NR 565 CERTIFICATION EVALUATION EXAMS
SOLVED QUESTIONS STUDY GUIDE
GUARANTEED TO PASS
◉ 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
SOLVED QUESTIONS STUDY GUIDE
GUARANTEED TO PASS
◉ 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
