Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

Chapter 07: Over-the-Counter Medications

Test Bank

MULTIPLE CHOICE

1. A patient asks a primary care nurse practitioner (NP) about using over-the-counter medications to treat an upper respiratory infection with symptoms of cough, fever, and nasal congestion. The NP should:

a.

recommend a cough preparation that also contains acetaminophen.

b.

suggest using single-ingredient products to treat each symptom separately.

c.

recommend a product containing antitussive, antipyretic, and decongestant ingredients.

d.

tell the patient that over-the-counter medications are usually not effective in manufacturer-recommended doses.

ANS: B

A basic principle guiding over-the-counter use is to look at specific symptoms and treat each separately because some products contain therapeutic doses of one ingredient and subtherapeutic doses of others. Cough preparations containing acetaminophen often do not contain therapeutic doses, and patients often overdose when they supplement with acetaminophen. Over-the-counter medications are effective at recommended doses. Patients should follow dosing recommendations on the package.

DIF: Cognitive Level: Understanding (Comprehension) REF: 89| 90

2. A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are:

a.

generally safe when label information is understood and followed.

b.

safer because over-the-counter doses are lower than prescription doses of the same drug.

c.

less safe because they are not well regulated by the Food and Drug Administration (FDA).

d.

not extensively tested, so claims made by manufacturers cannot be substantiated.

ANS: A

Over-the-counter products have a wider margin of safety because most of these drugs have undergone rigorous testing before marketing and further refinement through years of over-the-counter use by consumers. When labels are understood and followed, over-the-counter medications are safe. Over-the-counter medications are regulated by the FDA.

DIF: Cognitive Level: Understanding (Comprehension) REF: 88

3. A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent tells the NP that the medication label does not give instructions about how much to give a child. The NP should:

a.

order a prescription antitussive medication for the child.

b.

ask the parent to identify all of the ingredients listed on the medication label.

c.

calculate the dose for the active ingredient in the over-the-counter preparation.

d.

tell the parent to approximate the dose at about one third to one half the adult dose.

ANS: B

Over-the-counter cough medications often contain dextromethorphan, which can be toxic to young children. It is important to identify ingredients of an over-the-counter medication before deciding if it is safe for children. A prescription antitussive is probably not warranted until the cough is evaluated to determine the cause. Until the ingredients are known, it is not safe to approximate the child’s dose based on only the active ingredient.

DIF: Cognitive Level: Applying (Application) REF: 89

4. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:

a.

to take the dose recommended by the manufacturer.

b.

not to worry about taking this drug with any other medications.

c.

to avoid taking other drugs that cause sedation while taking this drug.

d.

that over-the-counter acid reflux medications are generally safe to take with other medications.

ANS: A

Because patients often increase over-the-counter drug doses themselves, it is important to reinforce the need to follow the manufacturer’s recommendations for dosing. As with any drug, interactions may occur with other medications. Antacids do not cause sedation, so patients need not be cautioned to avoid other sedating medications.

DIF: Cognitive Level: Applying (Application) REF: 89

5. A primary care NP is performing a previsit health history on a new patient. The patient reports taking vitamins every day. The NP should:

a.

ask the patient to bring all vitamin bottles to the clinic appointment.

b.

recommend natural vitamin products over synthetic vitamin products.

c.

reassure the patient that vitamins that are high in folic acid are safe to take.

d.

tell the patient that some vitamins, such as vitamin C, are safe in large doses.

ANS: A

It is important to determine exactly what the patient is taking, so asking patients to bring vitamin bottles to the clinic is appropriate. There is no evidence that natural products are better than synthetic products. High doses of folic acid may mask signs of vitamin B₁₂ deficiency. Vitamin C in high doses can cause dependency.

DIF: Cognitive Level: Applying (Application) REF: 89

6. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:

a.

review healthy dietary practices with this patient.

b.

make sure that the supplements contain large doses of vitamin A.

c.

tell the patient that antioxidants are especially important for patients who smoke.

d.

tell the patient that evidence shows antioxidants to be effective in preventing cancer.

ANS: A

Epidemiologic evidence indicates that people who eat fruits and vegetables regularly have a decreased risk of cancer. Although retrospective studies have suggested major benefits from antioxidants, no intervention studies have determined conclusively that antioxidants prevent cancer. Large doses of vitamin A can produce a yellow hue to the skin. Antioxidants can be beneficial, but in certain populations, such as smokers, they may be harmful.

DIF: Cognitive Level: Understanding (Comprehension) REF: 89

7. A patient who has an upper respiratory infection reports using over-the-counter cold preparations. The primary care NP should counsel this patient to use caution when taking additional over-the-counter medications such as:

a.

antipyretics.

b.

calcium supplements.

c.

acid reflux medications.

d.

antioxidant supplements.

ANS: A

Cold preparations often contain antipyretics such as acetaminophen or aspirin. Patients should be cautioned about taking additional antipyretics to avoid overdose.

DIF: Cognitive Level: Applying (Application) REF: 89