Cardiovascular
Lisinopril is most likely to affect what electrolyte?
Potassium
Chloride
Sodium
Magnesium
Potassium
Lisinopril is an angiotensin-converting enzyme inhibitor and can affect the sodium-potassium pump in the kidneys, leading to a potential increase in potassium
Mr. Jones is a 66-year-old obese male who has recently been prescribed omeprazole 20 mg daily. When should this medication be ideally taken?
2 hours prior to eating
30 minute before eating
With a meal
30-60 minutes after a meal
30 minute before eating
PPIs like omeprazole are generally dosed 30 minutes or so before meals; this is a recommendation for greatest efficacy, not an absolute (example, if a patient likes to get up and eat right away upon rising, the medication will still likely be beneficial, but may not have a maximal effect).
Mr. Johanssen is on fentanyl patches for his chronic pain. Which medication would have the greatest chance to increase the risk for respiratory depression?
Famotidine
Lisinopril
Clonazepam
Amlodipine
Clonazepam
There is a boxed warning that cautions against the use of benzodiazepines like clonazepam with fentanyl. The combination increases the risk fo respiratory depression and opioid overdose symptoms.
How should potassium supplements be administered?
On an empty stomach
At bedtime
At the same time as furosemide (if taking)
With food and water
With food and water
Stomach upset can happen with potassium supplements and it is ideal to give them with food and water to reduce this risk. It doesn't necessarily have to be given at the same time as furosemide but they are often sued together as furosemide depletes potassium levels.
Ms. Jones has asked about the risks with regard to her birth control. She informs you that she is taking Loestrin which is a combination of estrogen and progestin. You inform her that it can increase the risk of blood clots. Which part of her history would increase the risk of a blood clot?
1-2 glasses of wine per week
She runs marathons a few times per year
She is currently taking rifampin
She is a smoker
She is a smoker
Smoking and older age are two major risk factors that will increase the risk for blood clots associated with oral contraceptives. Rifampin may interact with estrogen and progestin combination products, but it would be more likely to reduce drug concentrations and not increase clot risk.
Upon initial assessment of a patient with severe hypertension, they report having troublesome edema. Which medication is most likely to cause peripheral edema?
Amlodipine
Clozapine
Lisinopril
Atenolol
Amlodipine
Since amlodipine exerts its effects on vascular smooth muscle, it can lead to fluid retention, especially in the lower extremities.
Which supplement may be necessary for a patient taking long-term pantoprazole?
Potassium
Thiamine
Vitamin B12
Zinc
Vitamin B12
It is ideal to use PPIs like pantoprazole short term if possible due to the increased risk of osteoporosis, low magnesium, and B12 deficiency if used long term.
JS is a 54-year-old male who has been recently diagnosed with angina and started on isosorbide mononitrate. Patient education should be provided about a drug interaction with which medication?
Naproxen
Sildenafil
Baby aspirin
Pantoprazole
Sildenafil
PDE-5 inhibitors can cause significant hypotension when used in combination with nitrate medications. This combination should be avoided.
Mrs. Belaga is a 78-year-old female with hypertension, edema, and hypokalemia. The current potassium level is 4.6 meq/L. She is taking furosemide, amlodipine, and potassium chloride. Which medication will increase the risk of hyperkalemia?
Clonidine
Metoprolol
Valsartan
Hydrochlorothiazide
Valsartan
ACE Inhibitors, ARBs, and potassium-sparing diuretics will increase the risk of hyperkalemia.
A patient taking oral contraceptives read on the package that it is "monophasic". What should you tell the patient this means?
She has to take it at the same time everyday and cannot vary
She is getting the same amount of hormone in every pill
She has a lower risk of blood clots with this formulation
She will not have periods with this type of birth control
She is getting the same amount of hormone in every pill
With monophasic oral contraceptives, the patient will receive the same amount of hormone in each active tablet. With triphasic, the amount of hormone will vary and try to more closely mimic physiologic hormone cycles.
Which medication is preferred for treating hypertension in pregnancy?
Clonidine
Lisinopril
Valsartan
Labetalol
Labetalol
The American College of Obstetricians and Gynecologists (ACOG) recommends labetalol and nifedipine extended-release as first-line treatments. Methyldopa is also an option to help manage hypertension in pregnancy but may be less effective.
Which medication acts on opioid receptors in the gut to help manage diarrhea?
Atropine
Cholestyramine
Dicyclomine
Loperamide
Loperamide acts on opioid receptors in the intestines and slows peristalsis (GI movement) and thus helping diarrhea symptoms. Cholestyramine bulks up the stool in helping diarrhea. Dicyclomine and atropine are both anticholinergic medications and would cause constipation via that mechanism
Which antibiotic would carry the highest risk to raise warfarin concentrations and ultimately a patient's INR?
Azithromycin
Cephalexin
Nitrofurantoin
Bactrim
Bactrim
Bactrim (trimethoprim/sulfamethoxazole) can inhibit CYP2C9 and significantly increase the concentrations of warfarin to a much greater extent than some of the other antibiotics that are listed.
Which of the following antibiotics should be avoided in moderate to severe kidney disease?
Ciprofloxacin
Nitrofurantoin
Bactrim
Levaquin
Nitrofurantoin
Nitrofurantoin is highly renally cleared and because it accumulates in the kidneys, should not be used in moderate to severe kidney disease.
A patient presents to your clinic for their Depo-Provera injection. They receive this injection every three months. Which of the following education should be provided to this patient?
Avoid all alcohol when on this injection and for at least 3 months after stopping
Encourage taking her blood pressure on a weekly basis
Ensure that the patient is taking adequate calcium and vitamin D
Avoid use of acetaminophen while taking this medication
Ensure that the patient is taking adequate calcium and vitamin D
Medroxyprogesterone (Depo-Provera) carries a boxed warning for reduced bone mineral density. Educating about this risk and ensuring adequate calcium and vitamin D intake would be the most important thing to do for this patient given the options listed.
You have recently performed vital signs on your patient and the pulse is reported at 52 beats per minute. Which medication would run the highest risk of contributing to bradycardia?
Hydrochlorothiazide
Spironolactone
Lisinopril
Metoprolol
Metoprolol
Beta-blockers (metoprolol) work to reduce the action of the heart and can bring it down too far in some situations causing bradycardia.
What is the primary mechanism of action for ondansetron?
Opioid agonist activity
Inhibition of neurokinin-1 receptor which can help stimulate antiemetic activity in the brain
Blocks dopamine and serotonin receptors in chemoreceptor zone (CRZ), lends to relief of nausea/vomiting
Blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone
Blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone
Ondansetron blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone.
Your patient reports that she has been taking furosemide as prescribed by her physician for heart failure symptoms. Her edema is not improving. As you review her medications, you realize that one of them needs to be addressed as it could be worsening her edema and counteracting the furosemide. Which one would need to be addressed?
Zinc
Diphenhydramine
Ibuprofen
Ferrous Sulfate
Ibuprofen
NSAIDs like ibuprofen can contribute to fluid retention and exacerbate symptoms of heart failure. It should be addressed and likely discontinued by the attending provider.
An elevation in which of the following serum electrolytes might help diagnose a drug-induced renal disorder?
Bicarbonate
Sodium
Chloride
Potassium
Potassium
Elevations in potassium may help diagnose a drug-induced renal disorder as it can indicate poor filtration and excretion.
As you review Mr. Stevens medication list, you realize that he has many PRN medications. Which one would be of highest concern with regard to drug interactions with tadalafil?
Calcium carbonate (Tums) for GERD
Nitroglycerin for chest pain
Ibuprofen for pain
Diphenhydramine for sleep
Nitroglycerin for chest pain
There is a drug interaction with systemic nitrate/nitroglycerin products; advise patients about the potential interaction and the risk of low blood pressure/hypotension.
Which medication would work primarily by blocking sodium reabsorption in the distal convoluted tubule and causing an increase in diuresis?
Clonidine
Hydrochlorothiazide
Nitroglycerin
Amlodipine
Hydrochlorothiazide
Thiazide diuretics blocks sodium reabsorption in the distal convoluted tubule which leads to an increase in diuresis.
Your patient is taking Tums on a routine basis at meals for heartburn symptoms. Which antibiotic would be most likely to have concentrations reduced if taken at the same time as Tums?
Ciprofloxacin
Nitrofurantoin
Amoxicillin
Ceftriaxone
Ciprofloxacin would be the most significantly bound medication by calcium products like Tums. Concentrations will be reduced and the patient would be at risk for antibiotic failure if these medications were coadministered.
A 74-year-old female has been diagnosed with MRSA and is being treated with linezolid. Which medication should be addressed by the primary provider due to a drug interaction?
Sertraline
Omeprazole
Atorvastatin
Oxycodone
Sertraline
Linezolid has MAO-inhibitor activity and therefore antidepressant drug interactions should be addressed prior to initiation, along with drug-food interactions (tyramine-containing foods such as cheese, cured meat, and beer).
A 22-year-old female has been placed on desmopressin for nocturia and bedwetting. When educating this patient, what lab/assessment would be critical for her to come in and get checked periodically?
Sodium
Liver Function
EKG
Blood glucose
Sodium
Desmopressin carries a boxed warning for life-threatening hyponatremia.
Mr. Jackson is a 55 year old male who has been diagnosed with erectile dysfunction. He is wondering what side effects he should be concerned about with his sildenafil prescription. His current diagnoses include, GERD, hypotension, osteoarthritis, and glaucoma. What would be most important to educate him about?
Risk for exacerbating GERD
Increasing joint pain
Drug interaction with glaucoma medications
Risk of lowering blood pressure
Risk of lowering blood pressure
One of the risks of sildenafil is that it can lower blood pressure. If he already has issues with hypotension, sildenafil could worsen this issue. He should be educated to stand up slowly and monitor for dizziness when changing positions.