Deck 2: Basic Principles of Pharmacology

Question 1

A patient has taken a narcotic analgesic for chronic pain for several months. At a follow-up appointment, the provider notes that the patient has been taking more than the prescribed dosage. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the provider suspect is responsible for the patient's response?

A) This patient exhibits a negative placebo effect with a reduced response to the drug.
B) This patient has developed tachyphylaxis because of repeated exposure to the drug.
C) This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
D) This patient has increased hepatic enzyme production as a result of prolonged exposure to the drug.

Answer 1

This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.

Question 2

When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity?

A) Avoid exercise for 2 hours after administration.
B) Substitute grapefruit juice with orange juice.
C) Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
D) Take the medication with an NSAID or other anti-inflammatory drug.

Answer 2

Substitute grapefruit juice with orange juice.

Question 3

When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to decrease risk to the patient?

A) Schedule drug administration intervals that exceed the drug's half-life.
B) Order the medication to be administered by the intravenous route.
C) Monitor the patient's plasma drug levels at regular intervals.
D) Teach the patient that optimal outcomes will require adherence to the medication regimen.

Answer 3

Monitor the patient's plasma drug levels at regular intervals.

Question 4

A patient develops shortness of breath shortly after taking the initial dose of a newly prescribed medication. The patient's heart rate is 86 beats/minute, the respiratory rate is 24 breaths/minute, and the blood pressure is 120/70 mm Hg. The prescriber will discontinue the drug based on the assumption the patient experienced what medication induced effect?

A) An allergic reaction
B) An idiosyncratic effect
C) An iatrogenic response
D) A side effect

Question 5

A provider considers prescribing tamoxifen for a woman with breast cancer. Upon reviewing results of genetic testing, the prescriber notes that the patient has variations in the CYP2Dy allele resulting in a deficiency of the CYP2D6 isoenzymes. What action will this deficiency warrant in the prescribing of tamoxifen, a CYP2D6 substrate?

A) The tamoxifen will not be prescribed.
B) The individual doses of tamoxifen will be increased.
C) The tamoxifen will be ordered but in lower than normal dosage.
D) The patient's serum tamoxifen level will be routinely monitored.

Question 6

A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct. Which possible cause of this situation will the provider explore?

A) Whether a loading dose was administered
B) If the drug was completely dissolved in the IV solution
C) Whether patient is taking a medication that binds to serum albumin
D) If the ordered dose frequency is longer than the gentamicin half-life

Question 7

When prescribing medications to infants, it is important for the provider to consider which fact? (Select all that apply.)

A) Breast-feeding infants are more likely to develop toxicity when the mother is taking lipid-soluble drugs.
B) Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
C) Infants have immature livers, which slows drug metabolism.
D) Infants are more sensitive to medications that act on the central nervous system (CNS).
E) Oral medications are contraindicated in infants.

Question 8

Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response to tamoxifen therapy?

A) African
B) French
C) Native American
D) Japanese

Question 9

The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain. What instruction will the prescriber include regarding alcohol intake?

A) "If you plan to drink alcohol, I will write an order for acetaminophen without hydrocodone for your pain."
B) "I'd suggest that you substitute ibuprofen for pain on days when you plan to drink alcohol."
C) "You should avoid drinking alcohol while you are taking the pain medication I've ordered."
D) "You should limit your alcohol intake to no more than two servings of alcohol daily while on the pain medication."

Question 10

A patient is prescribed digoxin. Which screening will the provider order to monitor for potential adverse effects from this drug?

A) Albumin
B) Blood urea nitrogen (BUN) and creatinine
C) Hepatic enzymes
D) Serum electrolytes

Question 11

A drug can cause symptoms that resemble those of Parkinson disease. What action should the prescriber take to minimize the potential patient risk?

A) Explain that these are teratogenic effects that must be reported immediately.
B) Thoroughly educate the patient about recognizing such symptoms and the need to notify the office immediately.
C) Order an evaluation of the patient's genetic predisposition to these effects.
D) Educate the patient about these symptoms and provide reassurance that the condition is expected.

Question 12

A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement informs the prescriber's response when explaining this phenomenon to the patient?

A) Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect.
B) Because the drug preparations are chemically equivalent, the actions of the two brands must be identical.
C) Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action.
D) The bioavailability of a drug is determined by the amount of the drug in each dose.

Question 13

Which order for furosemide is written appropriately by the prescriber?

A) Furosemide [Lasix] 20 mg PO QD
B) Furosemide [Lasix] 20 mg PO qd
C) Furosemide [Lasix] 20 mg daily
D) Furosemide [Lasix] 20 mg PO daily

Question 14

When considering the benefit of pharmacogenomics, what information should the prescriber include when prescribing a new medication?

A) Stress the need to contact the primary health care prescriber immediately if side effects occur.
B) Provide definitions and possible examples of related idiosyncratic responses to this medication.
C) Explain any necessary precautions to take regarding medication administration.
D) Give a detailed explanation regarding the method for discontinuing the medication, should it become necessary.

Question 15

A provider recommends genetic testing of a patient before prescribing a medication. What response should the provider give when asked by the patient about the purpose of genetic testing?

A) "Genetic testing better establishes the drug's therapeutic index."
B) "Such testing will tell us how quickly your body is likely to metabolize, or process, the drug."
C) "The testing helps identify any factors that could affect psychosocial variation in the drug's response."
D) "It guides the production of a drug that is tailored to your individual genetic makeup."

Question 16

A patient reports mild nausea within an hour after taking the first two doses of a newly approved medication. Nausea is not listed among the known side effects of this drug. What instructions will the provider give the patient?

A) "Take the next dose with food and call the office if the nausea reoccurs or if other symptoms develop."
B) "Discontinue the medication and a substitute will be prescribed."
C) "Reporting the situation to the MEDWATCH program will get us a recommendation about continuing the drug."
D) "I'll write a prescription for an antiemetic to counter this drug's effects."

Question 17

A patient who has been taking sertraline for depression was prescribed azithromycin to treat an infection by a provider at an after-hours clinic. What action will the primary care provider take to address the risk this combination of medication has posed for the patient?

A) Discontinue the azithromycin and write an order for an alternative antibiotic.
B) Discontinue the sertraline and write an order for a different antidepressant medication.
C) Reduce the sertraline dosage while taking azithromycin.
D) Withhold the sertraline until the azithromycin therapy is completed.

Question 18

Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor (EGFR) testing for the patient having which condition?

A) Breast cancer
B) Colorectal cancer
C) Bone cancer
D) Brain cancer

Question 19

A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate?

A) Increase dosage of the CYP3A4 inducer.
B) Decrease dosage of the CYP3A4 inducer.
C) Increase dosage of the CYP3A4 substrate.
D) Decrease dosage of the CYP3A4 substrate.

Question 20

A patient reports that a medication no longer effectively alleviates symptoms. What process informs the provider's response to the patient's concerns?

A) Endogenous antagonists compete with the drug for receptor sites.
B) Decreased selectivity for receptors results in a variety of effects.
C) Desensitization of receptor sites results from continual exposure to the drug.
D) Additional receptor sites are synthesized in response to the medication.

Question 21

Which actions occur in most of the fatal medication errors? (Select all that apply.)

A) Confusing drugs with similar packaging
B) Giving a drug intravenously instead of intramuscularly
C) Administering a drug that sounds like the prescribed drug
D) Using an infusion device that malfunctions
E) Writing a prescription illegibly

Question 22

A patient is found to have a genetic deficiency in the biomarker CYP2C19. The provider recognizes that prescribing clopidogrel will increase the patient's risk for developing what serious conditions? (Select all that apply.)

A) Myocardial infarction
B) Stroke
C) Peptic ulcer
D) Dementia
E) Stomach cancer

Question 23

What will the provider consider when prescribing two drugs that compete for plasma albumin receptor sites? (Select all that apply.)

A) Binding of one or both agents will be reduced.
B) Plasma levels of free drug will rise.
C) Plasma levels of free drug will fall.
D) The increase in free drug will cause sustained intensification of effects.
E) The increase in bound drug will cause sustained intensification of effects.