NR 565 - advanced pharmacology
midterm - Chamberlain
During what trimester is a pregnant woman most at risk for adverse drug reactions
with potential long term consequences? - ANSWER 1st trimester (fetus most at risk
d/t rapid growth)
What is BEERS criteria? - ANSWER Recommendations of medications
inappropriate for elderly (65 and older), prescriber ultimately decides
What is the CYP450 (cytochrome P450) - ANSWER liver enzyme system where
medications are metabolized, can either be inducers or inhibitors and create drug-
drug interactions
CYP450 inducers - ANSWER Speed up metabolism of drugs (drug is cleared
faster), drug has lesser effect (decrease blood levels of drug), elevate CYP450
enzymes
CYP450 inducers pneumonic - ANSWER "Bullshit Crap GPS INDUCES rage"
CYP450 inducer drug names - ANSWER Barbituates, St John wort,
Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
CYP450 inhibitors - ANSWER inhibit metabolism, increase blood levels of
medications
CYP450 pneumonic - ANSWER "VISA credit card debt INHIBITS spending on
designers like CK to look GQ"
CYP450 inhibitors drug names - ANSWER Valproate, isoniazid, sulfonamides,
amiodarone, chloramphenicol, ketoconazole, grapefruit juice, quinidine
Physiological changes during pregnancy that impact pharmacodynamics and
pharmacokinetic properties of drugs? - ANSWER 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 - ANSWER 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? - 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
Some medications that should be avoided in the pediatric patient? - ANSWER
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? - ANSWER
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? - 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
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
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
, Why do nitrates need to be taken no later than 4 PM? - ANSWER Need nitrate free
interval so tolerance doesn't develop
Nine factors that impact outcome of medication? - ANSWER Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - ANSWER yes
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
Difference between practice authority and prescriptive authority? - ANSWER
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? - ANSWER 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? - ANSWER is determined by state
practice and licensure laws.
What is full practice authority? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
midterm - Chamberlain
During what trimester is a pregnant woman most at risk for adverse drug reactions
with potential long term consequences? - ANSWER 1st trimester (fetus most at risk
d/t rapid growth)
What is BEERS criteria? - ANSWER Recommendations of medications
inappropriate for elderly (65 and older), prescriber ultimately decides
What is the CYP450 (cytochrome P450) - ANSWER liver enzyme system where
medications are metabolized, can either be inducers or inhibitors and create drug-
drug interactions
CYP450 inducers - ANSWER Speed up metabolism of drugs (drug is cleared
faster), drug has lesser effect (decrease blood levels of drug), elevate CYP450
enzymes
CYP450 inducers pneumonic - ANSWER "Bullshit Crap GPS INDUCES rage"
CYP450 inducer drug names - ANSWER Barbituates, St John wort,
Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
CYP450 inhibitors - ANSWER inhibit metabolism, increase blood levels of
medications
CYP450 pneumonic - ANSWER "VISA credit card debt INHIBITS spending on
designers like CK to look GQ"
CYP450 inhibitors drug names - ANSWER Valproate, isoniazid, sulfonamides,
amiodarone, chloramphenicol, ketoconazole, grapefruit juice, quinidine
Physiological changes during pregnancy that impact pharmacodynamics and
pharmacokinetic properties of drugs? - ANSWER 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 - ANSWER 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? - 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
Some medications that should be avoided in the pediatric patient? - ANSWER
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? - ANSWER
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? - 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
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
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
, Why do nitrates need to be taken no later than 4 PM? - ANSWER Need nitrate free
interval so tolerance doesn't develop
Nine factors that impact outcome of medication? - ANSWER Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - ANSWER yes
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
Difference between practice authority and prescriptive authority? - ANSWER
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? - ANSWER 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? - ANSWER is determined by state
practice and licensure laws.
What is full practice authority? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
