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47 Cards in this Set

  • Front
  • Back

A frail patient with dysphagia is given methadone in the Methadose formulation for chronic pain. Which of the following should be dispensed by the pharmacist with this medication?


Answer


AAn injection pen


BA pill counter


CAntacids


DA dose-measuring syringe or cup


EA calibrated pipette

DA dose-measuring syringe or cup

A patient is using Opana 5 mg tablets. Which of the following is an appropriate generic substitution for Opana?


Answer


AOxycodone


BOxymorphone


CHydromorphone


DMethadone


EMorphine


BOxymorphone

A patient has been instructed by her physician to purchase over-the-counter Aleve, and take one tablet twice daily. Choose the appropriate generic substitution:


Answer


AEtodolac


BMeloxicam


CDiclofenac


DIbuprofen


ENaproxen

ENaproxen

Choose the correct statement concerning tramadol:


Answer


AThe brand name is Ultracet.


BThe dose is 50 mg Q 4 hours PRN.


CThere is no risk of serotonin syndrome if used with serotonergic drugs.


DDiarrhea can occur with chronic use.


ETramadol is a C III.

BThe dose is 50 mg Q 4 hours PRN.

A patient is using oxymorphone for severe pain. Which of the following statements or counseling points concerning oxymorphone are correct? (Select ALL that apply.)


Answer


AThe brand name is Dilaudid.


BUse lower doses in elderly or renal impairment


CTake on an empty stomach


DThe drug is the safest opioid to recommend with hepatic impairment.


EDo not use with alcohol.

BUse lower doses in elderly or renal impairment


CTake on an empty stomach



EDo not use with alcohol.

An elderly female has been using morphine for pain. No one counseled the patient on constipation. She reports that her stool is hard and difficult to push out. She tried to use docusate 100 mg BID, and it helped a little with the hardness, but she is still not able to defecate easily. Choose the correct statements: (Select ALL that apply.)


Answer


AShe can begin to use senna, taken at bedtime.


BBased on her report, she may still need to use a stool softener.


CShe should begin therapy with methylnaltrexone.


DShe should begin therapy with alvimopan.


EShe should use a Fleets enema.

AShe can begin to use senna, taken at bedtime.


BBased on her report, she may still need to use a stool softener.

Which NSAID has a high risk of both severe skin reactions, including SJS/TEN, and GI toxicity, and should only be used in patients who cannot obtain adequate pain relief with other agents?


Answer


AIbuprofen


BIndomethacin


CPiroxicam


DNabumetone


EEtodolac


CPiroxicam

What is the correct indication for the Lidoderm patch?


Answer


APostherpetic neuralgia


BDiabetic neuropathic pain


CPost-polio syndrome


DAnkylosing spondylitis


EFibromyalgia

APostherpetic neuralgia

A pharmacist receives a prescription for Vimovo. This combination drug contains the following two individual agents:


Answer


AOmeprazole and sumatriptan


BEsomeprazole and sumatriptan


CNaproxen and sumatriptan


DIbuprofen and sumatriptan


ENaproxen and esomeprazole

ENaproxen and esomeprazole

Select the correct mechanism of action for milnacipran:


Answer


AAntagonist at the mu opioid receptor in the CNS.


BInhibits cyclooxygenase, which reduces prostaglandin formation, which decreases pain and inflammation.


CSerotonin/norepinephrine reuptake inhibitor.


DAgonist at the mu opioid receptor in the CNS.


EDecreases substance P and reduces pain transmission from the nerve ending (localized effect).

CSerotonin/norepinephrine reuptake inhibitor.

A patient has been prescribed Flexmid. Choose the appropriate generic substitution:


Answer


ACyclobenzaprine


BCarisoprodol


CMetaxalone


DTizanidine


EBaclofen


ACyclobenzaprine

Which of the following agents are approved for fibromyalgia? (Select ALL that apply.)


Answer


ACymbalta


BLyrica


CNucynta


DTramadol


ESavella

ACymbalta


BLyrica



ESavella

A hospitalized patient is being switched from morphine to hydromorphone. The pharmacist first calculates the total daily dose, and then reduces the dose of the new drug. What is the reason that the pharmacist has reduced the dose of hydromorphone?


Answer


AThe patient may be addicted to the morphine.


BThe patient may have developed pseudo-addiction to the morphine, and therefore require a lower hydromorphone dose.


CThe patient may have developed tolerance to the morphine, and therefore require a lower hydromorphone dose.


DThe patient may absorb less morphine than hydromorphone.


EThe patient may have been selling the morphine on the street.

CThe patient may have developed tolerance to the morphine, and therefore require a lower hydromorphone dose.

A patient has been prescribed Lioresal. Choose the appropriate generic substitution:


Answer


AGabapentin


BPregabalin


CDuloxetine


DTizanidine


EBaclofen

EBaclofen

Casey is a 28 year-old female who was in a car accident. She was not severely injured, but has a fair amount of soreness and aches. She was given a prescription for hydrocodone 5 mg-acetaminophen 325 mg and instructed to rotate using this medicine with over-the-counter extra strength acetaminophen 500 mg alone. She states she is using 4-5 prescription pills daily, and 6-8 of the over-the-counter acetaminophen. Choose the correct statement:


Answer


AThe primary risk for the patient is danger due to respiratory depression.


BThe primary risk for the patient is damage to the liver.


CThe primary risk to the patient is renal damage.


DThe primary risk to the patient is muscle toxicity.


EThe primary risk to the patient is cardiotoxicity.

BThe primary risk for the patient is damage to the liver.

A patient has purchased over-the-counter Zostrix HP. Which statements are correct? (Select ALL that apply.)


Answer


AThe medication should be applied topically twice daily.


BBe careful not to touch your eyes, nose, or genital areas; this will burn.


CIt may be best to begin with the lower potency formulation, at least until the burning sensation goes away.


DIt can take up to 1-2 weeks for the full effect.


EIt is less expensive to purchase a store-brand version of this product.

BBe careful not to touch your eyes, nose, or genital areas; this will burn.


CIt may be best to begin with the lower potency formulation, at least until the burning sensation goes away.



EIt is less expensive to purchase a store-brand version of this product.


Select the correct mechanism of action for morphine:


Answer


AAntagonist at the mu opioid receptor in the CNS.


BInhibits cyclooxygenase, which reduces prostaglandin formation, which decreases pain and inflammation.


CSerotonin/ norepinephrine reuptake inhibitor.


DAgonist at the mu opioid receptor in the CNS.


EDecreases substance P and reduces pain transmission from the nerve ending (localized effect).

DAgonist at the mu opioid receptor in the CNS

A patient has been prescribed Lyrica. The pharmacist should counsel her on the possibility of these side effects: (SelectALL that apply.)


Answer


ADizziness, somnolence


BPeripheral edema


CMild euphoria


DWeight loss


EDepression

ADizziness, somnolence


BPeripheral edema


CMild euphoria

A patient has been prescribed Voltaren. Choose the appropriate generic substitution:


Answer


AEtodolac


BMeloxicam


CDiclofenac


DNabumetone


ESulindac

CDiclofenac

Camden was running on the sidewalk and slipped on the curb. She had an X-ray, which was negative. The physician prescribed her cyclobenzaprine and ibuprofen. Choose the correct counseling statements for the safe use of cyclobenzaprine: (Select ALL that apply.)


Answer


AThis medication can cause excessive drowsiness and fatigue.


BDo not mix with alcohol.


CUse extreme caution if taking with other drugs that make you tired and confused.


DDo not drive a car while using this medicine, or operate any heavy machinery.


EDo not use with opioids or other analgesics, including ibuprofen, concurrently.

AThis medication can cause excessive drowsiness and fatigue.


BDo not mix with alcohol.


CUse extreme caution if taking with other drugs that make you tired and confused.


DDo not drive a car while using this medicine, or operate any heavy machinery.

A pharmacist receives a prescription for Arthrotec. This combination contains two individual drugs that work by these mechanisms:


Answer


AAn analgesic (NSAID) with a triptan agent, both used for migraine


BAm analgesic agent (NSAID) with a PPI to protect the gut from NSAID-induced GI irritation.


CAn NSAID with misoprostol to protect the gut from NSAID-induced GI irritation.


DAn NSAID and a triptan, to protect the gut from NSAID-induced GI irritation.


EAn opioid and an NSAID for combined analgesia.

CAn NSAID with misoprostol to protect the gut from NSAID-induced GI irritation.

A patient has been prescribed Savella for fibromyalgia. Her other medications include Toprol XL, diltiazem, warfarin and pivastatin. What would be the pharmacist's primary concern in filling the Savella?


Answer


AHypotension risk


BBleeding risk


CHistamine release, with pruritus


DElevated Savella levels


EDecreased Savella levels

BBleeding risk

Select the correct mechanism of action for capsaicin:


Answer


AAntagonist at the mu opioid receptor in the CNS.


BInhibits cyclooxygenase, which reduces prostaglandin formation, which decreases pain and inflammation.


CSerotonin/norepinephrine reuptake inhibitor.


DAgonist at the mu opioid receptor in the CNS.


EDecreases substance P and reduces pain transmission from the nerve ending (localized effect).

EDecreases substance P and reduces pain transmission from the nerve ending (localized effect).

Patient counseling for capsaicin cream should include the following: (Select ALL that apply.)


Answer


AIf applying to a place other than the hands you may wish to use gloves or an applicator tip.


BIf you place on your hands (such as on the outside of the hands for hand arthritis) wait 30 minutes (being careful not to touch your eyes) and then wash off with soap and water.


CIt is usually best to begin with the low potency, and if that helps and you want to try the higher potency, switch.


DThis medication can cause burning.


ECover with a bandage for faster response.

AIf applying to a place other than the hands you may wish to use gloves or an applicator tip.


BIf you place on your hands (such as on the outside of the hands for hand arthritis) wait 30 minutes (being careful not to touch your eyes) and then wash off with soap and water.


CIt is usually best to begin with the low potency, and if that helps and you want to try the higher potency, switch.


DThis medication can cause burning.

Which of the following agents are commonly used for neuropathic pain management? (Select ALL that apply.)


Answer


AZanaflex


BLyrica


CElavil


DCymbalta


EOxycontin

BLyrica


CElavil


DCymbalta

Which NSAID should be chosen if an agent with high COX-2 selectivity is requested, but Celebrex is too expensive (choose an alternative option):


Answer


AIndocin


BFeldene


CMeloxicam


DKetorolac


EAspirin

CMeloxicam

A pharmacist is counseling a mother on the safe use of over-the-counter analgesics for her 6 year-old son's fever. Counseling should include the following safety consideration:


Answer


AAspirin products should be avoided in children except if viral disease is present.


BInfant drops must be dispensed with a dosing cup or oral syringe.


CIbuprofen causes less stomach upset than acetaminophen in young children.


DIbuprofen lasts a little longer than acetaminophen.


EAcetaminophen provides better fever relief than ibuprofen.

DIbuprofen lasts a little longer than acetaminophen.

A patient has been instructed by the pharmacist to open the Avinza capsule and sprinkle the beads on applesauce. The pharmacist should include this essential information in the counseling:


Answer


AThe applesauce must be eaten immediately; do not chew the beads.


BThe applesauce can be stored for up to 30 minutes.


CThe applesauce can be stored for up to 60 minutes.


DThe beads can be crushed, if the patient continues to have difficulty swallowing.


EThe beads cannot be crushed, but can be chewed slowly.


AThe applesauce must be eaten immediately; do not chew the beads.

Esther will be discharged from the hospital after suffering a right femur fracture. She had surgery three days ago. Since the surgery she has been receiving the following medications: morphine 10 mg 3-4 times daily, enalapril 5 mg daily and milk of magnesia as-needed. She had been taking just one medication for hypertension prior to admission. The physician wishes to initiate a fentanyl patch. Choose the correct statement:


Answer


AShe can be started on the 12 mcg/hour patch.


BShe can be started on the 25 mcg/hour patch.


CShe can be started on the 50 mcg/hour patch.


DShe should be started on fentanyl sublingual at this time.


EShe is not a candidate at this time for the fentanyl patch.

EShe is not a candidate at this time for the fentanyl patch.

Against the advice of many of the members of their own advisory panel, the FDA approved a single agent hydrocodone extended-release formulation in 2013. It is a C II drug. What is the brand name for this hydrocodone formulation?


Answer


AZoladex ER


BZolinza ER


CZiagen ER


DZioptan ER


EZohydro ER

EZohydro ER

A patient regularly uses over-the-counter pain relieving creams such as BenGay and Icy Hot that she applies to the painful, tender skin around the Achilles tendon. What is the common ingredient in these OTC products?


Answer


AA salicylate, such as methyl salicylate


BTopical diclofenac


CTopical capsaicin


DTopical ibuprofen


ETopical naproxen

AA salicylate, such as methyl salicylate

A pharmacist is discussing skeletal muscle relaxants with the medical team. Correct statements should include the following. (Select ALL that apply.)


Answer


ACyclobenzaprine has the lowest efficacy in this group, but a lower abuse potential.


BCarisoprodol is thought to have the highest abuse potential, and can be very dangerous when mixed with other drugs.


CPoor CYP 2C19 metabolizers will have higher carisoprodol concentrations (up to 4-fold).


DCyclobenzaprine is the safest agent in the class if the patient is using other serotonergic agents.


ESome of the skeletal muscle relaxants can cause dry mouth.

BCarisoprodol is thought to have the highest abuse potential, and can be very dangerous when mixed with other drugs.


CPoor CYP 2C19 metabolizers will have higher carisoprodol concentrations (up to 4-fold).



ESome of the skeletal muscle relaxants can cause dry mouth.

A frail patient with cancer pain is given a prescription for a fentanyl patch. Counseling points should include: (Select ALLthat apply.)


Answer


AThis medication is stimulating: never start the three-day patch at night, or you will not be able to sleep.


BDo not exceed one alcoholic drink daily (females) or two drinks daily (males).


CThe brand name is Duragesic.


DThe brand name is Fentora.


EPress in place for 30 seconds on clean skin (relatively free of hair) on either the chest, back, flank (side) or upper arm.

CThe brand name is Duragesic.



EPress in place for 30 seconds on clean skin (relatively free of hair) on either the chest, back, flank (side) or upper arm.

A patient has received a prescription for the Lidoderm patch. Choose the correct statements: (Select ALL that apply.)


Answer


AThe patch releases drug into your body, which travels to your brain. The mechanism is called an "opioid receptor agonist."


BUp to three patches can be applied at one time (over the most painful area), for up to 12 hours each day.


CDo not cut the patch; this damages the release mechanism.


DLidoderm patches, even when used, contain enough drug that could harm a small child or pet.


EThe patch can be cut into smaller pieces (before the backing is removed).

BUp to three patches can be applied at one time (over the most painful area), for up to 12 hours each day.



DLidoderm patches, even when used, contain enough drug that could harm a small child or pet.


EThe patch can be cut into smaller pieces (before the backing is removed).

A patient has had anxiety for many years which keeps her from sleeping. She takes temazepam for sleep. Recently, she slipped on an ice patch and sustained a wrist fracture. She received a prescription for Vicodin. Her other medications include lisinopril, the clonidine patch, and propranolol. She has one alcoholic drink nightly prior to bedtime. Due to the combination of many of these agents, the patient would be expected to experience excessive: (Select ALL that apply.)


Answer


ASedation


BCognitive dysfunction


CExtrapyramidal side effects


DReflex tachycardia


EVomiting


ASedation


BCognitive dysfunction

A pharmacist has a prescription for Suboxone. This drug consists of the following agent/s. (Select ALL that apply.)


Answer


ANalmefene


BBuprenorphine


CHydromorphone


DMethadone


ENaloxone


BBuprenorphine



ENaloxone

Choose the correct statement concerning pregabalin:


Answer


AThis is a controlled drug (C I)


BThis is a controlled drug (C II).


CThis is a controlled drug (C IV).


DThis is a controlled drug (C V).


EThis drug is not controlled.


DThis is a controlled drug (C V).

A hospitalized patient who had a hip replacement has been receiving hydromorphone. The opioid was not dosed correctly for the patient. The nurse finds the patient with cold, clammy skin. On examination, the pupils are "pin-point" and the breathing is shallow and labored. Choose the correct antidote:


Answer


ASuboxone


BNaloxone


CFlumazenil


DDeferoxamine


EPhysostigmine

BNaloxone

A physician has received a DATA 2000 waiver from the DEA in order to prescribe buprenorphine. The pharmacist will know that the physician is authorized to write for this drug by the following indication:


Answer


AThe DEA number begins with a B.


BThe DEA number begins with a C.


CThe DEA number begins with a P.


DThe DEA number begins with a X.


ENo special designation is required.

DThe DEA number begins with a X.

A patient with type 1 diabetes and cancer has been using chronic opioid therapy for several months. He will begin usingRelistor. What is the correct reason to use this medication? (Select ALL that apply.)


Answer


AThe patient has diarrhea.


BThe patient has constipation.


CThe patient has tried using docusate with senna, and then docusate with bisacodyl, and neither worked well enough.


DThe patient is able to self-administer a SC injection.


EThe patient is using insulin; Relistor is for pain management in patients using insulin.


BThe patient has constipation.


CThe patient has tried using docusate with senna, and then docusate with bisacodyl, and neither worked well enough.


DThe patient is able to self-administer a SC injection.

Cyclobenzaprine, carisoprodol, metaxalone, tizanidine and baclofen are described as:


Answer


AAgonists at the benzodiazepine receptor


BAntagonists at the benzodiazepine receptor


CAnticonvulsants


DOpioid agonists


EMuscle relaxants

EMuscle relaxants

A pharmacist receives a prescription for Treximet. This combination drug contains the following two individual agents:


Answer


ANaproxen and sumatriptan


BIbuprofen and sumatriptan


CNaproxen and esomeprazole


DOmeprazole and sumatriptan


EEsomeprazole and sumatriptan

ANaproxen and sumatriptan

Select the correct mechanism of action for naproxen:


Answer


AAntagonist at the mu opioid receptor in the CNS.


BInhibits cyclooxygenase, which reduces prostaglandin formation, which decreases pain and inflammation.


CSerotonin/norepinephrine reuptake inhibitor.


DAgonist at the mu opioid receptor in the CNS.


EDecreases substance P and reduces pain transmission from the nerve ending (localized effect).

BInhibits cyclooxygenase, which reduces prostaglandin formation, which decreases pain and inflammation.

Which of the following agents come in formulations that are useful for topical pain application? (Select ALL that apply.)


Answer


AIbuprofen


BMethyl salicylate


CDiclofenac


DCapsaicin


ELidocaine viscous gel, lidocaine patch, OTC LidoPatch

BMethyl salicylate


CDiclofenac


DCapsaicin


ELidocaine viscous gel, lidocaine patch, OTC LidoPatch

Which of the following are stimulant laxatives and represent options for patients using around-the-clock, or chronic, opioid pain medications? (Select ALL that apply.)


Answer


AEx-Lax


BBisacodyl


CMilk of Magnesia (MOM)


DSenna


EMiraLax

AEx-Lax


BBisacodyl



DSenna

A patient has been instructed by her physician to purchase over-the-counter Advil, and take one tablet twice daily. Choose the appropriate generic substitution:


Answer


AEtodolac


BMeloxicam


CDiclofenac


DIbuprofen


ENaproxen

DIbuprofen

A patient has been using MS Contin 60 mg tablets BID for chronic baseline pain control. The patient has developed swallowing problems and has been choking on the medicine. She was tried initially on the Duragesic patch but felt thatDuragesic made her mind a little crazy and she does not wish to try it again. Choose the correct statements: (Select ALLthat apply.)


Answer


AInstruct the patient to crush the morphine tablets and mix in water or non-acidic beverage.


BInstruct the patient to crush the morphine tablets and mix in applesauce.


CContact the physician to change to a different formulation.


DThere are morphine formulations that come in capsules that can be put on a spoonful of applesauce and swallowed more easily.


EShe should use the morphine patch formulation instead.


CContact the physician to change to a different formulation.


DThere are morphine formulations that come in capsules that can be put on a spoonful of applesauce and swallowed more easily.