Advance Pharmacy NR565 MIDTERM
exam with complete solutions
·· Which schedule drugs can APRNs prescribe? - ANSWER- Schedule II-V
· Who determines and regulates prescriptive authority? - ANSWER- Nurse
practitioner scope of practice is determined by state practice and licensure laws.
· How does limited prescriptive authority impact patients within the healthcare
system? - ANSWER- limited authority creates problems for the patient. The
patient is not able to get the care they need
· What are the key responsibilities of prescribing? - ANSWER- 1. Be prudent and
deliberate in your decision-making process
2. Have a documented provider-patient relationship with the person for whom you
are prescribing
3. Do not prescribe medications for family or friends or for yourself
4. Document a thorough history and physical examination in your records
5.Include any discussions you have with the patient regarding risk factors, side
effects, or therapy options
6. Have a documented plan regarding drug monitoring or titration, if applicable
· What should be used to make prescribing decisions? - ANSWER-
Pharmakinetiscs and Pharmodynamics of older adults - ANSWER- drug
accumulation secondary to 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
- ANSWER-
· Beer's Criteria - ANSWER- •potentially Inappropriate Medication (PIM) use in
older adults
•PIM use in older adults due to medication-disease or medication-syndrome
interactions that may exacerbate the disease or syndrome
•medications to be used cautiously in older adults
•clinically significant drug interactions that should be avoided in older adults
•medications to be avoided or dosage decreased in the presence of impaired
kidney function in older adults (American Geriatric Society Beers Criteria Update
Expert Panel, 2019)
CYP450 - ANSWER- Many medications are metabolized through the liver enzyme
system called cytochrome P450 (CYP450). Metabolization can be inhibited or
induced by drugs and once this happens drug-drug interactions can occur.
VISA credit card dept Inhibits Spending on CK and GQ - ANSWER- Valproate
I-soniazid
S-ulfamids
A-miodarone
C-hloramphenical
Ketoconazole
G-rapefruit Juice
Q-uinidine
CYP450 Inhibitors - ANSWER- - Decreases the CYP450 which keeps the
medication in your body longer which can cause toxicity
CYP450 INDUCERS - ANSWER- Increase CYP450 to work faster causes
Drugs to leave your body faster.
Inducers for PY450 Chronic Alcholics Steal Phen Phen and Never Refuse Greasy
Carbs - ANSWER- Chronic Alcoholics
St. Johns Wort
Phenytoin
Phenobarbital
Nevirapine
, Refiampin
Griseofalvin
Carbamazepine
· What happens when someone has a poor metabolism phenotype? - ANSWER-
Metabolizes to slow or to fast.
How is absorption of intramuscular medication different in neonates? - ANSWER-
•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? -
ANSWER- Delayed gastric emptying (adult values reached by 6-8 months)
What are some medications that should be avoided in the pediatric patient? -
ANSWER- glucocorticoids, discoloration of developing teeth with tetracyclines,
and kernicterus with sulfonamides
•What should be included in medication administration patient education? -
ANSWER- 1. dosage size and timing
2. route and technique of administration
3. duration of treatment
4.drug storage
5.nature and time course of desired responses
6. nature and time course of adverse responses
•What are some of the Physiologic changes that occur in the body when a woman
is pregnant that can change the pharmacodynamic and pharmacokinetic
properties of many drugs? - ANSWER- - Increased GFR= Increased drug
excretion
- Increased hepatic metabolism for some drugs.
- Decreased tone and mobility of bowel
- Increased drug absorption.
•During what trimester is a pregnant woman most at risk for adverse drug
reactions with potential long-term consequences? - ANSWER- 1 trimester
•What are some medications that we know to be teratogenic? - ANSWER-
•Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones,
vitamin A in large doses, some anticoagulants, and hormonal medications such
as diethylstilbestrol (DES).
exam with complete solutions
·· Which schedule drugs can APRNs prescribe? - ANSWER- Schedule II-V
· Who determines and regulates prescriptive authority? - ANSWER- Nurse
practitioner scope of practice is determined by state practice and licensure laws.
· How does limited prescriptive authority impact patients within the healthcare
system? - ANSWER- limited authority creates problems for the patient. The
patient is not able to get the care they need
· What are the key responsibilities of prescribing? - ANSWER- 1. Be prudent and
deliberate in your decision-making process
2. Have a documented provider-patient relationship with the person for whom you
are prescribing
3. Do not prescribe medications for family or friends or for yourself
4. Document a thorough history and physical examination in your records
5.Include any discussions you have with the patient regarding risk factors, side
effects, or therapy options
6. Have a documented plan regarding drug monitoring or titration, if applicable
· What should be used to make prescribing decisions? - ANSWER-
Pharmakinetiscs and Pharmodynamics of older adults - ANSWER- drug
accumulation secondary to 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
- ANSWER-
· Beer's Criteria - ANSWER- •potentially Inappropriate Medication (PIM) use in
older adults
•PIM use in older adults due to medication-disease or medication-syndrome
interactions that may exacerbate the disease or syndrome
•medications to be used cautiously in older adults
•clinically significant drug interactions that should be avoided in older adults
•medications to be avoided or dosage decreased in the presence of impaired
kidney function in older adults (American Geriatric Society Beers Criteria Update
Expert Panel, 2019)
CYP450 - ANSWER- Many medications are metabolized through the liver enzyme
system called cytochrome P450 (CYP450). Metabolization can be inhibited or
induced by drugs and once this happens drug-drug interactions can occur.
VISA credit card dept Inhibits Spending on CK and GQ - ANSWER- Valproate
I-soniazid
S-ulfamids
A-miodarone
C-hloramphenical
Ketoconazole
G-rapefruit Juice
Q-uinidine
CYP450 Inhibitors - ANSWER- - Decreases the CYP450 which keeps the
medication in your body longer which can cause toxicity
CYP450 INDUCERS - ANSWER- Increase CYP450 to work faster causes
Drugs to leave your body faster.
Inducers for PY450 Chronic Alcholics Steal Phen Phen and Never Refuse Greasy
Carbs - ANSWER- Chronic Alcoholics
St. Johns Wort
Phenytoin
Phenobarbital
Nevirapine
, Refiampin
Griseofalvin
Carbamazepine
· What happens when someone has a poor metabolism phenotype? - ANSWER-
Metabolizes to slow or to fast.
How is absorption of intramuscular medication different in neonates? - ANSWER-
•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? -
ANSWER- Delayed gastric emptying (adult values reached by 6-8 months)
What are some medications that should be avoided in the pediatric patient? -
ANSWER- glucocorticoids, discoloration of developing teeth with tetracyclines,
and kernicterus with sulfonamides
•What should be included in medication administration patient education? -
ANSWER- 1. dosage size and timing
2. route and technique of administration
3. duration of treatment
4.drug storage
5.nature and time course of desired responses
6. nature and time course of adverse responses
•What are some of the Physiologic changes that occur in the body when a woman
is pregnant that can change the pharmacodynamic and pharmacokinetic
properties of many drugs? - ANSWER- - Increased GFR= Increased drug
excretion
- Increased hepatic metabolism for some drugs.
- Decreased tone and mobility of bowel
- Increased drug absorption.
•During what trimester is a pregnant woman most at risk for adverse drug
reactions with potential long-term consequences? - ANSWER- 1 trimester
•What are some medications that we know to be teratogenic? - ANSWER-
•Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones,
vitamin A in large doses, some anticoagulants, and hormonal medications such
as diethylstilbestrol (DES).
