NR 565 MIDTERM FINAL EXAM COMPLETE UPDATED (QUESTIONS AND ANSWERS)

NR 565 MIDTERM FINAL EXAM COMPLETE UPDATED (QUESTIONS AND ANSWERS) Which schedule drugs can APRNs prescribe? - CORRECT ANSWE-Varies state by state May include schedule II-V, but never schedule I Who determines and regulates prescriptive authority? - CORRECT ANSWE-The state's health professional board How does limited prescriptive authority impact patients within the healthcare system? - CORRECT ANSWE-Creates numerous barriers to quality, affordable, and accessible patient care May prevent outreach to areas of greatest need Physician approval of prescriptions can increase patient waits What are the key responsibilities of prescribing? - CORRECT ANSWE-A sound understanding of drugs and the conditions that they are used to manage Be deliberate in decision-making process Do not prescribe for family or friends Document thorough history and physical for the records, including education provided on drug Have a documented plan for monitoring and titration What should be used in making prescribing decisions? - CORRECT ANSWE-Cost, follow current guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for monitoring, special populations PK and PD changes in older adults and how that affects how you prescribe? - CORRECT ANSWE-Very high risk of adverse drug reactions and drug-drug interactions D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence Beer's Criteria - CORRECT ANSWE-List of potentially inappropriate medications to use in the older populations Updated annually Prescribers ultimately decide whether to prescribe or not Impacts/outcomes of polypharmacy? - CORRECT ANSWE-Increased ADRs and drugdrug interactions What are CYP450? - CORRECT ANSWE-Enzymes responsible for drug metabolism (biotransformation)-oxidization, reduction, hydrolyzed to promote renal dug excretion Hepatic enzyme system, composed of 12 enzyme families What do CYP450 enzymes do? - CORRECT ANSWE-Promote drug excretion by making them more "excretable"--hydrophilic/water soluble and charged (ion) Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease drug toxicity CYP450 inhibitor examples? - CORRECT ANSWE-VISA credit card debt inhibits spending on designers like CK to look GQ Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconzaole Grapefruit juice Quinidine What do CYP450 inhibitors do? - CORRECT ANSWE-Decrease the rate of metabolism Act on liver through process of inhibition Slows rate of metabolism, increases active drug accumulation which can lead to adverse reactions and drug toxicity What do CYP450 inhibitors do if not used correctly? - CORRECT ANSWE-Can lead to adverse effects and drug toxicity What happens when someone has a poor metabolism phenotype? - CORRECT ANSWE-Associated with accumulation of drugs in the body and they may experience drug toxicity What does the US FDA regulate when it comes to medications? - CORRECT ANSWERegulates safety and effectiveness of drugs sold in US Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA approval Once drug is on market, FDA continues oversight of drug safety and effectiveness Reasons for medication nonadherence? - CORRECT ANSWE-Forgetfulness, lack of planning, cost, dissatisfaction, altered dosing Black Box Warnings - CORRECT ANSWE-Strongest safety warning a drug can carry and still remain on the market Required by the FDA on drugs with serious or life-threatening risks Neonate and infant drug absorption - CORRECT ANSWE-Drug sensitivity d/t organ immaturity-increased risk of ADRs Drug action unusually intense and prolonged Transdermal absorption in neonates? - CORRECT ANSWE-Infants have thin skin with high blood flow- increased absoprtion and increased risk of toxicity IM absorption in neonates and infants? - CORRECT ANSWE-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? - CORRECT ANSWE-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? - CORRECT ANSWE-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? - CORRECT ANSWE-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 - CORRECT ANSWE-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 - CORRECT ANSWE-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? - CORRECT ANSWE-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? - CORRECT ANSWE-I have a CRAP GPS Carbamazepine