Charlie is a 65-year-old male who has been diagnosed with
hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to
treat his hypertension because it:
Increases peripheral vasoconstriction
Decreases detrusor muscle contractility
Lowers supine blood pressure more than
Relaxes smooth muscle in the bladder neck
Question 2. Question
Which of the following adverse effects are less likely in a
Impaired insulin release
Reflex orthostatic changes
Decreased triglycerides and cholesterol
Question 3. Question
Beta blockers have favorable effects on survival and disease
progression in heart failure. Treatment should be initiated when the:
Symptoms are severe
Patient has not responded to other therapies
Patient has concurrent hypertension
Left ventricular dysfunction is diagnosed
Question 4. Question
You are treating a patient with a diagnosis of Alzheimer’s
disease. The patient’s wife mentions difficulty with transportation to the
clinic. Which medication is the best choice?
Question 5. Question
Antonia is a 3-year-old child who has a history of status
epilepticus. Along with her routine antiseizure medication, she should also
have a home prescription for_________ to be used for an episode of status
Rectal diazepam (Diastat)
IV phenytoin (Dilantin)
Oral carbamazepine (Tegretol)
Question 6. Question
Dwayne has recently started on carbamazepine to treat
seizures. He comes to see you and you note that while his carbamazepine levels
had been in the therapeutic range, they are now low. The possible cause for the
low carbamazepine levels include:
Dwayne hasn’t been taking his carbamazepine
because it causes insomnia.
Carbamazepine auto-induces metabolism, leading
to lower levels in spite of good compliance.
Dwayne was not originally prescribed the
correct amount of carbamazepine.
Carbamazepine is probably not the right
antiseizure medication for Dwayne.
Question 7. Question
Kasey fractured his ankle in two places and is asking for
medication for his pain. The appropriate first-line medication would be:
Acetaminophen with hydrocodone (Vicodin)
Oral morphine (Roxanol)
Question 8. Question
Jack, age 8, has attention deficit disorder (ADD) and is
prescribed methylphenidate (Ritalin). He and his parents should be educated
about the side effects of methylphenidate, which are:
Slurred speech and insomnia
Bradycardia and confusion
Dizziness and orthostatic hypotension
Insomnia and decreased appetite
Question 9. Question
An appropriate first-line drug to try for mild to moderate
generalized anxiety disorder would be:
Question 10. Question
David is a 34-year-old patient who is starting on paroxetine
(Paxil) for depression. David’s education regarding his medication would
Paroxetine may cause intermittent diarrhea.
He may experience sexual dysfunction beginning
a month after he starts therapy.
He may have constipation and he should
increase fluids and fiber.
Paroxetine has a long half-life so he may
occasionally skip a dose.
Question 11. Question
An appropriate drug for the treatment of depression with
anxiety would be:
Question 12. Question
The longer-term Xanax patient comes in and 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?
They have become tolerant of the medication,
which is characterized by the need for higher and higher doses.
They are a drug seeker.
They are suicidal.
They only need additional counseling on
Question 13. Question
A first-line drug for abortive therapy in simple migraine
Butorphanol nasal spray (Stadol NS)
Butalbital and acetaminophen (Fioricet)
Question 14. Question
Xi, a 54-year-old female, has a history of migraines that do
not respond well to OTC migraine medication. She is asking to try Maxalt
(rizatriptan) because it works well for her friend. Appropriate decision making
Prescribe the Maxalt, but only give her four
tablets with no refills to monitor the use.
Prescribe Maxalt and arrange to have her
observed in the clinic or urgent care with the first dose.
Explain that rizatriptan is not used for
postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).
Prescribe sumatriptan (Imitrex) with the
explanation that it is the most effective triptan.
Question 15. Question
Kelly is a 14-year-old patient who presents to the clinic
with a classic migraine. She says she is having a headache two to three times a
month. The initial plan would be:
Prescribe NSAIDs as abortive therapy and have
her keep a headache diary to identify her triggers.
Prescribe zolmitriptan (Zomig) as abortive
therapy and recommend relaxation therapy to reduce her stress.
Prescribe acetaminophen with codeine (Tylenol
#3) for her to take at the first onset of her migraine.
Prescribe sumatriptan (Imitrex) nasal spray
and arrange for her to receive the first dose in the clinic.
Question 16. Question
James has been diagnosed with cluster headaches. Appropriate
acute therapy would be:
Butalbital and aspirin (Fiorinal)
Meperidine IM (Demerol)
Oxygen 100% for 15 to 30 minutes
Question 17. Question
If interventions to resolve the cause of pain (e.g., rest,
ice, compression, and elevation) are insufficient, pain medications are given
based on the severity of pain. Drugs are given in which order of use?
NSAIDs, opiates, corticosteroids
Low-dose opiates, salicylates, increased dose
Opiates, non-opiates, increased dose of
increased dose of non-opiate, opiate
Question 18. Question
Chemical dependency assessment is integral to the initial
assessment of chronic pain. Which of the following raises a “red flag” about
potential chemical dependency?
Use of more than one drug to treat the pain
Multiple times when prescriptions are lost
with requests to refill
Preferences for treatments that include
Presence of a family member who has abused
Question 19. Question
The Pain Management Contract is appropriate for:
Patients with cancer who are taking morphine
Patients with chronic pain who will require
long-term use of opiates
Patients who have a complex drug regimen
Patients who see multiple providers for pain
Question 20. Question
Which of the following statements is true about age and
Use of drugs that depend heavily on the renal
system for excretion may require dosage adjustments in very young children.
Among the NSAIDs, indomethacin is the
preferred drug because of lower adverse effects profiles than other NSAIDs.
Older adults who have dementia probably do not
experience much pain due to loss of pain receptors in the brain.
Acetaminophen is especially useful in both
children and adults because it has no effect on platelets and has fewer adverse
effects than NSAIDs.