NP Pharmacology & Prescribing Flashcards

A patient taking SSRIs is prescribed tramadol. Which serious drug interaction should the NP counsel the patient about?

Answer: Serotonin syndrome

Tramadol inhibits serotonin reuptake and, when combined with SSRIs, can precipitate serotonin syndrome, which is potentially life-threatening.

Which medication requires baseline and periodic monitoring of serum creatinine and potassium when prescribed for heart failure?

Answer: Spironolactone

Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia and nephrotoxicity, necessitating regular renal function and electrolyte monitoring.

When prescribing fluoroquinolones, the NP should warn patients about which rare but serious adverse effect?

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.

A patient with a penicillin allergy documented as 'hives and swelling' needs antibiotic coverage for a skin infection. The safest approach is to:

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.

Which analgesic is contraindicated in elderly patients due to increased risk of GI bleeding, renal impairment, and falls per the Beers Criteria?

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.

An NP is prescribing thyroid hormone replacement. Which medication significantly impairs levothyroxine absorption if taken together?

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.