Frontier PC 707 Advanced Pharmacology Final d d d d d d
Safety Exam Test With Mark Scheme d d d d d
Understand and identify evidenced-based prescribing resources -
d d d d d d d
ACOG, American Ca Society, National lung and heart instituete, EEP, Dynamed, Lexicomp,
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
Sanford guide, lactamed **NO PDR
d d d d
Understand PLLR: Drugs in Pregnancy and Lactation: Improved Benefit-Risk information. -
d d d d d d d d d d d
June 2015; 3 sections pregnancy-L&D, Lactation-nursing mothers; Fe/males of
d d d d d d d d d d d d d d d d d d d d d d d d d
reproductive age; labeling updated as new information arrives, more current information to discuss
d d d d d d d d d d d d d
risk vs benefit
d d
Type 1-IgE - d d d
d d d d d d d d d d d d d d d d Immediate hypersensitivity ex) angioedema, anaphylaxis
d d d d
Type 2-antibody Dependent -
d d d d
d d d d d d d d d d d d d d d d minutes to days ex) heparin induced thrombocytopenia
d d d d d d
Type 3- Immune Complex hypersensitivity -
d d d d d d
d d d d d d d d d d d d d d d d ex) arthrus reaction to tetanus
d d d d
Type 4- non-IgE, Cell mediated delayed -
d d d d d d d
d d d d d d d d d d d d d d d d 48-72 hours (delayed) ex) drug rash, Eosinophilia, poison Ivy,
d d d d d d d d
What are ADRs? What is the APRNs responsibility in ADRs? -
d d d d d d d d d d d
Adverse drug reactions 1) pharmacological (predictable) 2) idiosyneratic
d d d d d d d d d d d d d d d d d d d d d d d d
(unpredicted/severe); APRN: document & record specific reaction & drug; injury involved; FDA
d d d d d d d d d d d d
reporting
Concepts of pharmacokinetics and pharmacodynamics in safety. -
d d d d d d d d
d d d d d d d d d d d d d d d d Pharmacokinetics- how body handles drug or how it moves through the d d d d d d d d d d
1|Page
,Understand biotransformation, enzyme induction and inhibition and Grapefruit and CYP 450. -
d d d d d d d d d d d d
enzyme Inhibitors: decrease CYP450 enzymes, increasing pharmacological action of the
d d d d d d d d d d d d d d d d d d d d d d d d d d
drug (more drug, more action); basically inhibit the metabolizing system. Enzyme Induction: induces
d d d d d d d d d d d d
the CYP450 causing increased amount of CYP450 which results in the increased metabolism, which
d d d d d d d d d d d d d d d
decreases pharmacologic action of the drug.
d d d d d
Grapefruit juice - d d d
prevents certain drugs in GI system from breaking down or metabolizing, therefore when
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
combined with certain drugs it equals increased action.
d d d d d d d
Common side effects - d d d d
d d d d d d d d d d d d d d d d skin reactions-happen commonly; also nausea, headache, dizziness
d d d d d d
Serious side effects - d d d d
those that result in death; life threatening, hospitalization, dehibilitating, prolonged QT
d d d d d d d d d d d d d d d d d d d d d d d d d d d
prolongation
Absolute contraindication - d d d
d d d d d d d d d d d d d d d d DO NOT prescribe d d
Relative contraindication - d d d
d d d d d d d d d d d d d d d d risk of not using the med may outweigh risk of using
d d d d d d d d d d
Precautions - d d
d d d d d d d d d d d d d d d d consider risk, benefits & alternatives (pregnancy/lactation, pediatric, elderly)
d d d d d d d
Understand medication reconciliation and safety. - d d d d d d
Always ask about Allergies. Detail review of pt medication hx including herbals, OTCs or
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
PRN meds DO THIS AT EVERY VISIT. A-allergies V-vitamins O-old drugs/OTC I-Interactions D-
d d d d d d d d d d d d
dependence M-mendel-family hx-benefits or reactions; goal of therapy -related drug class -MOA -
d d d d d d d d d d d d
features of specific drugs -how do they get into body (PO, inject)-metabolized and excretion
d d d d d d d d d d d d d
Know The World Health Organization (WHO) Six Step Model of Rational Prescribing -
d d d d d d d d d d d d d
2|Page
, 1-define pt problem 2-specify therapeutic objective 3-choose tx 4-start tx 5-educate pt 6-
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
d monitor effectiveness d
Review physiologic changes in the elderly. -
d d d d d d d
Increased gastric PH; decreased peristalisis (increased length of time for absorption to
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
occur); decreased muscle mass; decreased total body water (decreased distribution); decreased
d d d d d d d d d d d
liver mass (effects metabolism); Also polypharmacy >5 drugs
d d d d d d d
Review physiologic changes in pregnancy. -
d d d d d d
Numerous changes-most drugs don't need dosage change Increased volume= decreased
d d d d d d d d d d d d d d d d d d d d d d d d d d
albumin=increased unbound drug=increased clearance Increased blood flow to organs, increased
d d d d d d d d d d
GFR Increased renal excretion Decreased gastric motility=longer transport times, increased
d d d d d d d d d d
bioavailability Ex) SSRI-3rd trimester increased metabolism & increased excretion = increased
d d d d d d d d d d d
amounts, more frequent dosing because of increased excretion, and longer transport/distribution
d d d d d d d d d d
Review physiologic changes in peds. -
d d d d d d
Higher rate of metabolism; drugs are less protein bound, higher water concentration=
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
increased distribution. Dosing based on kg; Infants= organ immaturity which can increase toxicity
d d d d d d d d d d d d d
(decreased metabolism & excretion); underdeveloped blood brain barriar=drugs readily to CNS; PO
d d d d d d d d d d d d
drugs not absorbed well due to variable peristalsis
d d d d d d d
What is Beers list and STOPP Tools and use implications? -
d d d d d d d d d d d
BEERS-1991 used to identify harmful drugs for elderly; >65 START-screening tool STOPP-
d d d d d d d d d d d d d d d d d d d d d d d d d d d
screening tool >65 Tools-benefit outweighs risk, use drug; Guidelines not protocols
d d d d d d d d d d
Understand the impact of genomics and metabolism. -
d d d d d d d d
Personalization of drug; each pt responds differently to drugs based on individual genetic
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
makeup; genetic data can guide selection of drugs & avoid ADRs; cheek swab (inadequate efficacy
d d d d d d d d d d d d d d d
& safety); especially important for depression meds
d d d d d d
What is a teratogen? -
d d d d d
d d d d d d d d d d d d d d d d Causing malformation of embryo-characterized by effect at gestation time
d d d d d d d d
Scheduled drugs and RX writing - d d d d d d
Scheduled: controlled substances (I-V); high potential for abuse (some narcotic, some
d d d d d d d d d d d d d d d d d d d d d d d d d d d
not) Prescription drugs: not all are scheduled, need a script; cannot buy over the counter ex) PCN
d d d d d d d d d d d d d d d d
3|Page
Safety Exam Test With Mark Scheme d d d d d
Understand and identify evidenced-based prescribing resources -
d d d d d d d
ACOG, American Ca Society, National lung and heart instituete, EEP, Dynamed, Lexicomp,
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
Sanford guide, lactamed **NO PDR
d d d d
Understand PLLR: Drugs in Pregnancy and Lactation: Improved Benefit-Risk information. -
d d d d d d d d d d d
June 2015; 3 sections pregnancy-L&D, Lactation-nursing mothers; Fe/males of
d d d d d d d d d d d d d d d d d d d d d d d d d
reproductive age; labeling updated as new information arrives, more current information to discuss
d d d d d d d d d d d d d
risk vs benefit
d d
Type 1-IgE - d d d
d d d d d d d d d d d d d d d d Immediate hypersensitivity ex) angioedema, anaphylaxis
d d d d
Type 2-antibody Dependent -
d d d d
d d d d d d d d d d d d d d d d minutes to days ex) heparin induced thrombocytopenia
d d d d d d
Type 3- Immune Complex hypersensitivity -
d d d d d d
d d d d d d d d d d d d d d d d ex) arthrus reaction to tetanus
d d d d
Type 4- non-IgE, Cell mediated delayed -
d d d d d d d
d d d d d d d d d d d d d d d d 48-72 hours (delayed) ex) drug rash, Eosinophilia, poison Ivy,
d d d d d d d d
What are ADRs? What is the APRNs responsibility in ADRs? -
d d d d d d d d d d d
Adverse drug reactions 1) pharmacological (predictable) 2) idiosyneratic
d d d d d d d d d d d d d d d d d d d d d d d d
(unpredicted/severe); APRN: document & record specific reaction & drug; injury involved; FDA
d d d d d d d d d d d d
reporting
Concepts of pharmacokinetics and pharmacodynamics in safety. -
d d d d d d d d
d d d d d d d d d d d d d d d d Pharmacokinetics- how body handles drug or how it moves through the d d d d d d d d d d
1|Page
,Understand biotransformation, enzyme induction and inhibition and Grapefruit and CYP 450. -
d d d d d d d d d d d d
enzyme Inhibitors: decrease CYP450 enzymes, increasing pharmacological action of the
d d d d d d d d d d d d d d d d d d d d d d d d d d
drug (more drug, more action); basically inhibit the metabolizing system. Enzyme Induction: induces
d d d d d d d d d d d d
the CYP450 causing increased amount of CYP450 which results in the increased metabolism, which
d d d d d d d d d d d d d d d
decreases pharmacologic action of the drug.
d d d d d
Grapefruit juice - d d d
prevents certain drugs in GI system from breaking down or metabolizing, therefore when
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
combined with certain drugs it equals increased action.
d d d d d d d
Common side effects - d d d d
d d d d d d d d d d d d d d d d skin reactions-happen commonly; also nausea, headache, dizziness
d d d d d d
Serious side effects - d d d d
those that result in death; life threatening, hospitalization, dehibilitating, prolonged QT
d d d d d d d d d d d d d d d d d d d d d d d d d d d
prolongation
Absolute contraindication - d d d
d d d d d d d d d d d d d d d d DO NOT prescribe d d
Relative contraindication - d d d
d d d d d d d d d d d d d d d d risk of not using the med may outweigh risk of using
d d d d d d d d d d
Precautions - d d
d d d d d d d d d d d d d d d d consider risk, benefits & alternatives (pregnancy/lactation, pediatric, elderly)
d d d d d d d
Understand medication reconciliation and safety. - d d d d d d
Always ask about Allergies. Detail review of pt medication hx including herbals, OTCs or
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
PRN meds DO THIS AT EVERY VISIT. A-allergies V-vitamins O-old drugs/OTC I-Interactions D-
d d d d d d d d d d d d
dependence M-mendel-family hx-benefits or reactions; goal of therapy -related drug class -MOA -
d d d d d d d d d d d d
features of specific drugs -how do they get into body (PO, inject)-metabolized and excretion
d d d d d d d d d d d d d
Know The World Health Organization (WHO) Six Step Model of Rational Prescribing -
d d d d d d d d d d d d d
2|Page
, 1-define pt problem 2-specify therapeutic objective 3-choose tx 4-start tx 5-educate pt 6-
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
d monitor effectiveness d
Review physiologic changes in the elderly. -
d d d d d d d
Increased gastric PH; decreased peristalisis (increased length of time for absorption to
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
occur); decreased muscle mass; decreased total body water (decreased distribution); decreased
d d d d d d d d d d d
liver mass (effects metabolism); Also polypharmacy >5 drugs
d d d d d d d
Review physiologic changes in pregnancy. -
d d d d d d
Numerous changes-most drugs don't need dosage change Increased volume= decreased
d d d d d d d d d d d d d d d d d d d d d d d d d d
albumin=increased unbound drug=increased clearance Increased blood flow to organs, increased
d d d d d d d d d d
GFR Increased renal excretion Decreased gastric motility=longer transport times, increased
d d d d d d d d d d
bioavailability Ex) SSRI-3rd trimester increased metabolism & increased excretion = increased
d d d d d d d d d d d
amounts, more frequent dosing because of increased excretion, and longer transport/distribution
d d d d d d d d d d
Review physiologic changes in peds. -
d d d d d d
Higher rate of metabolism; drugs are less protein bound, higher water concentration=
d d d d d d d d d d d d d d d d d d d d d d d d d d d d
increased distribution. Dosing based on kg; Infants= organ immaturity which can increase toxicity
d d d d d d d d d d d d d
(decreased metabolism & excretion); underdeveloped blood brain barriar=drugs readily to CNS; PO
d d d d d d d d d d d d
drugs not absorbed well due to variable peristalsis
d d d d d d d
What is Beers list and STOPP Tools and use implications? -
d d d d d d d d d d d
BEERS-1991 used to identify harmful drugs for elderly; >65 START-screening tool STOPP-
d d d d d d d d d d d d d d d d d d d d d d d d d d d
screening tool >65 Tools-benefit outweighs risk, use drug; Guidelines not protocols
d d d d d d d d d d
Understand the impact of genomics and metabolism. -
d d d d d d d d
Personalization of drug; each pt responds differently to drugs based on individual genetic
d d d d d d d d d d d d d d d d d d d d d d d d d d d d d
makeup; genetic data can guide selection of drugs & avoid ADRs; cheek swab (inadequate efficacy
d d d d d d d d d d d d d d d
& safety); especially important for depression meds
d d d d d d
What is a teratogen? -
d d d d d
d d d d d d d d d d d d d d d d Causing malformation of embryo-characterized by effect at gestation time
d d d d d d d d
Scheduled drugs and RX writing - d d d d d d
Scheduled: controlled substances (I-V); high potential for abuse (some narcotic, some
d d d d d d d d d d d d d d d d d d d d d d d d d d d
not) Prescription drugs: not all are scheduled, need a script; cannot buy over the counter ex) PCN
d d d d d d d d d d d d d d d d
3|Page
