Advanced Pharmacotherapeutics MSN Exam Questions With Correct Solutions

Drug Safety - ANS Maximum effect with minimum amount of side effects FDA all medications must be approved by the FDA anyone who prescribes needs an NPI (national provider identifier)...used for electronic tracking for anything or any prescription of medical devices (i.e. diabetic shoes, a cane, etc.) > this is provided by the CENTERS FOR MEDICARE OR MEDICAID SERVICES = CMS. Phase I clinical trials - ANS on healthy people (occurs after testing on animals) Phase II clinical trials - ANS the first time the drug is administered in patients with the actual disease process for which the drug is intended to treat. - effectiveness and tolerability - multicentric Phase III clinical control - ANS randomized controlled with double-blinded arms. may also include dose-ranging studies. - multicentric approved or rejected - ANS Phase IV (phase four) - ANS are we comparing this drug to another drug? post marketing studies. This is where we see a lot of side effects because so many more people are taking it. scheduled drugs - ANS schedule is 1-5 (schedule 1 is the most intense = highest potential for abuse, highly addictive. little to no therapeutic effect. i.e. heroin, cocaine) CANNOT BE PRESCRIBED schedule 2 (high abuse high addictive..prescribed for very specific situations). needs a paper prescription. no refills allowed). can't really be called in. print it out, hand sign and date it (i.e. no "30" but "thirty") NEED DEA NUMBER schedule 3 (lower addiction lower abuse but still some addiction) i.e. percocet. paper prescripiton, signed and dated. New prescription each month just like schedule 2 NEED DEA NUMBER schedule 4 (benzos, valium, ativan...less addictive still but still some potential) NEED DEA NUMBER schedule 5 (robitussin with codeine) NEED DEA NUMBER DEA - ANS US Drug Enforcement Agency (controls number and caliber of people who have the license) - ANS a patient can be affected if they go between brand name to generic or generic to generic meds. CAM - ANS Complimentary or Alternative Medicine sold as food supplements so not FDA approved truth in labeling act, in 2004 ability to prescribe is determined by... - ANS the state African Americans - ANS VERY responsive to Calcium channel blockers but NOT to ACE inhibitors Nurse practitioner prescriptive authority is regulated by - ANS The State Board of Nursing for each state Rx Requirements (for practitioner) - ANS Name and Title Practice address and phone License and NPI DEA # if a controlled substance ...also name and number of collaborating physician but you don't need their NPI or DEA number Rx Requirements (for patient) - ANS Patient Information (dob) Medication and formulation strength and frequency Quantitity (may need to spell out) refills signature Pharmacogenomics - ANS Pharmacogenetics starts with an unexpected drug response result and looks for a genetic cause Pharmacogenomics on the other hand begins with looking for genetic differences within a population that explain certain observed responses to a drug or susceptibility to a health problem First Pass Effect - ANS most drugs given orally must first pass through the liver. Destroys part of the drug before its distributed widely "dosage" refers the the amount of the drug that is absorbed by the body AFTER first pass effect Pharmacology - ANS - The study of drugs Drug - Any substance that when taken into a living organism, may modify 1 or more of its functions - ANS - Any substance that when taken into a living organism, may modify 1 or more of its functions Pharmacotherapeutics - ANS - Use of drugs to prevent, treat, or diagnose a disease Pharmacokinetics - ANS - How the body deals with the drug - Absorption: Rate and efficiency depend on route of administration; Transfer of a drug from the site of administration to the bloodstream Bioavailability - % of drug given that reaches the bloodstream in an un-metabolized form - Ex: 100g of drug given, 50g enters bloodstream - the drug is 50% bioavailable - Influenced by route of administration; IV drugs are 100% bioavailable - Distribution - Metabolism - Elimination Factors Effecting Absorption/Bioavailability - ANS • Drug formulation influences rate of absorption - Dissolution must occur before absorption - Immediate release (IR) formulations dissolve quickly - Extended, delayed release formulations dissolve slowly → absorbed over an extended time - Enteric coating (EC) delays absorption • EC ASA dissolves in the intestines to prevent gastric irritation ie aspirin can have an enteric coating. good for patients who have heart disease and would benefit from aspirin but have a history of stomach ulcers. Aspirin is really acidic and will increase the acidity of gastric contents. WE NEVER REALLY KNOW WHAT IS GOING TO HAPPEN TO THE DRUG • Rate of gastric emptying affects absorption - ↑ gastric emptying → drug is delivered to the small intestine more quickly to enhance absorption • Blood flow to intestine is > than that of the stomach → ↑ absorption • Diet and gastric emptying - High fat meals and solid foods = decreased gastric emptying • Drugs that slow gastric motility = increased absorption - Example is anticholinergics • Laxatives and diarrhea = decreased absorption • ↓ Gastric motility • Blood circulation - Injected drugs into a hypoperfused arealimited bioavailability - ↓ blood flow to GI mucosa