BHP Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A client taking an MAOI antidepressant asks if they can eat aged cheese. What is the primary concern?
- Lactose intolerance interaction
- Tyramine-induced hypertensive crisis (Correct answer)
- Calcium absorption interference
- Increased sedation risk
Correct answer: Tyramine-induced hypertensive crisis
MAOIs block tyramine metabolism, and tyramine-rich foods like aged cheese can trigger a life-threatening hypertensive crisis.
Question 2: Which medication class is most commonly associated with tardive dyskinesia as a long-term side effect?
- SSRIs
- Benzodiazepines
- First-generation antipsychotics (Correct answer)
- Mood stabilizers
Correct answer: First-generation antipsychotics
First-generation (typical) antipsychotics block dopamine D2 receptors extensively, leading to tardive dyskinesia with prolonged use.
Question 3: A client on lithium reports coarse tremor, confusion, and vomiting. The BHP's priority action is to:
- Administer an extra dose to stabilize levels
- Reassure the client this is a normal side effect
- Withhold the dose and contact the prescriber immediately (Correct answer)
- Encourage increased caffeine intake
Correct answer: Withhold the dose and contact the prescriber immediately
These symptoms indicate lithium toxicity, which is a medical emergency requiring immediate prescriber notification and medication hold.
Question 4: Buprenorphine/naloxone (Suboxone) is prescribed for opioid use disorder. The naloxone component serves primarily to:
- Enhance the analgesic effect of buprenorphine
- Deter intravenous misuse by precipitating withdrawal (Correct answer)
- Reduce the risk of respiratory depression at therapeutic doses
- Improve buprenorphine absorption sublingually
Correct answer: Deter intravenous misuse by precipitating withdrawal
Naloxone is poorly absorbed sublingually but becomes active if injected, precipitating opioid withdrawal to deter IV misuse.
Question 5: Which of the following is a key nursing consideration when a client is prescribed clozapine?
- Monitor blood glucose weekly
- Obtain regular CBC to detect agranulocytosis (Correct answer)
- Restrict dietary sodium intake
- Measure lithium serum levels monthly
Correct answer: Obtain regular CBC to detect agranulocytosis
Clozapine can cause agranulocytosis, so regular CBC monitoring is mandatory under the REMS program.
Question 6: A client stabilized on an SSRI begins taking St. John's Wort for mild depression. The BHP should be most concerned about:
- Hepatotoxicity
- Serotonin syndrome (Correct answer)
- QT prolongation
- Hypoglycemia
Correct answer: Serotonin syndrome
Combining an SSRI with St. John's Wort, which also increases serotonergic activity, raises the risk of serotonin syndrome.
Question 7: When educating a client about taking oral naltrexone for alcohol use disorder, which statement is most accurate?
- It causes severe illness if alcohol is consumed, so drinking must be avoided before starting
- It reduces cravings and blunts the rewarding effects of alcohol (Correct answer)
- It must be taken within 2 hours of consuming alcohol to be effective
- It is safe to abruptly discontinue without medical supervision
Correct answer: It reduces cravings and blunts the rewarding effects of alcohol
Naltrexone blocks opioid receptors involved in alcohol's rewarding effects, reducing cravings and the reinforcing pleasure of drinking.
BHP Pharmacology & Medication Management 2
A client taking an MAOI antidepressant asks if they can eat aged cheese.
What is the primary concern?