CHAMBERLAIN NR 565 MIDTERM PRACTICE
QUESTION AND ANSWER 100 OUT OF 100
GRADED A
What is the most important cause of adverse drug reactions? (older age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy
decreased renal excretion
Distribution of medication can be affected in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin
2, 3, 4
changes in body composition associated with age due to an increase in body fat percentage and
decrease in lean muscle mass. There is also a decrease in total body water. Distribution can also
be impacted by decreased total body water and decreased cardiac output. Absorption can be
impacted by increase gastric pH, decreased absorption surface area decreased G.I. motility and
decrease gastric emptying. Metabolism can be impacted by de Cristo paddock blood flow,
paddock mask, and activity of hepatic enzymes. Excretion can be impacted by decreased renal
blood flow, decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications "take forever" to
work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption.
2&3
Order of HTN medications typically prescribed
,Thiazide diuretics
Ace Inhibitors
ARBS
CCB
BB
Which is best HTN medication for someone with diabetes
ACE inhibitor and ARB
Which medication to avoid in a patient who is pregnant or breastfeeding?
Avoid ACE and ARBs in patients who are pregnant or may become pregnant. Especially ARBs in
the second and third trimester.
Medications best for HTN for patient who is pregnant?
labetalol, methyldopa, nifedipine
For general population which HTN class is appropriate?
thiazide diuretics
For African Americans which class of HTN medications is appropriate?
thiazide, CCB, BB
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic
properties of drugs?
increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
Examples of medications that can be teratogenic
Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large
doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
How is absorption of intramuscular medications different in neonates?
slow and erratic due to low blood flow in muscles first few days of life
,Why is absorption of medication in the stomach increased in infancy?
delayed gastric emptying
Some medications that should be avoided in the pediatric patient?
glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus with
sulfonamides, levofloxacin (antibiotics)
aspirin (Severe intoxication from acute overdose)
what should be included in medication administration patient education?
dosage size and timing
route and technique of administration
duration of treatment
drug storage
nature and time course of desired responses
nature and time course of adverse responses
finish taking antibiotic
What are some things that put the elderly patient at higher risk for adverse drug reactions?
reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
use of drugs that have a low therapeutic index (e.g., digoxin)
increased individual variation secondary to altered pharmacokinetics
inadequate supervision of long-term therapy
poor patient adherence
How can healthcare providers decrease likelihood of an elderly patient experiencing an
adverse drug reaction?
obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness
periodically reviewing the need for continued drug therapy
encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
, How can we promote medication adherence with elderly patients?
simplifying drug regimens
providing clear and concise verbal and written instructions
using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
monitoring frequently
affordability of drugs
support systems
Why do nitrates need to be taken no later than 4 PM?
Need nitrate free interval so tolerance doesn't develop
Nine factors that impact outcome of medication?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing?
yes
What is the purpose of the Genetic Information Non-Discriminatory Act?
Protects patients from discrimination by employers and insurance providers based on genetic
information
Difference between practice authority and prescriptive authority?
Practice authority refers to the nurse practitioner's ability to practice without physician
oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescribe medications independently and without limitations.
Who regulates prescriptive authority?
QUESTION AND ANSWER 100 OUT OF 100
GRADED A
What is the most important cause of adverse drug reactions? (older age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy
decreased renal excretion
Distribution of medication can be affected in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin
2, 3, 4
changes in body composition associated with age due to an increase in body fat percentage and
decrease in lean muscle mass. There is also a decrease in total body water. Distribution can also
be impacted by decreased total body water and decreased cardiac output. Absorption can be
impacted by increase gastric pH, decreased absorption surface area decreased G.I. motility and
decrease gastric emptying. Metabolism can be impacted by de Cristo paddock blood flow,
paddock mask, and activity of hepatic enzymes. Excretion can be impacted by decreased renal
blood flow, decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications "take forever" to
work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption.
2&3
Order of HTN medications typically prescribed
,Thiazide diuretics
Ace Inhibitors
ARBS
CCB
BB
Which is best HTN medication for someone with diabetes
ACE inhibitor and ARB
Which medication to avoid in a patient who is pregnant or breastfeeding?
Avoid ACE and ARBs in patients who are pregnant or may become pregnant. Especially ARBs in
the second and third trimester.
Medications best for HTN for patient who is pregnant?
labetalol, methyldopa, nifedipine
For general population which HTN class is appropriate?
thiazide diuretics
For African Americans which class of HTN medications is appropriate?
thiazide, CCB, BB
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic
properties of drugs?
increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
Examples of medications that can be teratogenic
Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large
doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
How is absorption of intramuscular medications different in neonates?
slow and erratic due to low blood flow in muscles first few days of life
,Why is absorption of medication in the stomach increased in infancy?
delayed gastric emptying
Some medications that should be avoided in the pediatric patient?
glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus with
sulfonamides, levofloxacin (antibiotics)
aspirin (Severe intoxication from acute overdose)
what should be included in medication administration patient education?
dosage size and timing
route and technique of administration
duration of treatment
drug storage
nature and time course of desired responses
nature and time course of adverse responses
finish taking antibiotic
What are some things that put the elderly patient at higher risk for adverse drug reactions?
reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
use of drugs that have a low therapeutic index (e.g., digoxin)
increased individual variation secondary to altered pharmacokinetics
inadequate supervision of long-term therapy
poor patient adherence
How can healthcare providers decrease likelihood of an elderly patient experiencing an
adverse drug reaction?
obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness
periodically reviewing the need for continued drug therapy
encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
, How can we promote medication adherence with elderly patients?
simplifying drug regimens
providing clear and concise verbal and written instructions
using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
monitoring frequently
affordability of drugs
support systems
Why do nitrates need to be taken no later than 4 PM?
Need nitrate free interval so tolerance doesn't develop
Nine factors that impact outcome of medication?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing?
yes
What is the purpose of the Genetic Information Non-Discriminatory Act?
Protects patients from discrimination by employers and insurance providers based on genetic
information
Difference between practice authority and prescriptive authority?
Practice authority refers to the nurse practitioner's ability to practice without physician
oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescribe medications independently and without limitations.
Who regulates prescriptive authority?
