NR 565 - advanced pharmacology midterm – Chamberlain questions and solutions

NR 565 - advanced pharmacology midterm – Chamberlain
questions and solutions

During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term
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consequences? - answers1st trimester (fetus most at risk d/t rapid growth)
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What is BEERS criteria? - answersRecommendations of medications inappropriate for elderly (65 and older), prescribe
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ultimately decides
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What is the CYP450 (cytochrome P450) - answersliver enzyme system where medications are metabolized, can either
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be inducers or inhibitors and create drug-drug interactions
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CYP450 inducers - answersSpeed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blo
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levels of drug), elevate CYP450 enzymes
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CYP450 inducers pneumonic - answers"Bullshit Crap GPS INDUCES rage"
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CYP450 inducer drug names - answersBarbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin,
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griseofulvin, phenobarbital, sulfonylureas
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CYP450 inhibitors - answersinhibit metabolism, increase blood levels of medications
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CYP450 pneumonic - answers"VISA credit card debt INHIBITS spending on designers like CK to look GQ"
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CYP450 inhibitors drug names - answersValproate, isoniazid, sulfonamides, amiodarone, chloramphenicol,
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ketoconazole, grapefruit juice, quinidine
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Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties of drugs? -
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answersincrease glomerular filtration rate leads to increase durg excretion
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increase hepatic metabolism ak ak




decrease tone and motility of bowel ak ak ak ak ak




increase drug absorption ak ak




Examples of medications that can be teratogenic - answersAntiepileptic drugs, antimicrobials such as tetracyclines an
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fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol
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(DES).
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How is absorption of intramuscular medications different in neonates? - answersslow and erratic due to low blood flow in
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muscles first few days of life
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Why is absorption of medication in the stomach increased in infancy? - answersdelayed gastric emptying
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Some medications that should be avoided in the pediatric patient? - answersglucocorticoids, discoloration of developin
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teeth with tetracyclines, and kernicterus with sulfonamides, levofloxacin (antibiotics)
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aspirin (Severe intoxication from acute overdose)
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what should be included in medication administration patient education? - answersdosage size and timing
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,route and technique of administration
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duration of treatment ak ak




drug storage ak




nature and time course of desired responses ak ak ak ak ak ak




nature and time course of adverse responses ak ak ak ak ak ak




finish taking antibiotic ak ak




What are some things that put the elderly patient at higher risk for adverse drug reactions? - answersreduced renal
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function
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polypharmacy (the use of five or more medications daily) ak ak ak ak ak ak ak ak




greater severity of illness ak ak ak




presence of comorbidities ak ak




use of drugs that have a low therapeutic index (e.g., digoxin)
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increased individual variation secondary to altered pharmacokinetics ak ak ak ak ak ak




inadequate supervision of long-term therapy ak ak ak ak




poor patient adherence
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How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? -
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answersobtaining a thorough drug history that includes over-the-counter medications
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considering pharmacokinetic and pharmacodynamics changes due to age ak ak ak ak ak ak ak




monitoring the patient's clinical response and plasma drug levels ak ak ak ak ak ak ak ak




using the simplest regimen possible
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monitoring for drug-drug interactions and iatrogenic illness ak ak ak ak ak ak




periodically reviewing the need for continued drug therapy ak ak ak ak ak ak ak




encouraging the patient to dispose of old medications ak ak ak ak ak ak ak




taking steps to promote adherence and to avoid drugs on the Beers list
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How can we promote medication adherence with elderly patients? - answerssimplifying drug regimens
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providing clear and concise verbal and written instructions ak ak ak ak ak ak ak




using an appropriate dosage form
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clearly labeling and dispensing easy-to-open containers
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developing daily reminders ak ak




monitoring frequently ak




affordability of drugs ak ak




support systems ak




Why do nitrates need to be taken no later than 4 PM? - answersNeed nitrate free interval so tolerance doesn't develop
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Nine factors that impact outcome of medication? - answersGender and race
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Genetics and pharmacogenomics ak ak




Variability in absorption ak ak




placebo effect ak




Tolerance
patho
age
bodyweight

Do you need informed consent for genetic testing? - answersyes
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What is the purpose of the Genetic Information Non-Discriminatory Act? - answersProtects patients from discrimination
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by employers and insurance providers based on genetic information
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,Difference between practice authority and prescriptive authority? - answersPractice authority refers to the nurse
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practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse
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practitioner's authority to prescribe medications independently and without limitations.
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Who regulates prescriptive authority? - answersthe jurisdiction of a health professional board. This may be the State
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Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state.
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What is scope of practice determined by? - answersis determined by state practice and licensure laws.
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What is full practice authority? - answersNurse practitioners have the autonomy to evaluate patients, diagnose, order a
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interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without
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physician oversight.
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What is reduced practice authority? - answersNurse practitioners are limited in at least one element of practice. The sta
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requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient
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care. ex/ physician involvement for 5 yrs than independent
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What is restricted practice authority? - answersNurse practitioners are limited in at least one element of practice by
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requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to
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provide patient care.- typically doctor on site
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What are components of Rx? - answersPrescriber Contact info
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Prescribers name ak




NPI
DEA
Patient name ak




DOB
Date
Allergies
Medication name ak




Strength
Quantity
Indication for use ak ak




Direction for use ak ak




Refills
Signature

What are some potential problems that arise with written prescriptions? - answersMust contain all elements
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May have pre-populated information ak ak ak




Write legibly ak




Avoid error prone abbreviations ak ak ak




Tamper resistant scripts are often required ak ak ak ak ak




Reasons for monitoring drug therapy - answersdetermining therapeutic dosage ak ak ak ak ak ak ak ak




evaluating medication adequacy ak ak




identifying adverse effects ak ak




serious or life-threatening risks. ak ak ak




Which schedules of drugs can APRNs prescribe? - answersdepends on state - most II-V
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