NR 565 MIDTERM STUDY AND GUIDE EXAM | QUESTIONS AND DETAILED
ANSWERS| 100% CORRECT| GRADE A+ |100% PASS
Which schedule drugs can APRNs prescribe? - ANSWER Varies state by state
May include schedule II-V, but never schedule I
Who determines and regulates prescriptive authority? - ANSWER The state's health
professional board
Neonate and infant drug absorption - ANSWER Drug sensitivity d/t organ immaturity-increased
risk of ADRs
Drug action unusually intense and prolonged
Transdermal absorption in neonates? - ANSWER Infants have thin skin with high blood flow-
increased absoprtion and increased risk of toxicity
IM absorption in neonates and infants? - ANSWER Neonate- absorption is slow and erratic d/t
low blood flow through muscle in first days of life
Early infancy- absorption is faster d/t increased blood flow
PO absorption in neonates and infants? - ANSWER Gastric emptying delayed (adult emptying by
6-8mos)
Increased absorption of drugs absorbed in stomach, decreased for those absorbed in intestines
Low gastric acid for first 24 hours, adult acidity by 24 months--increased absorption of acid-
labile drugs
When does absorption reach adult level? - ANSWER Generally by 1 year
Metabolism is faster in kids <2yo and gradually declines til puberty
Long-term dosing may need adjusting
, Common fears with genetic testing? - ANSWER Many providers don't have knowledge/comfort
to order and interpret testing
High financial cost, usually not covered by insurance
Fear of discrimination from employers, insurance companies or providers
GINA helps protect genetic testing info from employers and insurance
Pharmacokinetics - ANSWER Study of the drug's movement throughout the body
ADME-absoprtion, distribution, metabolism, excretion
ADME controls the concentration of drugs at the site of action
Pharmacodynamics - ANSWER Study of the biochemical and physiologic effects of drugs on the
body and the molecular mechanisms by which those effects are produced
What do CYP450 inducers do? - ANSWER Work on liver to stimulate enzyme synthesis
Increase drug metabolism, which decreases amount of active drug and plasma drug levels fall
Dose adjustments need to be made to accomodate this or pt may not achieve therapeutic levels
CYP450 inducer examples? - ANSWER I have a CRAP GPS
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
Guiding principles for prescribers (pain) - ANSWER Find lowest effective dose for tolerable pain
, Determine what kind of pain it is (visceral-NSAIDs/steroids)
Determine when to initiate opioids for pain
What's an example of a pure opioids agonist? - ANSWER Drugs that bind to opioid receptors
and produce analgesic effects
Morphine (strong agonist) and codeine (moderate to strong agonist)
What is used to calculate a patient's overdose risk? - ANSWER Calculate the total daily dose of
opioids in morphine milligram equivalents (MMEs)
Concern in >= 50 MME/day
How would you know when to refer someone to a pain specialist for pain management? -
ANSWER Required for patients taking 120 mg per day of MMEs
Prescription Drug Monitoring Program - ANSWER Electronic database that enables provides to
access information regarding patients' history of controlled substances
Nearly all states have it
Shown results in changing prescribing behaviors, decreases use of multiple prescribers,
decreases substance abuse treatment admissions
How do renal and hepatic function impact opioid medication levels in the body? - ANSWER
Decrease function leads to less ability to metabolize and excrete drugs
Pts can experience greater peak effects and longer duration of action
Lowers threshold for res depression and OD to occur
How to assess someone for possible drug diversion? - ANSWER Occurs when medication is
redirected from its intended destination for personal use, sale, or distribution to others
Signs=Frequent med/wasting errors, patients complaining of lack of meds, altering med orders,
changes in behavior, etc
ANSWERS| 100% CORRECT| GRADE A+ |100% PASS
Which schedule drugs can APRNs prescribe? - ANSWER Varies state by state
May include schedule II-V, but never schedule I
Who determines and regulates prescriptive authority? - ANSWER The state's health
professional board
Neonate and infant drug absorption - ANSWER Drug sensitivity d/t organ immaturity-increased
risk of ADRs
Drug action unusually intense and prolonged
Transdermal absorption in neonates? - ANSWER Infants have thin skin with high blood flow-
increased absoprtion and increased risk of toxicity
IM absorption in neonates and infants? - ANSWER Neonate- absorption is slow and erratic d/t
low blood flow through muscle in first days of life
Early infancy- absorption is faster d/t increased blood flow
PO absorption in neonates and infants? - ANSWER Gastric emptying delayed (adult emptying by
6-8mos)
Increased absorption of drugs absorbed in stomach, decreased for those absorbed in intestines
Low gastric acid for first 24 hours, adult acidity by 24 months--increased absorption of acid-
labile drugs
When does absorption reach adult level? - ANSWER Generally by 1 year
Metabolism is faster in kids <2yo and gradually declines til puberty
Long-term dosing may need adjusting
, Common fears with genetic testing? - ANSWER Many providers don't have knowledge/comfort
to order and interpret testing
High financial cost, usually not covered by insurance
Fear of discrimination from employers, insurance companies or providers
GINA helps protect genetic testing info from employers and insurance
Pharmacokinetics - ANSWER Study of the drug's movement throughout the body
ADME-absoprtion, distribution, metabolism, excretion
ADME controls the concentration of drugs at the site of action
Pharmacodynamics - ANSWER Study of the biochemical and physiologic effects of drugs on the
body and the molecular mechanisms by which those effects are produced
What do CYP450 inducers do? - ANSWER Work on liver to stimulate enzyme synthesis
Increase drug metabolism, which decreases amount of active drug and plasma drug levels fall
Dose adjustments need to be made to accomodate this or pt may not achieve therapeutic levels
CYP450 inducer examples? - ANSWER I have a CRAP GPS
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
Guiding principles for prescribers (pain) - ANSWER Find lowest effective dose for tolerable pain
, Determine what kind of pain it is (visceral-NSAIDs/steroids)
Determine when to initiate opioids for pain
What's an example of a pure opioids agonist? - ANSWER Drugs that bind to opioid receptors
and produce analgesic effects
Morphine (strong agonist) and codeine (moderate to strong agonist)
What is used to calculate a patient's overdose risk? - ANSWER Calculate the total daily dose of
opioids in morphine milligram equivalents (MMEs)
Concern in >= 50 MME/day
How would you know when to refer someone to a pain specialist for pain management? -
ANSWER Required for patients taking 120 mg per day of MMEs
Prescription Drug Monitoring Program - ANSWER Electronic database that enables provides to
access information regarding patients' history of controlled substances
Nearly all states have it
Shown results in changing prescribing behaviors, decreases use of multiple prescribers,
decreases substance abuse treatment admissions
How do renal and hepatic function impact opioid medication levels in the body? - ANSWER
Decrease function leads to less ability to metabolize and excrete drugs
Pts can experience greater peak effects and longer duration of action
Lowers threshold for res depression and OD to occur
How to assess someone for possible drug diversion? - ANSWER Occurs when medication is
redirected from its intended destination for personal use, sale, or distribution to others
Signs=Frequent med/wasting errors, patients complaining of lack of meds, altering med orders,
changes in behavior, etc
