NR 565: Advanced Pharmacology
Midterm Examination Study Guide
A Comprehensive Review of
Pharmacokinetics, Pharmacodynamics,
and Clinical Prescribing for the Advanced
Practice Nurse
Conventional DMARDs – answer MTX, leflunomide,
sulfasalazine, hydroxychloroquine
Inhibits dihydroflorate reductase, inhibits lymphocyte proliferation
Monitor LFTs, creatinine
NSAIDs - answeribuprofen, naproxen, diclofenac potassium,
meloxicam, indomethacin, celecoxib
Starting Disease Modifying Antirheumatic Drugs (DMARDs) -
answerBaseline-CBC with diff, TB testing, pregnancy test,
liver/renal status
Complete H&P
Biologic DMARDs - answerAdalimumab (Humira), certolizumab
pegol, etanerdept, golimumab
Binds and inhibits tumor necrosis factor-alpha, reducing
inflammation and altering immune response
Which schedule drugs can APRNs prescribe? - answerVaries
state by state
May include schedule II-V, but never schedule I
,Who determines and regulates prescriptive authority? -
answerThe state's health professional board
How does limited prescriptive authority impact patients within the
healthcare system? - answerCreates numerous barriers to quality,
affordable, and accessible patient care
May prevent outreach to areas of greatest need
Physician approval of prescriptions can increase patient waits
What are the key responsibilities of prescribing? - answerA sound
understanding of drugs and the conditions that they are used to
manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including
education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions? -
answerCost, follow current guidelines, availability, interactions,
side effects, allergies, hepatic/renal function, need for monitoring,
special populations
PK and PD changes in older adults and how that affects how you
prescribe? - answerVery high risk of adverse drug reactions and
drug-drug interactions
D/t altered PK, multiple and severe illnesses, polypharmacy, poor
adherence
Beer's Criteria - answerList of potentially inappropriate
medications to use in the older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
, Impacts/outcomes of polypharmacy? - answerIncreased ADRs
and drug-drug interactions
What are CYP450? - answerEnzymes responsible for drug
metabolism (biotransformation)-oxidization, reduction, hydrolyzed
to promote renal dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do? - answerPromote drug excretion
by making them more "excretable"--hydrophilic/water soluble and
charged (ion)
Inactivate drugs, increase therapeutic action through metabolism,
activate a prodrug, decrease drug toxicity
CYP450 inhibitor examples? - answerVISA credit card debt
inhibits spending on designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
Quinidine
What do CYP450 inhibitors do? - answerDecrease the rate of
metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation
which can lead to adverse reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly? - answerCan
lead to adverse effects and drug toxicity
Midterm Examination Study Guide
A Comprehensive Review of
Pharmacokinetics, Pharmacodynamics,
and Clinical Prescribing for the Advanced
Practice Nurse
Conventional DMARDs – answer MTX, leflunomide,
sulfasalazine, hydroxychloroquine
Inhibits dihydroflorate reductase, inhibits lymphocyte proliferation
Monitor LFTs, creatinine
NSAIDs - answeribuprofen, naproxen, diclofenac potassium,
meloxicam, indomethacin, celecoxib
Starting Disease Modifying Antirheumatic Drugs (DMARDs) -
answerBaseline-CBC with diff, TB testing, pregnancy test,
liver/renal status
Complete H&P
Biologic DMARDs - answerAdalimumab (Humira), certolizumab
pegol, etanerdept, golimumab
Binds and inhibits tumor necrosis factor-alpha, reducing
inflammation and altering immune response
Which schedule drugs can APRNs prescribe? - answerVaries
state by state
May include schedule II-V, but never schedule I
,Who determines and regulates prescriptive authority? -
answerThe state's health professional board
How does limited prescriptive authority impact patients within the
healthcare system? - answerCreates numerous barriers to quality,
affordable, and accessible patient care
May prevent outreach to areas of greatest need
Physician approval of prescriptions can increase patient waits
What are the key responsibilities of prescribing? - answerA sound
understanding of drugs and the conditions that they are used to
manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including
education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions? -
answerCost, follow current guidelines, availability, interactions,
side effects, allergies, hepatic/renal function, need for monitoring,
special populations
PK and PD changes in older adults and how that affects how you
prescribe? - answerVery high risk of adverse drug reactions and
drug-drug interactions
D/t altered PK, multiple and severe illnesses, polypharmacy, poor
adherence
Beer's Criteria - answerList of potentially inappropriate
medications to use in the older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
, Impacts/outcomes of polypharmacy? - answerIncreased ADRs
and drug-drug interactions
What are CYP450? - answerEnzymes responsible for drug
metabolism (biotransformation)-oxidization, reduction, hydrolyzed
to promote renal dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do? - answerPromote drug excretion
by making them more "excretable"--hydrophilic/water soluble and
charged (ion)
Inactivate drugs, increase therapeutic action through metabolism,
activate a prodrug, decrease drug toxicity
CYP450 inhibitor examples? - answerVISA credit card debt
inhibits spending on designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
Quinidine
What do CYP450 inhibitors do? - answerDecrease the rate of
metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation
which can lead to adverse reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly? - answerCan
lead to adverse effects and drug toxicity
