NP NP Pharmacology & Prescribing 1 — Questions and Answers
Question 1: A nurse practitioner prescribes metformin for a patient with type 2 diabetes. Which condition is an absolute contraindication to metformin use?
- eGFR < 30 mL/min/1.73m² (Correct answer)
- BMI > 35 kg/m²
- Age > 65 years
- HbA1c > 9%
Correct answer: eGFR < 30 mL/min/1.73m²
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to the risk of lactic acidosis from drug accumulation.
Question 2: When prescribing warfarin, which INR target range is appropriate for a patient with atrial fibrillation and no mechanical heart valve?
- 1.0–1.5
- 2.0–3.0 (Correct answer)
- 2.5–3.5
- 3.0–4.0
Correct answer: 2.0–3.0
For non-valvular atrial fibrillation, the target INR range is 2.0–3.0 to balance stroke prevention with bleeding risk.
Question 3: A patient is started on lisinopril and develops a dry, persistent cough. What is the most appropriate next step?
- Add a cough suppressant and continue lisinopril
- Switch to an ARB such as losartan (Correct answer)
- Reduce the lisinopril dose by half
- Order pulmonary function tests before changing therapy
Correct answer: Switch to an ARB such as losartan
ACE inhibitor–induced cough is a class effect caused by bradykinin accumulation; switching to an ARB eliminates this side effect.
Question 4: Which schedule II controlled substance requires a new written or electronic prescription for each fill in most US states and cannot be called in by phone?
- Tramadol
- Oxycodone (Correct answer)
- Gabapentin
- Alprazolam
Correct answer: Oxycodone
Oxycodone is a Schedule II opioid; federal law prohibits oral prescriptions for Schedule II substances, requiring a written or electronic prescription for each supply.
Question 5: An NP prescribes azithromycin for a patient already taking amiodarone. What is the primary safety concern?
- Increased risk of hepatotoxicity
- Prolonged QT interval and risk of torsades de pointes (Correct answer)
- Reduced bioavailability of amiodarone
- Serotonin syndrome
Correct answer: Prolonged QT interval and risk of torsades de pointes
Both azithromycin and amiodarone independently prolong the QT interval; combining them significantly increases the risk of potentially fatal arrhythmias.
Question 6: Which drug class is first-line therapy for newly diagnosed hypertension in a non-Black patient without compelling indications, per JNC guidelines?
- Beta-blockers
- Thiazide diuretics, ACE inhibitors, ARBs, or CCBs (Correct answer)
- Alpha-blockers
- Direct vasodilators
Correct answer: Thiazide diuretics, ACE inhibitors, ARBs, or CCBs
Current guidelines recommend thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers as first-line agents for most non-Black hypertensive patients.
NP NP Pharmacology & Prescribing 1
A nurse practitioner prescribes metformin for a patient with type 2 diabetes.
Which condition is an absolute contraindication to metformin use?