NR 565 - advanced pharmacology midterm – Chamberlain Questions and Answers Already Passed

NR 565 - advanced pharmacology midterm – Chamberlain Questions and Answers Already Passed During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term consequences? 1st trimester (fetus most at risk d/t rapid growth) What is BEERS criteria? Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately decides What is the CYP450 (cytochrome P450) liver enzyme system where medications are metabolized, can either be inducers or inhibitors and create drug-drug interactions CYP450 inducers Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blood levels of drug), elevate CYP450 enzymes CYP450 inducers pneumonic "Bullshit Crap GPS INDUCES rage" CYP450 inducer drug names Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas CYP450 inhibitors inhibit metabolism, increase blood levels of medications CYP450 pneumonic "VISA credit card debt INHIBITS spending on designers like CK to look GQ" CYP450 inhibitors drug names Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole, grapefruit juice, quinidine 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? the jurisdiction of a health professional board. This may be the State Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state. What is scope of practice determined by? is determined by state practice and licensure laws. What is full practice authority? Nurse practitioners have the autonomy to evaluate patients, diagnose, order and interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without physician oversight. What is reduced practice authority? Nurse practitioners are limited in at least one element of practice. The state requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient care. ex/ physician involvement for 5 yrs than independent What is restricted practice authority? Nurse practitioners are limited in at least one element of practice by requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to provide patient care.- typically doctor on site What are components of Rx? Prescriber Contact info Prescribers name NPI DEA Patient name DOB Date Allergies Medication name Strength Quantity Indication for use Direction for use Refills Signature What are some potential problems that arise with written prescriptions? Must contain all elements May have pre-populated information Write legibly Avoid error prone abbreviations Tamper resistant scripts are often required Reasons for monitoring drug therapy determining therapeutic dosage evaluating medication adequacy identifying adverse effects serious or life-threatening risks. Which schedules of drugs can APRNs prescribe? depends on state - most II-V How does limited prescriptive authority impact patients