PC707 Final Safety Exam Study Guide

Understand, identify, and rank evidence-based prescribing resources - *Trusted sources* Research: RCT, systematic reviews Expert orgs like ACOG, AAFP, etc Lexicomp Natural Meds LactMeds DailyMed CredibleMeds (QT) Describe safe and ethical prescribing for family and friends - *if* you do it, treat as any patient full history, exam, etc Rx only with *extreme* caution if even allowed in your state Understand pregnancy letter categories and PLLR - Categories A, B, C, D, X --phasing out, too confusing PLLR is more comprehensive and specific about known risks Immune-mediated adverse drug reactions (hypersensitivity rxn) - Type 1: immediate, IgE, anaphylaxis Type 4: delayed, t-cell, dermatitis, SJS Understand agonist/antagonist and receptor site activity - Agonist=activates receptor Antagonist=blocks drug from binding to receptor Know term - absolute contraindication - Risk always outweighs benefit, never give Know term - relative contraindication - Benefit *may* outweigh risk Know term - precaution - =warnings Understand med reconciliation and safety - Review meds at *every* visit for changes -including supplements -medicinal foods -polypharmacy (5+ concurrent meds) -increased risk of adverse reaction Understand how physiologic changes in the elderly impact prescribing - Small liver mass--less enzymes--less effective metabolism==lower dose Same with kidneys - less mass and capability to break down and clear drugs, remain in blood stream longer Understand how physiologic changes in peds impact prescribing - neonates/infants have immature metabolic capacity, cannot break down and clear drugs as well as everyone else Review OTC meds regarding safety in pregnant women and peds - -Not well known r/t lack of research -few "A" drugs: acetaminophen, 1st gen antihistamines -pediatric formulation important, may have same name as for adults but contain different active ingredient What is BEERS list and STOPP tool and use implications - -guidelines of rx'ing to those 65+ -identifies Potentially Inappropriate Medications -not hard rules, but considerations Genomics: Poor metabolizer - No alleles to metab drug Active drug: increased exposure b/c not metabolized out of body Prodrug: decreased exposure b/c not metabolized into active form Genomics: Intermediate metabolizer - Decreased alleles to metab drug Active drug: increased exposure b/c not metabolized out of body as efficiently