NP NP Pharmacology & Prescribing 2 — Questions and Answers
Question 1: A patient taking SSRIs is prescribed tramadol. Which serious drug interaction should the NP counsel the patient about?
- Hypertensive crisis
- Serotonin syndrome (Correct answer)
- Neuroleptic malignant syndrome
- Stevens-Johnson syndrome
Correct answer: Serotonin syndrome
Tramadol inhibits serotonin reuptake and, when combined with SSRIs, can precipitate serotonin syndrome, which is potentially life-threatening.
Question 2: Which medication requires baseline and periodic monitoring of serum creatinine and potassium when prescribed for heart failure?
- Carvedilol
- Spironolactone (Correct answer)
- Digoxin
- Isosorbide mononitrate
Correct answer: Spironolactone
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia and nephrotoxicity, necessitating regular renal function and electrolyte monitoring.
Question 3: When prescribing fluoroquinolones, the NP should warn patients about which rare but serious adverse effect?
- Agranulocytosis
- Tendon rupture (Correct answer)
- Pulmonary fibrosis
- Pseudotumor cerebri
Correct answer: Tendon rupture
Fluoroquinolones carry an FDA black box warning for tendinitis and tendon rupture, particularly of the Achilles tendon, especially in patients over 60 on corticosteroids.
Question 4: A patient with a penicillin allergy documented as 'hives and swelling' needs antibiotic coverage for a skin infection. The safest approach is to:
- Prescribe amoxicillin-clavulanate because cross-reactivity is rare
- Use clindamycin or TMP-SMX as an alternative antibiotic class (Correct answer)
- Administer penicillin under observation since allergies fade over time
- Refer to allergy specialist before treating
Correct answer: Use clindamycin or TMP-SMX as an alternative antibiotic class
For patients with documented IgE-mediated penicillin allergy, using an unrelated antibiotic class such as clindamycin or trimethoprim-sulfamethoxazole avoids cross-reactivity risk.
Question 5: Which analgesic is contraindicated in elderly patients due to increased risk of GI bleeding, renal impairment, and falls per the Beers Criteria?
- Acetaminophen
- Indomethacin (Correct answer)
- Tramadol
- Gabapentin
Correct answer: Indomethacin
Indomethacin is listed on the Beers Criteria as a potentially inappropriate medication for older adults due to its high risk for GI toxicity and CNS adverse effects.
Question 6: An NP is prescribing thyroid hormone replacement. Which medication significantly impairs levothyroxine absorption if taken together?
- Atorvastatin
- Calcium carbonate antacids (Correct answer)
- Metoprolol
- Sertraline
Correct answer: Calcium carbonate antacids
Calcium, iron, and antacids bind levothyroxine in the GI tract, reducing absorption by up to 40%; patients should take levothyroxine 30–60 minutes before these agents.
NP NP Pharmacology & Prescribing 2
A patient taking SSRIs is prescribed tramadol.
Which serious drug interaction should the NP counsel the patient about?