NR565/NR 565 ADVANCED PHARMACOLOGY CARE OF FUNDAMENTALS MIDTERM EXAM WITH VERIFIED ANSWERS

NR565/NR 565 ADVANCED PHARMACOLOGY CARE OF FUNDAMENTALS MIDTERM EXAM WITH VERIFIED ANSWERS QUESTION How does strength of fentanyl compare to morphine Answer: high milligram potency (about 100 times that of morphine) QUESTION through what system is fentanyl metabolized? Answer: CYP34A (isoenzyme of CYP450), levels of fentanyl can be increased by CYP34A inhibitors QUESTION What is methadone used to treat? Answer: relieve pain and treat opioid addiction QUESTION What are some things that put the elderly patient at higher risk for adverse drug reactions? Answer: 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 QUESTION How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? Answer: 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 QUESTION How can we promote medication adherence with elderly patients? Answer: 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 QUESTION Why do nitrates need to be taken no later than 4 PM? Answer: Need nitrate free interval so tolerance doesn't develop QUESTION Nine factors that impact outcome of medication? Answer: Gender and race Genetics and pharmacogenomics Variability in absorption placebo effect Tolerance patho age bodyweight QUESTION Do you need informed consent for genetic testing? Answer: yes QUESTION What is the purpose of the Genetic Information Non-Discriminatory Act? Answer: Protects patients from discrimination by employers and insurance providers based on genetic information QUESTION What are some things that put the elderly patient at higher risk for adverse drug reactions? Answer: 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 QUESTION How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? Answer: 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 QUESTION How can we promote medication adherence with elderly patients? Answer: 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 QUESTION Why do nitrates need to be taken no later than 4 PM? Answer: Need nitrate free interval so tolerance doesn't develop QUESTION Nine factors that impact outcome of medication? Answer: Gender and race Genetics and pharmacogenomics Variability in absorption placebo effect Tolerance patho age bodyweight QUESTION Do you need informed consent for genetic testing? Answer: yes