Test Bank For Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

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Test Bank For Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

Chapter 03: General Pharmacokinetic and Pharmacodynamic Principles

MULTIPLE CHOICE

1. A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-American woman. When selecting a drug and determining the correct dose, the NP should understand that the knowledge of how age, race, and gender may affect drug excretion is based on an understanding of:

a.

bioavailability.

b.

pharmacokinetics.

c.

pharmacodynamics.

d.

anatomy and physiology.

 

 

ANS: B

Pharmacokinetics is the study of the action of drugs in the body and may be thought of as what the body does to the drug. Factors such as age, race, and gender may change the way the body acts to metabolize and excrete a drug. Bioavailability refers to the amount of drug available at the site of action. Pharmacodynamics is the study of the effects of drugs on the body. Anatomy and physiology is a basic understanding of how the body functions.

 

DIF: Cognitive Level: Understanding (Comprehension) REF: 21

 

2. A patient asks the primary care NP which medication to use for mild to moderate pain. The NP should recommend:

a.

APAP.

b.

Tylenol.

c.

acetaminophen.

d.

any over-the-counter pain product.

 

 

ANS: C

Providers should use generic drug names when prescribing drugs or recommending them to patients, unless a particular brand is essential for some reason. Because acetaminophen can have many trade names, it is important for patients to understand that the drug is the same for all to avoid overdosing on acetaminophen. APAP is a commonly used abbreviation but should not be used when recommending the drug to patients.

 

DIF: Cognitive Level: Applying (Application) REF: 21

 

3. A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug:

a.

may cause different adverse effects.

b.

does not necessarily have the same therapeutic effect.

c.

is likely to be less safe than the brand specified in the prescription.

d.

may vary in the amount of drug that reaches the site of action in the body.

 

 

ANS: D

Different formulations of the same drug may have varying degrees of bioavailability, and it may be important to stick to a particular brand for drugs with narrow therapeutic ranges. All drugs with similar active ingredients should have the same therapeutic actions and side effects and should be equally safe.

 

DIF: Cognitive Level: Applying (Application) REF: 22

 

4. A primary care NP wishes to order a drug that will be effective immediately after administration of the drug. Which route should the NP choose?

a.

Rectal

b.

Topical

c.

Sublingual

d.

Intramuscular

 

 

ANS: C

The sublingual route is preferred for quick action because the drug is directly absorbed into the bloodstream and avoids the pass through of the liver, where much of an oral drug is metabolized. Rectal routes have unpredictable absorption rates. Topical routes are the slowest. Intramuscular routes are slow.

 

DIF: Cognitive Level: Remembering (Knowledge) REF: 22

 

5. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form:

a.

is absorbed less quickly.

b.

has reduced bioavailability.

c.

has fewer systemic side effects.

d.

provides dosing that is easier to regulate.

 

 

ANS: C

An inhaled corticosteroid goes directly to the site of action and does not have to pass through gastrointestinal tract absorption or the liver to get to the lungs. It is generally well absorbed at this site, although dosing is not necessarily easier to regulate because it is not always clear how much of an inhaled drug gets into the lungs.

 

DIF: Cognitive Level: Applying (Application) REF: 21

 

6. A patient takes an oral medication that causes gastrointestinal upset. The patient asks the primary care NP why the drug information insert cautions against using antacids while taking the drug. The NP should explain that the antacid may:

a.

alter drug absorption.

b.

alter drug distribution.

c.

lead to drug toxicity.

d.

increase stomach upset.

 

 

ANS: A

Changing the pH of the gastric mucosa can alter the absorption of the drug. Drug distribution is not affected. It may indirectly cause drug toxicity if a significant amount more of the drug is absorbed. It would decrease stomach upset.

 

DIF: Cognitive Level: Applying (Application) REF: 22

 

7. A patient will begin taking two drugs that are both protein-bound. The primary care NP should:

a.

prescribe increased doses of both drugs.

b.

monitor drug levels, actions, and side effects.

c.

teach the patient to increase intake of protein.

d.

stagger the doses of drugs to be given 1 hour apart.

 

 

ANS: B

Protein-bound drugs bind to albumin, and serum albumin levels may affect how drugs are distributed. The provider should monitor drug levels, actions, and side effects and change dosing accordingly. Increasing the dose of both drugs is not recommended unless monitoring indicates. Increasing dietary protein does not affect this. Staggering the drugs will not affect this.

 

DIF: Cognitive Level: Applying (Application) REF: 25

 

8. A patient is taking drug A and drug B. The primary care NP notes increased effects of drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450) enzyme:

a.

inhibitor.

b.

substrate.

c.

inducer.

d.

metabolizer.

 

 

ANS: A

If drug A is a CYP450 enzyme inhibitor, it decreases the capacity of the enzyme to metabolize drug B, causing more of drug B to be available. A substrate is a drug acted on by the enzyme. If drug B is an enzyme inducer, it would cause increased metabolism of drug A.

 

DIF: Cognitive Level: Applying (Application) REF: 26 – 27

 

9. The primary care NP should understand that a drug is at a therapeutic level when it is:

a.

at peak plasma level.

b.

past 4 or 5 half-lives.

c.

at its steady plasma state.

d.

between minimal effective concentration and toxic levels.

 

 

ANS: D

The therapeutic range of a drug is the area between the minimal effective concentration and the toxic concentration. Peak plasma level is the highest level the drug reaches and may be well into the toxic range. Steady state occurs when there is a stable concentration of the drug and generally occurs after 4 or 5 half-lives.

 

DIF: Cognitive Level: Applying (Application) REF: 31

 

10. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:

a.

monitor frequently for desired and adverse effects.

b.

administer a much higher initial dose as a loading dose.

c.

monitor creatinine clearance at baseline and periodically.

d.

administer the drug via a route that avoids the first-pass effect.

 

 

ANS: A

Drugs with nonlinear kinetics are not eliminated based on dose or concentration of the drug, and these drugs have a narrow therapeutic window and must be monitored closely for desired effects and toxicity.

 

DIF: Cognitive Level: Applying (Application) REF: 32

 

11. A primary care NP is prescribing a drug for a patient who does not take any other medications. The NP should realize that:

a.

CYP450 enzyme reactions will not interfere with this drug’s metabolism.

b.

substrates such as alcohol cannot interfere with the drug when the patient is abstaining.

c.

food-drug interactions are limited to those where food enhances or inhibits drug absorption.

d.

a thorough history of diet, alcohol use, smoking, and over-the-counter and herbal products is required.

 

 

ANS: D

Drugs are not the only substances that interfere with drug kinetics and dynamics. The primary care NP should conduct a thorough history of food and alcohol intake, smoking, and over-the-counter and herbal supplements to identify things that might interfere with a drug. All of these may interfere with CYP enzymes. Alcohol intake can influence this even when the patient is abstaining because of long-term effects on the liver.

 

DIF: Cognitive Level: Understanding (Comprehension) REF: 38-39