PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSE PRESCRIBERS QUESTION AND ANSWERS

  Nurse practitioner prescriptive authority is regulated by who? - Correct Answers: The State Board of Nursing for Each State What is the benefits of having an APRN prescriber? - Correct Answers: APRN's care for patients more holistically and include patients in making decisions regarding their care What does clinical judgement in prescribing include? - Correct Answers: Factoring in the cost of the particular What is included in the criteria for choosing and effective drug for a disorder? - Correct Answers: Consulting nationally recognized guidelines for disease management NP's thrive under the new health-care reform because of what? - Correct Answers: NP's have the ability to control care cost and improve patient outcome Nutritional intake and lab results reflect hypoalbuminemia; why is this important for prescribers? - Correct Answers: The Distribution of drugs to target tissues may be affected Drugs that have an significant first-pass effect what? - Correct Answers: they are rapidly metabolized by the liver and may have little if any desired action The route of excretion of a volatile drug will likely be? - Correct Answers: Lungs Medroxyprogesterone (Depo Provera) is prescribed IM to create storage reservoir of the drug. What are storage reserviors> - Correct Answers: Increased the length of time a drug is available and active Why is Cephalexin given every 8 hours? What knowledge of the drug does the NP know? - Correct Answers: Half Life Azithromycin doing requires that the first day's doing be twice those of the other four day; This is considered a loading does. What is a loading dose? - Correct Answers: Rapidly actives drug levels in the therapeutic range The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - Correct Answers: Onset of action Phenytoin required that a trough level be drawn. When and why are peak and trough levels are done - Correct Answers: To determine if a d rug is in the therapeutic range Drugs that are receptor agonists may demonstrate what property? - Correct Answers: Concentrations will produce an adverse effect Factors that affect gastric drug absorption include - Correct Answers: Lipid solubility of the drug Drugs that are receptors antagonists, such as beta-blockers, may cause what? - Correct Answers: An exaggerated response if abrupt discontinues Drug administration via IV: 1) need to be lipid soluble in order to absorb easily 2) Begin distribution in the body immediately 3) Are easily absorbed if they are nonionized 4) May use pinocytosis to be absorbed - Correct Answers: Are easily absorbed if they are nonionized What is the combination effect when a medication is added to a regimen for a synergistic effect? - Correct Answers: Greater than the sum of the effects of each drug individually Which of the following statements about bioavailability is true? 1) Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2) brands of a drug have the same bioavailability. 3) Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4) Combining an active drug with an inert substance does not affect bioavailability. - Correct Answers: Bioavailability issues are especially important for drugs with narrow therapeutic Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1) Water soluble and ionized drugs cross these barriers rapidly. 2) The blood-brain barrier slows the entry of many drugs into and from brain cells. 3) The fetal-placental barrier protects the fetus from drugs taken by the mother. 4) Lipid-soluble drugs do not pass these barriers and are safe for pregnant women - Correct Answers: The blood-brain barrier slows the entry of many drugs into and from brain cells. What is the purpose of phase I and phase II of metabolism in the liver? - Correct Answers: Change drug molecules to a form that an excretory organ can excrete What happens to the metabolites after they are metabolized in the liver? - Correct Answers: the metabolite may or may not be more active than the parent drug and they are totally deactivated so they are excreted without and effect; it depends on the medication being given What causes the body to increased the excretion of a drug through the renal system - Correct Answers: Unbinding a nonvolatile drug from plasma proteins. What is "steady state"? - Correct Answers: When the amount of the drug in the body remains constant When two pain medications are given together to treat pain, what kind of drug-to-drug interaction occurs? - Correct Answers: Additive Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: 1) Reducing the dosage of one of the drugs 2) Scheduling their administration at different times 3) Prescribing a third drug to counteract the adverse reaction of the combination 4) Reducing the dosage of both drugs - Correct Answers: Prescribing a third drug to counteract the adverse reaction of the combination What reduces the inhibition properties of Phase 1 Oxidative reductive process of drug metabolism? - Correct Answers: What is the period of time called that it takes for a drug too decreased by 50% in the body? - Correct Answers: Half Life Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug - Correct Answers: Is modified by the concurrent administration of another drug What happens when a drug antagonist is given regularly? - Correct Answers: Down regulated the number of specific receptors What should be included in the education fo those who are prescribed oral enteric coated tables - Correct Answers: To achieve best effect, take the tablet with at least 8 oz of fluids What is the main reason for not crushing a sustained-released. capsule? - Correct Answers: It can cause toxicity What medication in the follow is mostly absorbed in the intestines rather than the stomach? 1) Sodium bicarb 2) ascorbic acid 3) salicylic acid 4) glucose - Correct Answers: Sodium Bicarb Which of the following variables is a factor in drug absorption? 1) The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2) A rich blood supply to the area of absorption leads to better absorption. 3) The less soluble the drug, the more easily it is absorbed. 4) Ionized drugs are easily absorbed across the cell membrane. - Correct Answers: A rich blood supply of the are of absorption leads to better absorption What is an advantage of prescribing a sublingual medication? - Correct Answers: Absorbed rapidly Drugs that use CYP 3A4 isoenzymes for metabolism may? - Correct Answers: Induced and inhibit the metabolism of another drug When do drugs reach steady state? - Correct Answers: After four or give half lives Ppregulation or hyper sensitization may lead to - Correct Answers: An exaggerated response if the drug is withdrawn Why do prescribers often use liquid medications such as liquid ibuprofen for children? - Correct Answers: Children often able to swallow pills In deciding which of multiple drugs used to treat a condition, the NPO chooses Drug A because it: 1) Has serious side effects and it is being used for a life-threatening condition 2) Will be taken twice daily and will be taken at home 3) Is expensive, but covered by health insurance 4) Non of these are important in choosing a drug - Correct Answers: Will be taken twice daily and will be taken at home What is known about the differences between the pharmacokinetics of men and women. - Correct Answers: Percentage of fat differs between genders What is the first step of the prescribing process according to WHO? - Correct Answers: Diagnosis the problem Treatment goals in prescribing should: - Correct Answers: be patient-centered The therapeutic goals when prescribing include - Correct Answers: curative, palliative, and preventative When determining drug treatment, what should an NP always do? - Correct Answers: Individualize the drug choice for the specific patient What should patient education include when prescribing a medication? - Correct Answers: Discussion on adverse effects of the medication Passive monitoring of drug effectiveness includes: 1. Therapeutic drug levels 2. Adding or subtracting medications from the treatment regimen 3. Ongoing provider visits 4. Instructing the patient to report if the drug is not effective - Correct Answers: Instructing the patient to report if the drug is not effective Pharmacokinetic factors that affect prescribing include - Correct Answers: Bioavailability What recommendations bu the Institute of Medicine were made to address the impact of pharmaceutical promotion - Correct Answers: Conflicts of interest and financial relationships should be disclosed by those providing education Under new U.S. FDA labeling, Pregnancy Categories will be: - Correct Answers: Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label What does the US FDA Regulate? - Correct Answers: The official labeling of all prescriptions and over the counter drugs What is approval of the FDA required for? - Correct Answers: Medical devices, including artificial joints When is an investigational new drug filed with the FDA? - Correct Answers: Prior to human testing of any new drug entity Phase IV clinical trials in the US are also known as - Correct Answers: Postmarketing research trials Is off-label prescribing legal? - Correct Answers: yes if there is scientific evidence for the use What does the US Drug Enforcement Administration Regulate? - Correct Answers: Registers manufacturers and prescribers of controlled substances Are drugs that are disgnedated Schedule II by the DEA refillable - Correct Answers: No. A new prescription needs to be written What are some precautions when prescribing a controlled substance? - Correct Answers: Using tamper-proof paper for all prescriptions written for controlled drugs. What are some strategies for prescribers to use to prevent the misuse of controlled prescriptions? - Correct Answers: Use a chemical dependency screening tool; fir limit-setting regarding controlled substances; and practicing saying no to deal with patients who are push overs What are some behaviors that predict addition to controlled substances - Correct Answers: Stealing and borrowing another patients drugs When are medications agreements/pain medication contracts recommended? - Correct Answers: Universally for all medications prescribed for chronic pain When and what do prescriptions needs to be written - Correct Answers: Medical devices, controlled drugs, and legend drugs Based on the patients below, who is at high risk for experiencing an adverse drug reaction? 1) 32-year old male 2) 22- year told female 3) 3 month old female 4)48 year old male - Correct Answers: 3 month old Why are infants and babies are a higher risk of adverse drug reactions? - Correct Answers: lack of safety and efficacy studies in pediatric populations Why are elderly at high risk of adverse drug reactions? - Correct Answers: Age-related decrease in renal function The type of adverse drug reaction that is idiosyncratic when a drug is given in the usual therapeutic dose is type - Correct Answers: Type B Digoxin may cause a type A adverse drug reaction due to: 1. Idiosyncratic effects 2. Its narrow therapeutic index 3. Being a teratogen 4. Being a carcinogen - Correct Answers: Its narrow therapeutic index What type of reaction occurs after a medication is used? - Correct Answers: Type IV If neutropenia occurs after the use of a topical medication, what type of reaction is neutropenia characterized as - Correct Answers: Cytotoxic hypersensitivyt reaction What type of reaction is anaphylactic shock? - Correct Answers: Type 1 Reaction; Also known as an immediate hypersensitivity reaction What time of reaction is someone using a corticosteroid at risk for? - Correct Answers: Type C Why do immunomodulators such as azathioprine cause a delayed reaction (type D reaction) - Correct Answers: because they are carcinogens An example of a first-dose reaction that may occur includes: 1. Orthostatic hypotension that does not occur with repeated doses 2. Purple glove syndrome with phenytoin use 3. Hemolytic anemia from ceftriaxone use 4. Contact dermatitis from neomycin use - Correct Answers: Orthostatic hypotension that does not occur with repeated doses Drugs that are prone to cause adverse drug reactions include - Correct Answers: Insulins US FDA MedWatch system is activated when: - Correct Answers: An adverse even or serious problem occurs with a medication that is not already identified on the label The Vaccine Adverse Events Reporting System is - Correct Answers: A voluntary reporting system that healthcare providers or consumers may use to report vaccine adverse events What is pharmacoeconomics? - Correct Answers: The analysis of the cost and consequences of any health-care related treatment or services The direct cost of drug therapy includes - Correct Answers: Pain and suffering due to inadequate drug therapy Indirect costs associated with drug therapy include? - Correct Answers: Loss of wages while undergoing drug therapy The intangible cost of drug therapy include? - Correct Answers: Inconvenience, pain, and suffering incurred with therapy What is it called when a pharmacoeconomic analysis takes place regarding two similar treatments for a disease? - Correct Answers: Cost-minimization analysis Cost-effectiveness analysis compares two or more treatments or programs that are: - Correct Answers: not necessarily therapeutically equivalent When the cost of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as - Correct Answers: Cost-benefit analysis What is a two-tiered prescription benefit plan? - Correct Answers: Higher co-pay for brand name drugs than for generic drugs When a provider proscribes a less expensive drug what does it increase and how? - Correct Answers: Compliance & by decreasing the financial burden set on the patient When someone asks to explain what a coverage plan means, such as a Medicare plan, what should the NP do? - Correct Answers: Refer the patient to a Medicare Specialist at his insurance carrier to explain the benefits of his insurance Digoxin levels need to be monitored closely when the following medication is started: 1. Loratadine 2. Diphenhydramine 3. Ipratropium 4. Albuterol - Correct Answers: Albuterol Patients with pheochromocytoma should avoid what class of drug and why? - Correct Answers: Beta-2-Agonists as it causes hypertensive crisis What medications should be use cautiously with African American men with moderate persistent asthma? - Correct Answers: Salmeterol - It is an inhaled long-acting beta agonist; studies showed increase of respiratory and asthma related deaths in African Americans LTBA's received a black box warning due to? - Correct Answers: increased risk of asthma related deaths What is the bronchodilator of choice for those taking propranolol? - Correct Answers: Ipratropium Life-style management for those taking theophylline. - Correct Answers: self-monitoring of respiratory status w. peak flowmeter; stop smoking; voice environmental triggers for asthma What does Tiotropium bromide treat (Spiriva)? - Correct Answers: COPD the medication is an inhaled anticholinergic How often should Beclomethasone be used for someone with asthma? - Correct Answers: Daily What are some side effects if montelukast (singular)? - Correct Answers: Aggression, anxiety, depression, and or suicidal thoughts Who can montelukast be prescribed for? - Correct Answers: a child with moderate persistent asthma Are there known drug reactions with Beclomethasone (QVAR) - Correct Answers: No What prescription of the following will someone with acute rhinitis benefit from? 1) Fluticasone 2) Cetirizine (Zyrtec) 3) OTC Cromolyn Nasap Spray (Nasalcrom) 4) Any of the Above? - Correct Answers: Any of the above What should be monitor for those who are taking diphenhydramine? - Correct Answers: Urinary retention Why are second generation antihistamines such as Claritin taking for seasonal allergies instead of first generation? - Correct Answers: They are less sedating then first generation antihistamines Who can be prescribed Sudafed? - Correct Answers: Anyone over the age of 4 years old In what populations should cough and cold medicines that contain sympathomimetic decongestion be used cautiously? - Correct Answers: Older adults, infects, and hypertensive patients What is the first line decongestant for someone who is hypertensive? - Correct Answers: Nasal Oxymetazoline What is the first line treatment for a 5 year old with a URI? - Correct Answers: Fluids and symptomatic care What is an effective, cost effective treatment for impetigo form an insect bite? - Correct Answers: Bacitracin and Ploymixin B What are the instructions for applying a topical antibiotic or antiviral ointment? - Correct Answers: Was hands before and after the application of topical antimicrobials