Nokea
Pharmacokinetic changes in the elderly that affect drug dosing include:
- A. Decreased renal function
- B. Increased liver metabolism
- C. Decreased body fat
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because decreased renal function in the elderly slows drug excretion, requiring dose adjustments to prevent accumulation, per geriatric pharmacology. Choice B is incorrect as liver metabolism decreases, not increases. Choice C is wrong because body fat increases, not decreases. Choice D is incorrect since only A is accurate.
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An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:
- A. Upregulate the total number of receptors
- B. Block the receptor with a partial agonist
- C. Alter the drug's metabolism
- D. Downregulate the numbers of that specific receptor
Correct Answer: D
Rationale: Choice D is correct because frequent agonist use can cause the body to downregulate receptors, reducing sensitivity to overstimulation as a compensatory mechanism. Choice A is incorrect as upregulation occurs with antagonists, not agonists. Choice B is wrong because partial agonists compete, not result from frequent use. Choice C is incorrect since metabolism changes aren't the primary receptor response.
Signs of controlled substance misuse include:
- A. Requesting early refills
- B. Reporting lost prescriptions
- C. Using multiple prescribers
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because early refills, lost prescription claims, and multiple prescribers are classic misuse signs, per DEA and clinical red flags. Choice A is incorrect alone as it's one sign. Choice B is wrong by itself because lost reports are just part. Choice C is incorrect solo since multiple prescribers is only one indicator.
The U.S. Drug Enforcement Administration:
- A. Registers manufacturers and prescribers of controlled substances
- B. Regulates NP prescribing at the state level
- C. Sanctions providers who prescribe drugs off-label
- D. Provides prescribers with a number they can use for insurance billing
Correct Answer: A
Rationale: Choice A is correct because the DEA registers those handling controlled substances, issuing numbers for tracking and prescribing, its primary role. Choice B is incorrect as state boards, not the DEA, regulate NP prescribing. Choice C is wrong because off-label prescribing isn't DEA-regulated. Choice D is incorrect since the DEA number is for controlled substances, not insurance billing.
Schedule II drugs are characterized by:
- A. High potential for abuse
- B. Low potential for abuse
- C. No accepted medical use
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because Schedule II drugs (e.g., oxycodone) have a high abuse potential with accepted medical use, per DEA rules. Choice B is incorrect as low potential is Schedule IV/V. Choice C is wrong because no medical use is Schedule I. Choice D is incorrect since only A applies.
An 80-year-old patient who has COPD takes TMP/SMX for acute exacerbations, which occur three or four times each year. To monitor this patient for adverse drug reactions, the primary care NP should order:
- A. liver function tests.
- B. blood urea nitrogen and creatinine.
- C. serum bilirubin levels.
- D. a complete blood count (CBC) with differential.
Correct Answer: D
Rationale: The correct answer is D because elderly patients on TMP/SMX risk bone marrow suppression, monitored via CBC. Choice A is incorrect (liver tests pre-treatment). Choice B is wrong (renal pre-treatment). Choice C is inaccurate (bilirubin not primary).