MN 553 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Peak drug level - ✔✔*Time it takes a drug to demonstrate its full therapeutic effect.
*The peak level is the highest concentration of a drug in the patient's bloodstream.
**Note: Random drug levels may be ordered and are appropriate for monitoring drug
usage if drug is being administered by continuous IV infusion.
✔✔Investigating new drugs - ✔✔*New drug investigation is filed with the USDA prior to
human testing of any new drug entity.
*An Investigational New Drug (IND) is a drug developed by a pharmaceutical or biotech
company or other organization that is ready for clinical trials on humans. When a drug
reaches this point, the pharma company submits an application to get the consent of the
Food and Drug Administration (FDA) to begin these trials.
✔✔Being an Interpreter - ✔✔*Use reliable person at hospital (employee)
*Use certified interpreters for language, hearing and speech impairments. Provider
liable for poor outcomes if lay interpreter is used
✔✔Nonadherence - ✔✔Choose drugs with higher tolerability & fewer SE such as n/v, &
dizziness.
Contributing factors:
-poor communication
-forgetfulness (especially if it is a side effect of a drug), lack of knowledge, dementia,
mental health problems, simple procrastination, or an overextended lifestyle.
-Adverse Drug Reactions.
-Cognitive Impairment and Psychiatric Illness.
-Complexity of Drug Regimen and Polypharmacy.
Top 4 Reasons for Non-Adherence
•Side Effects
•Cost
•Too Complex and/or Forgetfulness
•"I'm Cured" Complex
✔✔Poor health outcomes in vulnerable populations - ✔✔-Discrimination, cultural
barriers, and lack of health care.
- Chronically ill and disabled
-Low-income and/or homeless individuals
-Certain geographical communities (rural areas), Native Americans living on
reservations are also vulnerable.
-LGBTQ+ population (have faced or fear facing discrimination).
-Children & elderly
,✔✔Tamoxifen - ✔✔- Selective estrogen receptor modulator (SERM) class used to tx
conditions that respond to adding or withdrawing estrogen.
-Tamoxifen blocks estradiol-induced cancer cell growth (in breast tissue) inhibiting the
tumor blood supply. (A provider may test the pt for CYP2D6 variants prior to starting
Tamoxifen to reduce the likelihood of therapeutic failure w/tx)
✔✔Cont. Tamoxifen - ✔✔-Tamoxifen can increase your risk of stroke or blood clots.
*Pharmacodynamics: Complete with estrogen for binding sites in tissues high in
esterogen receptors, such as breast tissues. This mechanism deprives estrogen-
sensitive tumors of estgerogen. It also inhibits the growth of most cancer & other
epithelioid cells.
Contraindications/precautions: Caution in those with myelolsuppression and who are
pregnancy or breast-feeding.
*Adverse effects: hot flashes (in premenopausal women), mild nausea, HA, light-
headedness, weight gain, vaginal bleeding/discharge, visual side effects, skin rash.
*Drug-drug oral anticoagulants and bromociptine. Dietary: grapefruit and tangerines can
lessen the effectiveness of tamoxifen.
*May increase levels of: calcium, cholesterol & triglycerides.
*Assess for s/sx: N/V, constipation, hypotonicity of muscles, and deep bone and flank
pain.
*PATIENT TEACHING- Women should be advised not to become pregnant while taking
tamoxifen and should use barrier contra
✔✔Ginseng - ✔✔OTC to help improve memory, can potentiate (increase power or
effect of) INSULIN.
Adverse effects.drug interactions: hypoglycemia, anticoagulant properties (epistaxis,
vaginal bleeding), increases risk if clots when used with warfarin. Cant use w/MAOIs,
may cause HA, nervousness, mood disorders. Do not give to hypertensive pts.
Adverse effects: diarrhea, unstable mood, skin rash, itching, loss of menstrual periods,
vaginal bleeding in menopause, reduced libido, gynecomastia in men. Do not use in
women w/breast/uterine CA or endometriosis.
✔✔Pharmacoeconomics - ✔✔The analysis of costs & consequences of any health care
related tx or service.
Definition: Branch of health economics that compares the value of pharmaceutical to
one another.
✔✔FACTORS INFLUENCING PHARMACOECONOMIC OUTCOMES - ✔✔Research
Type
, Clinical outcomes
Efficacy
Safety
Adverse drug reaction
Drug-drug reaction
Hospital admission, clinic visits
Humanistic outcomes
Patient satisfaction with care
Quality of life measured by validated instrument
Economic outcomes
Cost associated with immunosuppressive therapy
Cost to treat adverse drug reactions
Cost to treat drug-drug interactions
Cost to treat long-term toxicity (nephrotoxicity, hypertension)
Cost of laboratory workups
✔✔Commonly Used Pharmacoeconomic Research Methodologies - ✔✔**Cost-
minimization
Outcome: Outcome must be clinically identical in similar patient population
All social costs should be considered
EX: Adalat CC vs Procardia XL. Generic azathioprine vs brand-name azathioprine.
**Cost-effectiveness
Different clinical outcome
Justify the incremental cost increase for the therapeutic benefit from extra costs
associated with treatment
EX: antilymphocyte induction vs no induction.
**Cost-benefit
Expressing clinical outcome purely in monetary units
Assigns a dollar value to specific disease state
Unethical and should be avoided
Ex: 10 mm Hg reduction in blood pressure worth $100
✔✔Pharmacoeconomics - ✔✔Pharmacoeconomics is the study of the appropriate
utilization of drugs for the treatment of a specific disease. Pharmacoeconomic studies
characterize the improved outcomes while justifying additional drug expenditures.
Because the value and economics of many approved drugs are unknown at the time,
the true impact of new drug substitution on the cost and care of most patients with
complicated conditions is also unknown. In theory, if a therapeutically equivalent and
less expensive product is available, it should be substituted. This may substantially
affect the cost of drug therapy and overall health-care costs. Applying
pharmacoeconomics to prescribing practice involves understanding the impact of drug
costs on patients and making an educated prescribing decision to ensure the best
outcome.
SOLUTIONS GRADED A+
✔✔Peak drug level - ✔✔*Time it takes a drug to demonstrate its full therapeutic effect.
*The peak level is the highest concentration of a drug in the patient's bloodstream.
**Note: Random drug levels may be ordered and are appropriate for monitoring drug
usage if drug is being administered by continuous IV infusion.
✔✔Investigating new drugs - ✔✔*New drug investigation is filed with the USDA prior to
human testing of any new drug entity.
*An Investigational New Drug (IND) is a drug developed by a pharmaceutical or biotech
company or other organization that is ready for clinical trials on humans. When a drug
reaches this point, the pharma company submits an application to get the consent of the
Food and Drug Administration (FDA) to begin these trials.
✔✔Being an Interpreter - ✔✔*Use reliable person at hospital (employee)
*Use certified interpreters for language, hearing and speech impairments. Provider
liable for poor outcomes if lay interpreter is used
✔✔Nonadherence - ✔✔Choose drugs with higher tolerability & fewer SE such as n/v, &
dizziness.
Contributing factors:
-poor communication
-forgetfulness (especially if it is a side effect of a drug), lack of knowledge, dementia,
mental health problems, simple procrastination, or an overextended lifestyle.
-Adverse Drug Reactions.
-Cognitive Impairment and Psychiatric Illness.
-Complexity of Drug Regimen and Polypharmacy.
Top 4 Reasons for Non-Adherence
•Side Effects
•Cost
•Too Complex and/or Forgetfulness
•"I'm Cured" Complex
✔✔Poor health outcomes in vulnerable populations - ✔✔-Discrimination, cultural
barriers, and lack of health care.
- Chronically ill and disabled
-Low-income and/or homeless individuals
-Certain geographical communities (rural areas), Native Americans living on
reservations are also vulnerable.
-LGBTQ+ population (have faced or fear facing discrimination).
-Children & elderly
,✔✔Tamoxifen - ✔✔- Selective estrogen receptor modulator (SERM) class used to tx
conditions that respond to adding or withdrawing estrogen.
-Tamoxifen blocks estradiol-induced cancer cell growth (in breast tissue) inhibiting the
tumor blood supply. (A provider may test the pt for CYP2D6 variants prior to starting
Tamoxifen to reduce the likelihood of therapeutic failure w/tx)
✔✔Cont. Tamoxifen - ✔✔-Tamoxifen can increase your risk of stroke or blood clots.
*Pharmacodynamics: Complete with estrogen for binding sites in tissues high in
esterogen receptors, such as breast tissues. This mechanism deprives estrogen-
sensitive tumors of estgerogen. It also inhibits the growth of most cancer & other
epithelioid cells.
Contraindications/precautions: Caution in those with myelolsuppression and who are
pregnancy or breast-feeding.
*Adverse effects: hot flashes (in premenopausal women), mild nausea, HA, light-
headedness, weight gain, vaginal bleeding/discharge, visual side effects, skin rash.
*Drug-drug oral anticoagulants and bromociptine. Dietary: grapefruit and tangerines can
lessen the effectiveness of tamoxifen.
*May increase levels of: calcium, cholesterol & triglycerides.
*Assess for s/sx: N/V, constipation, hypotonicity of muscles, and deep bone and flank
pain.
*PATIENT TEACHING- Women should be advised not to become pregnant while taking
tamoxifen and should use barrier contra
✔✔Ginseng - ✔✔OTC to help improve memory, can potentiate (increase power or
effect of) INSULIN.
Adverse effects.drug interactions: hypoglycemia, anticoagulant properties (epistaxis,
vaginal bleeding), increases risk if clots when used with warfarin. Cant use w/MAOIs,
may cause HA, nervousness, mood disorders. Do not give to hypertensive pts.
Adverse effects: diarrhea, unstable mood, skin rash, itching, loss of menstrual periods,
vaginal bleeding in menopause, reduced libido, gynecomastia in men. Do not use in
women w/breast/uterine CA or endometriosis.
✔✔Pharmacoeconomics - ✔✔The analysis of costs & consequences of any health care
related tx or service.
Definition: Branch of health economics that compares the value of pharmaceutical to
one another.
✔✔FACTORS INFLUENCING PHARMACOECONOMIC OUTCOMES - ✔✔Research
Type
, Clinical outcomes
Efficacy
Safety
Adverse drug reaction
Drug-drug reaction
Hospital admission, clinic visits
Humanistic outcomes
Patient satisfaction with care
Quality of life measured by validated instrument
Economic outcomes
Cost associated with immunosuppressive therapy
Cost to treat adverse drug reactions
Cost to treat drug-drug interactions
Cost to treat long-term toxicity (nephrotoxicity, hypertension)
Cost of laboratory workups
✔✔Commonly Used Pharmacoeconomic Research Methodologies - ✔✔**Cost-
minimization
Outcome: Outcome must be clinically identical in similar patient population
All social costs should be considered
EX: Adalat CC vs Procardia XL. Generic azathioprine vs brand-name azathioprine.
**Cost-effectiveness
Different clinical outcome
Justify the incremental cost increase for the therapeutic benefit from extra costs
associated with treatment
EX: antilymphocyte induction vs no induction.
**Cost-benefit
Expressing clinical outcome purely in monetary units
Assigns a dollar value to specific disease state
Unethical and should be avoided
Ex: 10 mm Hg reduction in blood pressure worth $100
✔✔Pharmacoeconomics - ✔✔Pharmacoeconomics is the study of the appropriate
utilization of drugs for the treatment of a specific disease. Pharmacoeconomic studies
characterize the improved outcomes while justifying additional drug expenditures.
Because the value and economics of many approved drugs are unknown at the time,
the true impact of new drug substitution on the cost and care of most patients with
complicated conditions is also unknown. In theory, if a therapeutically equivalent and
less expensive product is available, it should be substituted. This may substantially
affect the cost of drug therapy and overall health-care costs. Applying
pharmacoeconomics to prescribing practice involves understanding the impact of drug
costs on patients and making an educated prescribing decision to ensure the best
outcome.
