Nokea
Mary has a two-tiered prescription benefit plan, which means:
- A. She can receive differing levels of care based on whether she chooses an 'in-plan' provider or not.
- B. She is eligible for the new Medicare Part D 'donut hole' reduction of costs program.
- C. She pays a higher copay for brand-name drugs than for generic drugs.
- D. She must always choose to be treated with generic drugs first.
Correct Answer: C
Rationale: A two-tiered plan typically involves higher copays for brand-name drugs.
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Aminoglycosides are poorly absorbed from the gut and must therefore be delivered via parenteral routes.
- A. TRUE
- B. FALSE
Correct Answer: A
Rationale: Aminoglycosides have poor oral bioavailability due to their polar nature, requiring parenteral administration (e.g., IV or IM) for systemic effects.
The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patient's system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours?
- A. 22 mcg
- B. 16.5 mcg
- C. 11 mcg
- D. 5.5 mcg
Correct Answer: C
Rationale: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.
Patients need to be instructed regarding the drug interactions with St John's wort, including:
- A. MAO inhibitors
- B. Serotonin reuptake inhibitors
- C. Over-the-counter cough and cold medications
- D. All of the above
Correct Answer: D
Rationale: St John's wort interacts with MAOIs, SSRIs (risk of serotonin syndrome), and OTC drugs via CYP450 induction.
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:
- A. Decreases the amount of calcium inside the cell
- B. Reduces stroke volume
- C. Increases the activity of the Na+/K+/ATPase pump indirectly
- D. Decreases heart rate
Correct Answer: A
Rationale: Calcium channel blockers reduce intracellular calcium, relaxing vascular smooth muscle.
A patient is using the Commit lozenge 2 mg to help quit smoking and reports nausea and indigestion. The nurse will instruct the patient to perform which action?
- A. Allow the lozenge to dissolve slowly over 20 to 30 minutes
- B. Chew the lozenge thoroughly before swallowing it
- C. Increase to 4 mg and use less often
- D. Take the lozenge with food and a full glass of water
Correct Answer: A
Rationale: Slow dissolution minimizes GI upset from nicotine lozenges; chewing worsens it. The patient should allow the lozenge to dissolve slowly.