Nokea
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.
Correct Answer: A
Rationale: The correct answer is A because a CYP450 inhibitor (drug A) reduces metabolism of drug B, increasing its effects. Choice B is incorrect as a substrate is acted upon, not inhibiting. Choice C is wrong since an inducer increases metabolism, reducing effects. Choice D is inaccurate as 'metabolizer' isn’t a CYP450 role.
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Genetic testing prior to prescribing which drug could prevent serious adverse drug reactions?
- A. Acetaminophen
- B. Codeine
- C. Albuterol
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because genetic testing for CYP2D6 variants can prevent ADRs with codeine; poor metabolizers get no pain relief, while ultrarapid metabolizers risk morphine toxicity. Choice A is incorrect as acetaminophen metabolism isn't strongly tied to genetic variants causing serious ADRs. Choice C is wrong because albuterol's inhaled use has minimal genetic metabolism risks. Choice D is incorrect since only codeine benefits significantly from pre-prescribing genetic testing.
Over-the-counter drugs that should be avoided in patients with hypertension include:
- A. Acetaminophen
- B. Pseudoephedrine
- C. Ibuprofen
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because pseudoephedrine, a decongestant, raises blood pressure via vasoconstriction, risky in hypertension, per guidelines. Choice A is incorrect as acetaminophen doesn't affect BP. Choice C is wrong because ibuprofen's BP effect is milder and not absolute avoidance. Choice D is incorrect since only pseudoephedrine is key.
Strategies to improve adherence to medication regimes include:
- A. Assuming that the patient understands the directions on the prescription bottle
- B. Using pictograms or illustrations to explain how to take the medication
- C. Assuming that the patient's health literacy level is the same as their general literacy
- D. Using the patient's preferred language when there is a language barrier
Correct Answer: B
Rationale: Choice B is correct because pictograms clarify instructions visually, aiding comprehension and adherence, especially for low-literacy patients. Choice A is incorrect as assuming understanding can lead to errors. Choice C is wrong because health literacy varies from general literacy, needing specific attention. Choice D is incorrect here as it's a good strategy but not listed in this question's options correctly—B fits best.
Drugs that may cause sedation in the elderly include:
- A. Benzodiazepines
- B. Antihistamines
- C. Opioids
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because benzodiazepines (e.g., lorazepam), antihistamines (e.g., diphenhydramine), and opioids (e.g., oxycodone) all cause sedation, increasing fall risk in the elderly, per Beers Criteria. Choice A is incorrect alone as it's one class. Choice B is wrong by itself because antihistamines are just part. Choice C is incorrect solo since opioids are only one group.
Drugs that may cause increased adverse effects in women include:
- A. Lipid-soluble drugs
- B. Water-soluble drugs
- C. Drugs that are highly protein bound
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because women's lower lean mass reduces the volume of distribution for water-soluble drugs, increasing concentrations and ADR risk. Choice A is incorrect as lipid-soluble drugs distribute more in fat, not necessarily causing more ADRs. Choice C is wrong because protein binding isn't sex-specific enough here. Choice D is incorrect since only water-soluble drugs align.