NR 565 MIDTERM EXAM FINALS (QUESTIONS AND ANSWERS)

NR 565 MIDTERM EXAM FINALS (QUESTIONS AND ANSWERS) What are medication examples of Schedule II drugs? - CORRECT ANSWER--Ativan & Valium -Fentanyl -Oxycodone -Methadone What medications are Schedule III drugs? - CORRECT ANSWER--Xanax -Tramadol -anabolic steroids -<90mg of codeine What medications are Schedule IV drugs? - CORRECT ANSWER--Ativan -Tramadol -Methadone -Adderall Which schedule drugs can APRNs prescribe? - CORRECT ANSWER-Schedule II through Schedule IV examples of reasons for medication non-adherence - CORRECT ANSWER--too busy -too expensive -ran out 7-forgetting -traveling & busy Distribution in medication in elderly can be affected in what ways? - CORRECT ANSWER--decreased lean mass -decreased albumin -decreased body fat -slower gastric acidity -slower absorption results in delayed response In the elderly decrease albumin and decreased lean mass affects medications how? - CORRECT ANSWER-medication binds to protein so decreased protein affects how medication is absorbed and distributed In elderly decreased body fat affects medications how? - CORRECT ANSWER-need fat to transport medications and some drug metabolism is dependent on body weight When prescribing medication, we must understand that liver function declines with age due to.... - CORRECT ANSWER-decreased blood flow to the liver, decreased hepatic enzymes What is the most important cause of adverse drug reactions? - CORRECT ANSWER- ***overprescribing/polypharmacy ***decreased renal excretion -high drug dosages (start low & go slow) -lack of monitoring medications What can a poor metabolism phenotype do to a metabolism of a drug? - CORRECT ANSWER--slow or increase absorption -slow the metabolism -keep drug in body longer -increase toxicity How does poor metabolism affect a high or low therapeutic index? - CORRECT ANSWER--increase drug toxicity (example plavix - clots & increased platelets) Black box warning for Opioids - CORRECT ANSWER-respiratory depression Black box warning for Fentanyl - CORRECT ANSWER-FATAL respiratory depression Black box warning for Methadone (NP cannot prescribe) - CORRECT ANSWER-QT interval prolongation Black box warning for Codeine - CORRECT ANSWER--breastfeeding and infant death can occur -10% of dose converts to morphine Black box warning for hydromorphone & oxymorphone (NP cannot prescribe long acting hydromorphone and oxymorphone) - CORRECT ANSWER--risk for high abuse & overdose -respiratory depression Black box warning for oxycodone (NP need additional training to prescribe for chronic pain) - CORRECT ANSWER--HIGH potential for abuse -respiratory depression Meds that require special training for APNs to prescribe are... - CORRECT ANSWER-- Opioids -Fentanyl -Methadone -Codeine -Hydromorphone & oxymorphone -Oxycodone What are therapeutic uses for morphine? - CORRECT ANSWER-MODERATE TO SEVERE PAIN -acute pain -post op/surgical pain -end of life pain management -MI -labor & delivery -cancer What are therapeutic uses for Fentanyl? - CORRECT ANSWER-BREAKTHROUGH PAIN surgical pain severe pain opioid tolerant patients What are therapeutic uses for codeine? - CORRECT ANSWER-MILD TO MODERATE PAIN cough What is MME and when to use it? - CORRECT ANSWER-morphine milligram equivalent used for overdose(OD) assess where patient is at in their pain management and monitor them safely What is the PDPM and when to use it? - CORRECT ANSWER--database to access to patient's prescription history of controlled substances used to ensure safe prescribing to prevent overdosing and polypharmacy -use prior to starting opioid therapy and during opioid therapy Renal and hepatic insufficiencies with opioids 1)Codeine - CORRECT ANSWER-stays in body longer & metabolism is effected Renal and hepatic insufficiencies with opioids 2) Morphine - CORRECT ANSWER-neurotoxicity Renal and hepatic insufficiencies with opioids 3)Oxycodone - CORRECT ANSWER-overdose can use with extreme caution and reduction of dosage Renal and hepatic insufficiencies with opioids 4)Fentanyl - CORRECT ANSWER-monitor closely for sedation Risk factors for Opioid Use Disorder (OUD) - CORRECT ANSWER-family history mental health disorder (anxiety, depression) social factors prior drug use pain management poly-substance abuse prescribe post surgery for long period of time When to prescribe Naloxone? - CORRECT ANSWER->50 mme/day prior hx of OD concurrent benzo use Drugs not safe to take with Opioids - CORRECT ANSWER-Benzos Alcohol CNS depressants Tricyclic Barbituates Antihistamines Antiseizure What are some provider responsibilities when prescribing Opioids? - CORRECT ANSWER-patient education & safety documentation check PDMP set goals urinalysis discuss risks vs benefits contract offer alternative pain control options In what patient population are statins contraindicated? (prescribed for ages 10 or greater) - CORRECT ANSWER-pregnant women hepatic impairment patients taking colchine In what patient population is Warfarin contraindicated? - CORRECT ANSWERpregnancy (give heparin instead) What patient population needs a lower dose of Warfarin? - CORRECT ANSWERchildren elderly What blood pressure medications are ok to use during pregnancy? - CORRECT ANSWER-Labetalol Methyldopa