Frontier PC 707 Advanced Pharmacology Final Safety Exam (100% correct and graded A+)

Understand and identify evidenced-based prescribing resources - Answer-ACOG, American Ca Society, National lung and heart instituete, EEP, Dynamed, Lexicomp, Sanford guide, lactamed **NO PDR Understand PLLR: Drugs in Pregnancy and Lactation: Improved Benefit-Risk information. - AnswerJune 2015; 3 sections pregnancy-L&D, Lactation-nursing mothers; Fe/males of reproductive age; labeling updated as new information arrives, more current information to discuss risk vs benefit Type 1-IgE - Answer-Immediate hypersensitivity ex) angioedema, anaphylaxis Type 2-antibody Dependent - Answer-minutes to days ex) heparin induced thrombocytopenia Type 3- Immune Complex hypersensitivity - Answer-ex) arthrus reaction to tetanus Type 4- non-IgE, Cell mediated delayed - Answer-48-72 hours (delayed) ex) drug rash, Eosinophilia, poison Ivy, What are ADRs? What is the APRNs responsibility in ADRs? - Answer-Adverse drug reactions 1) pharmacological (predictable) 2) idiosyneratic (unpredicted/severe); APRN: document & record specific reaction & drug; injury involved; FDA reporting Concepts of pharmacokinetics and pharmacodynamics in safety. - Answer-Pharmacokinetics- how body handles drug or how it moves through the Understand biotransformation, enzyme induction and inhibition and Grapefruit and CYP 450. - Answer-enzyme Inhibitors: decrease CYP450 enzymes, increasing pharmacological action of the drug (more drug, more action); basically inhibit the metabolizing system. Enzyme Induction: induces the CYP450 causing increased amount of CYP450 which results in the increased metabolism, which decreases pharmacologic action of the drug. Grapefruit juice - Answer-prevents certain drugs in GI system from breaking down or metabolizing, therefore when combined with certain drugs it equals increased action.Common side effects - Answer-skin reactions-happen commonly; also nausea, headache, dizziness Serious side effects - Answer-those that result in death; life threatening, hospitalization, dehibilitating, prolonged QT prolongation Absolute contraindication - Answer-DO NOT prescribe Relative contraindication - Answer-risk of not using the med may outweigh risk of using Precautions - Answer-consider risk, benefits & alternatives (pregnancy/lactation, pediatric, elderly) Understand medication reconciliation and safety. - Answer-Always ask about Allergies. Detail review of pt medication hx including herbals, OTCs or PRN meds DO THIS AT EVERY VISIT. A-allergies Vvitamins O-old drugs/OTC I-Interactions D-dependence M-mendel-family hx-benefits or reactions; goal of therapy -related drug class -MOA -features of specific drugs -how do they get into body (PO, inject)-metabolized and excretion Know The World Health Organization (WHO) Six Step Model of Rational Prescribing - Answer-1- define pt problem 2-specify therapeutic objective 3-choose tx 4-start tx 5-educate pt 6- monitor effectiveness Review physiologic changes in the elderly. - Answer-Increased gastric PH; decreased peristalisis (increased length of time for absorption to occur); decreased muscle mass; decreased total body water (decreased distribution); decreased liver mass (effects metabolism); Also polypharmacy 5 drugs Review physiologic changes in pregnancy. - Answer-Numerous changes-most drugs don't need dosage change Increased volume= decreased albumin=increased unbound drug=increased clearance Increased blood flow to organs, increased GFR Increased renal excretion Decreased gastric motility=longer transport times, increased bioavailability Ex) SSRI-3rd trimester increased metabolism & increased excretion = increased amounts, more frequent dosing because of increased excretion, and longer transport/distribution Review physiologic changes in peds. - Answer-Higher rate of metabolism; drugs are less protein bound, higher water concentration= increased distribution. Dosing based on kg; Infants= organimmaturity which can increase toxicity (decreased metabolism & excretion); underdeveloped blood brain barriar=drugs readily to CNS; PO drugs not absorbed well due to variable peristalsis What is Beers list and STOPP Tools and use implications? - Answer-BEERS-1991 used to identify harmful drugs for elderly; 65 START-screening tool STOPP-screening tool 65 Tools-benefit outweighs risk, use drug; Guidelines not protocols Understand the impact of genomics and metabolism. - Answer-Personalization of drug; each pt responds differently to drugs based on individual genetic makeup; genetic data can guide selection of drugs & avoid ADRs; cheek swab (inadequate efficacy & safety); especially important for depression meds What is a teratogen? - Answer-Causing malformation of embryo-characterized by effect at gestation time Scheduled drugs and RX writing - Answer-Scheduled: controlled substances (I-V); high potential for abuse (some narcotic, some not) Prescription drugs: not all are scheduled, need a script; cannot buy over the counter ex) PCN