatory Processes

1. Henry presents to clinic with a significantly swollen, painful great toe & is diagnosed with gout. Of the following, which would be the best treatment for Henry?

1. High-dose colchicine

2. Low-dose colchicine

3. High-dose aspirin

4. Acetaminophen with codeine

2. Patient education when prescribing colchicine includes:

1. Colchicine may be constipating.

2. Colchicine always causes some degree of diarrhea.

3. Mild muscle weakness is normal.

4. Moderate amounts of alcohol are safe with colchicine.

3. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:

1. Complete blood count

2. Blood glucose

3. C-reactive protein

4. BUN, creatinine, & creatinine clearance

4. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:

1. Gout may worsen with therapy.

2. Febuxostat may cause severe diarrhea.

3. He should consume a high-calcium diet.

4. He will need frequent CBC monitoring.

5. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:

1. Gout

2. Iron deficiency anemia

3. Osteoporosis

4. Renal dysfunction

6. Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:

1. Metformin, a biguanide to prevent diabetes

2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

3. Naproxen, an NSAID to treat joint pain

4. Furosemide, a diuretic to treat fluid retention

7. Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?

1. Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids.

2. Prednisone can be abruptly discontinued with no adverse effects.

3. Develop a tapering schedule to slowly wean Daniel off the prednisone.

4. Substitute the prednisone with another anti-inflammatory such as ibuprofen.

8. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?

1. A bisphosphonate

2. Calcium supplementation

3. Vitamin D

4. All of the above

9. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:

1. Serum glucose

2. Stool culture

3. Folate levels

4. Vitamin B12

10. Patients who are on chronic long-term corticosteroid therapy need education regarding:

1. Receiving all vaccinations, especially the live flu vaccine

2. Reporting black tarry stools or abdominal pain

3. Eating a high carbohydrate diet with plenty of fluids

4. Small amounts of alcohol are generally tolerated.

11. All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:

1. Potential for causing life-threatening GI bleeds

2. Increased risk of developing systemic arthritis with prolonged use

3. Risk of life-threatening rashes, including Stevens-Johnson

4. Potential for transient changes in serum glucose

12. Jamie has fractured his ankle & has received a prescription for acetaminophen & hydrocodone (Vicodin). Education when prescribing Vicodin includes:

1. It is okay to double the dose of Vicodin if the pain is severe.

2. Vicodin is not habit-forming.

3. He should not take any other acetaminophen-containing medications.

4. Vicodin may cause diarrhea; increase his fluid intake.

13. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:

1. Omeprazole, a proton pump inhibitor

2. Combined oral contraceptives

3. Diphenhydramine, an antihistamine

4. Warfarin, an anticoagulant

14. Josefina is a 2-year-old child with acute otitis media & an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?

1. They can cut an adult ibuprofen tablet in half to give Josefina.

2. The ibuprofen dose can be doubled for severe pain.

3. Josefina needs to be well-hydrated while taking ibuprofen.

4. Ibuprofen is completely safe in children with no known adverse effects.

15. Henry is 82 years old & takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

1. Add an H2 blocker such as ranitidine to his therapy.

2. Discontinue the aspirin & switch him to Vicodin for the pain.

3. Decrease the aspirin dose to one tablet daily.

4. Have Henry take an antacid 15 minutes before taking the aspirin each day.

Chapter 26. Drugs Used in Treating Eye & Ear Disorders

1. The Centers for Disease Control recommends all newborn infants receive prophylactic administration of __ within 1 hour of birth.

1. Gentamicin ophthalmic ointment

2. Ciprofloxacin ophthalmic drops

3. Erythromycin oral suspension

4. Erythromycin ophthalmic ointment

2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with:

1. Sulfacetamide 10% ophthalmic solution (Bleph-10)

2. Bacitracin/polymyxin B (Polysporin) ophthalmic drops

3. Ciprofloxacin (Ciloxan) ophthalmic drops

4. High-dose oral amoxicillin

3. Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:

1. None, wait for the culture results to determine the course of treatment

2. Ciprofloxacin (Ciloxan) ophthalmic drops

3. IM ceftriaxone

4. High-dose oral amoxicillin

4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:

1. Throwing away eye makeup & purchasing new

2. Redness & intense burning is normal with ophthalmic antibiotics

3. When applying eye ointment, set the tip of the tube on the lower lid & squeeze in inch

4. Use a cotton swab to apply ointment, spreading the ointment all over the lid & in the conjunctival sac

5. Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because:

1. There may be an antagonistic reaction between the two.

2. The additive effects may include bradycardia.

3. They may potentiate each other & cause respiratory depression.

4. The additive effects may cause metabolic acidosis.

6. David presents to the clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes:

1. He should not wear his soft contacts while using the cromolyn eye drops.

2. Cromolyn drops are instilled once a day to prevent allergy symptoms.

3. Long-term use may cause glaucoma.

4. He may experience bradycardia as an adverse effect.

7. Ciprofloxacin otic drops are contraindicated in:

1. Children

2. Patients with acute otitis externa

3. Patients with a perforated tympanic membrane

4. Swimmer’s ear

8. __ is / are prescribed to prevent swimmer’s ear.

1. Ciprofloxacin otic drops (Ciloxan)

2. Isopropyl ear drops (EarSol)

3. Colistin (Coly-Mycin S Otic)

4. Gentamicin otic drops

9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes:

1. Fill the canal with the drops with each dose.

2. Some redness & itching around the ear canal is normal.

3. Warm the bottle of ear drops in his or her h& before administering.

4. Cipro HC otic may cause ototoxicity.

10. Janie presents to the clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen include:

1. Moisten a cotton swab (Q-tip) & swab the ear canal twice daily.

2. Instill tap water in both ears while bathing.

3. Squirt hydrogen peroxide into ears with each bath.

4. Instill carbamide peroxide (Debrox) twice daily until canals are clear.

Chapter 27. Anemia

1. Pernicious anemia is treated with:

1. Folic acid supplements

2. Thiamine supplements

3. Vitamin B12

4. Iron

2. Premature infants require iron supplementation with:

1. 10 mg/day of iron

2. 2 mg/kg per day until age 12 months

3. 7 mg/day in their diet

4. 1 mg/kg per day until they are receiving adequate intake of iron from foods

3. Breastfed infants should receive iron supplementation of:

1. 3 mg/kg per day

2. 6 mg/kg per day

3. 1 mg/kg per day

4. Breastfed babies do not need iron supplementation

4. Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 & her ferritin is 15 ng/mL. Initial treatment for her anemia would be:

1. 18 mg/day of iron supplementation

2. 6 mg/kg per day of iron supplementation

3. 325 mg ferrous sulfate per day

4. 325 mg ferrous sulfate tid

5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:

1. 18 mg/day of iron supplementation

2. 6 mg/kg per day of elemental iron

3. 325 mg ferrous sulfate per day

4. 325 mg ferrous sulfate tid

6. Monitoring for a patient taking iron to treat iron deficiency anemia is:

1. Hemoglobin, hematocrit, & ferritin 4 weeks after treatment is started

2. Complete blood count every 4 weeks throughout treatment

3. Annual complete blood count

4. Reticulocyte count in 4 weeks

7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include:

1. Take the iron with milk if it upsets her stomach.

2. Antacids may help with the nausea & GI upset caused by iron.

3. Increase fluids & fiber to treat constipation.

4. Iron is best tolerated if it is taken at the same time as her other medications.

8. Allie has just had her pregnancy confirmed & is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy?

1. 40 mcg/day

2. 200 mcg/day

3. 800 mcg/day

4. 2 gm/day

9. Kyle has Crohn’s disease & has a documented folate deficiency. Drug therapy for folate deficiency anemia is:

1. Oral folic acid 1 to 2 mg per day

2. Oral folic acid 1 gram per day

3. IM folate weekly for at least 6 months

4. Oral folic acid 400 mcg daily

10. Patients who are being treated for folate deficiency require monitoring of:

1. Complete blood count every 4 weeks

2. Hematocrit & hemoglobin at 1 week & then at 8 weeks

3. Reticulocyte count at 1 week

4. Folate levels every 4 weeks until hemoglobin stabilizes

11. The treatment of vitamin B12 deficiency is:

1. 1,000 mcg daily of oral cobalamin

2. 2 gm per day of oral cobalamin

3. Vitamin B12 100 mcg/day IM

4. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week

12. The dosage of Vitamin B12 to initially treat pernicious anemia is:

1. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month

2. Vitamin B12 IM monthly

3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month

4. Oral cobalamin 1,000 mcg daily

13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?

1. Reticulocyte count, hemoglobin, & hematocrit

2. Iron

3. Vitamin B12

4. All of the above

14. should be monitored when vitamin B12 therapy is started.

1. Serum calcium

2. Serum potassium

3. Ferritin

4. C-reactive protein

15. Anemia due to chronic renal failure is treated with:

1. Epoetin alfa (Epogen)

2. Ferrous sulfate

3. Vitamin B12

4. Hydroxyurea

Chapter 28. Chronic Stable Angina & Low-Risk Unstable Angina

1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) & dem& (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?

1. Calcium channel blockers

2. Beta blockers

3. Angiotensin-converting-enzyme (ACE) inhibitors

4. Aspirin

2. Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:

1. Pulmonary embolism

2. Pneumonia

3. Gastroesophageal reflux

4. All of the above

3. The New York Heart Association & the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:

1. I

2. II

3. III

4. IV

4. Patients at high risk for developing significant coronary heart disease are those with:

1. LDL values between 100 & 130

2. Systolic blood pressure between 120 & 130

3. Class III angina

4. Obesity

5. To reduce mortality, all patients with angina, regardless of class, should be on:

1. Aspirin 81 to 325 mg/d

2. Nitroglycerin sublingually for chest pain

3. ACE inhibitors or angiotensin receptor blockers

4. Digoxin

6. Patients who have angina, regardless of class, who are also diabetic, should be on:

1. Nitrates

2. Beta blockers

3. ACE inhibitors

4. Calcium channel blockers

7. Management of all types & grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification & the reason for it must be true for the answer to be correct.

1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload.

2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume & cardiac workload.

3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility & oxygen supply.

4. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function.

8. Nitrates are especially helpful for patients with angina who also have:

1. Heart failure

2. Hypertension

3. Both 1 & 2

4. Neither 1 nor 2

9. Beta blockers are especially helpful for patients with exertional angina who also have:

1. Arrhythmias

2. Hypothyroidism

3. Hyperlipidemia

4. Atherosclerosis

10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

1. These drugs are useful for immediate symptom relief when the patient is certain it is angina.

2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away.

3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911.

4. All of the above

11. Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. & 2 p.m. because:

1. Long-acting forms have a higher risk for toxicity.

2. Orthostatic hypotension is a common adverse effect.

3. It must be taken with milk or food.

4. Nitrate tolerance can develop.

12. Combinations of a long-acting nitrate & a beta blocker are especially effective in treating angina because:

1. Nitrates increase MOS & beta blockers increase MOD.

2. Their additive effects permit lower doses of both drugs & their adverse reactions cancel each other out.

3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease.

4. All of the above

13. Drug choices to treat angina in older adults differ from those of younger adults only in:

1. Consideration of risk factors for diseases associated with & increased in aging

2. The placement of drug therapy as a treatment choice before lifestyle changes are tried

3. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult

4. Those with higher risk for silent myocardial infarction

14. Which of the following drugs has been associated with increased risk for myocardial infarction in women?

1. Aspirin

2. Beta blockers

3. Estrogen replacement

4. Lipid-lowering agents

15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:

1. Patients often require multiple drugs

2. A large number of angina patients are older adults on fixed incomes

3. Generic formulations may be cheaper but are rarely bioequivalent

4. Lack of drug selectivity may result in increased adverse reactions

Chapter 29. Anxiety & Depression

1. Common mistakes practitioners make in treating anxiety disorders include:

1. Switching medications after an 8- to 12-week trial

2. Maximizing dosing of antianxiety medications

3. Encouraging exercise & relaxation therapy before starting medication

4. Thinking a partial response to medication is acceptable

2. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:

1. Alprazolam (Xanax)

2. Diazepam (Valium)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

3. An appropriate drug to initially treat panic disorder is:

1. Alprazolam (Xanax)

2. Diazepam (Valium)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

4. Prior to starting antidepressants, patients should have laboratory testing to rule out:

1. Hypothyroidism

2. Anemia

3. Diabetes mellitus

4. Low estrogen levels

5. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include:

1. Paroxetine may cause intermittent diarrhea.

2. He may experience sexual dysfunction beginning a month after he starts therapy.

3. He may have constipation & he should increase fluids & fiber.

4. Paroxetine has a long half-life so he may occasionally skip a dose.

6. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:

1. Appetite & concentration improve in the first 1 to 2 weeks.

2. Sleep should improve almost immediately upon starting citalopram.

3. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose.

4. His dysphoric mood will improve in 1 to 2 weeks.

7. An appropriate drug for the treatment of depression with anxiety would be:

1. Alprazolam (Xanax)

2. Escitalopram (Lexapro)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

8. An appropriate first-line drug for the treatment of depression with fatigue & low energy would be:

1. Venlafaxine (Effexor)

2. Escitalopram (Lexapro)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

9. The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is:

1. Complete blood count every 3 to 4 months

2. Therapeutic blood levels every 6 months after a steady state is achieved

3. Blood glucose every 3 to 4 months

4. There is no laboratory monitoring required

10. Jaycee has been on escitalopram (Lexapro) for a year & is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants?

1. Change dose to every other day dosing for a week

2. Reduce dose by 50% for 3 to 4 days

3. Reduce dose by 50% every other day

4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life

11. The longer-term Xanax patient comes in & states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?

1. They have become tolerant of the medication, which is characterized by the need for higher & higher doses.

2. They are a drug seeker.

3. They are suicidal.

4. They only need additional counseling on lifestyle modification.

12. What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor?

1. They will have insomnia for a week.

2. They can feel a bit of nausea, but this resolves in a week.

3. They will have an “onset seizure” but this is considered normal.

4. They will no longer dream.

13. Which of the following should not be taken with a selective serotonin reuptake inhibitor?

1. Aged blue cheese

2. Grapefruit

3. Alcohol

4. Green leafy vegetables

14. Why is the consistency of taking paroxetine (Paxil) & never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?

1. It has a shorter half-life & withdrawal syndrome has a faster onset without taper.

2. It has the longest half-life & the withdrawal syndrome has a faster onset.

3. It is quasi-addictive in the dopaminergic reward system.

4. It is the most activating of SSRI medications & will cause the person to have sudden deep sadness.

15. The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response?

1. This is a good idea because this class of medications generally makes people sleepy.

2. Have you noticed that you are having more sleep issues since you started that?

3. This a good way to remember to take your daily medications because it is near your toothbrush.

4. This is a good plan because you can eat grapefruit if there is 8–12 hours difference in the time each are ingested.

Chapter 30. Asthma & Chronic Obstructive Pulmonary Disease

1. Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur:

1. Daily

2. Daily & limit physical activity

3. Less than twice a week

4. More than twice a week & less than once a day

2. In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:

1. At nighttime one to two times a month

2. At nighttime three to four times a month

3. Less than twice a week

4. Daily

3. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:

1. Ability to use albuterol daily to control symptoms

2. Minimize exacerbations to once a month

3. Keep nighttime symptoms at a maximum of twice a week

4. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms

4. A stepwise approach to the pharmacologic management of asthma:

1. Begins with determining the severity of asthma & assessing asthma control

2. Is used when asthma is severe & requires daily steroids

3. Allows for each provider to determine their personal approach to the care of asthmatic patients

4. Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma

5. Treatment for mild intermittent asthma is:

1. Daily inhaled medium-dose corticosteroids

2. Short-acting beta-2-agonists (albuterol) as needed

3. Long-acting beta-2-agonists every morning as a preventative

4. Montelukast (Singulair) daily

6. The first-line therapy for mild-persistent asthma is:

1. High-dose montelukast

2. Theophylline

3. Low-dose inhaled corticosteroids

4. Long-acting beta-2-agonists

7. Monitoring a patient with persistent asthma includes:

1. Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment

2. Monthly in-office spirometry testing

3. Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations

4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

8. Asthma exacerbations at home are managed by the patient by:

1. Increasing frequency of beta-2-agonists & contacting their provider

2. Doubling inhaled corticosteroid doses

3. Increasing frequency of beta-2-agonists

4. Starting montelukast (Singulair)

9. Patients who are at risk of a fatal asthma attack include patients:

1. With moderate persistent asthma

2. With a history of requiring intubation or ICU admission for asthma

3. Who are on daily inhaled corticosteroid therapy

4. Who are pregnant

10. Pregnant patients with asthma may safely use throughout their pregnancy.

1. Oral terbutaline

2. Prednisone

3. Inhaled corticosteroids (budesonide)

4. Montelukast (Singulair)

11. One goal of asthma management in children is:

1. They independently manage their asthma

2. Participation in school & sports activities

3. No exacerbations

4. Minimal use of inhaled corticosteroids

12. Medications used in the management of patients with chronic obstructive pulmonary disease(COPD) include:

1. Inhaled beta-2-agonists

2. Inhaled anticholinergics (ipratropium)

3. Inhaled corticosteroids

4. All of the above

13. Patients with a COPD exacerbation may require:

1. Doubling of inhaled corticosteroid dose

2. Systemic corticosteroid burst

3. Continuous inhaled beta-2-agonists

4. Leukotriene therapy

14. Patients with COPD require monitoring of:

1. Beta-2-agonist use

2. Serum electrolytes

3. Blood pressure

4. Neuropsychiatric effects of montelukast

15. Education of patients with COPD who use inhaled corticosteroids includes:

1. Doubling the dose at the first sign of a URI

2. Using their inhaled corticosteroid first & then their bronchodilator

3. Rinsing their mouth after use

4. Abstaining from smoking for at least 30 minutes after using

16. Education for patients who use an inhaled beta-agonist & an inhaled corticosteroid includes:

1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.

2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.

3. Increase fluid intake to 3 liters per day.

4. Avoid use of aspirin or ibuprofen while using inhaled medications.