AANP Pharmacology 2 — Questions and Answers
Question 1: Which opioid analgesic has active metabolites that can accumulate in renal failure, causing CNS toxicity?
- Fentanyl
- Morphine (Correct answer)
- Buprenorphine
- Methadone
Correct answer: Morphine
Morphine-6-glucuronide, an active metabolite of morphine, accumulates in renal failure and can cause prolonged sedation and respiratory depression.
Question 2: A nurse practitioner prescribes trimethoprim-sulfamethoxazole to a patient on methotrexate. What serious risk exists?
- Serotonin syndrome
- Bone marrow suppression and pancytopenia (Correct answer)
- QT prolongation
- Hepatotoxicity only
Correct answer: Bone marrow suppression and pancytopenia
TMP-SMX inhibits dihydrofolate reductase and can potentiate methotrexate toxicity, leading to severe bone marrow suppression and pancytopenia.
Question 3: What is the antidote for acetaminophen overdose?
- Naloxone
- Flumazenil
- N-acetylcysteine (Correct answer)
- Activated charcoal alone
Correct answer: N-acetylcysteine
N-acetylcysteine replenishes glutathione stores in the liver, neutralizing the toxic metabolite NAPQI that causes hepatotoxicity in acetaminophen overdose.
Question 4: Which SSRI has the longest half-life and is least likely to cause discontinuation syndrome?
- Paroxetine
- Sertraline
- Fluoxetine (Correct answer)
- Citalopram
Correct answer: Fluoxetine
Fluoxetine has a half-life of 2–6 days (with active metabolite norfluoxetine at 4–16 days), which effectively tapers itself and minimizes discontinuation symptoms.
Question 5: A patient prescribed a fluoroquinolone antibiotic reports new-onset tendon pain. What should the NP do?
- Continue the antibiotic and add NSAIDs for pain
- Discontinue the fluoroquinolone and switch to an alternative antibiotic (Correct answer)
- Reduce the dose and monitor
- Order an MRI before any medication change
Correct answer: Discontinue the fluoroquinolone and switch to an alternative antibiotic
Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture; the drug should be discontinued immediately and an alternative antibiotic selected.
Question 6: Which medication is most appropriate for smoking cessation in a patient with a history of seizures?
- Bupropion
- Varenicline (Correct answer)
- Nicotine patch
- Clonidine
Correct answer: Varenicline
Bupropion lowers the seizure threshold and is contraindicated in patients with seizure disorders; varenicline does not have this risk and is preferred.
AANP Pharmacology 2
Which opioid analgesic has active metabolites that can accumulate in renal failure, causing CNS toxicity?