ADVANCE PHARMACY NR565 MIDTERM QUESTIONS WITH CERTIFIED SOLUTIONS

QUESTIONS WITH CERTIFIED SOLUTIONS Which schedule drugs can APRNs prescribe? Schedule II-V · Who determines and regulates prescriptive authority? Nurse practitioner scope of practice is determined by state practice and licensure laws. · How does limited prescriptive authority impact patients within the healthcare system? limited authority creates problems for the patient. The patient is not able to get the care they need · What are the key responsibilities of prescribing? 1. Be prudent and deliberate in your decision-making process 2. Have a documented provider-patient relationship with the person for whom you are prescribing 3. Do not prescribe medications for family or friends or for yourself 4. Document a thorough history and physical examination in your records 5.Include any discussions you have with the patient regarding risk factors, side effects, or therapy options 6. Have a documented plan regarding drug monitoring or titration, if applicable · What should be used to make prescribing decisions? Pharmakinetiscs and Pharmodynamics of older adults drug accumulation secondary to 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 · Beer's Criteria •potentially Inappropriate Medication (PIM) use in older adults •PIM use in older adults due to medication-disease or medication-syndrome interactions that may exacerbate the disease or syndrome •medications to be used cautiously in older adults •clinically significant drug interactions that should be avoided in older adults •medications to be avoided or dosage decreased in the presence of impaired kidney function in older adults (American Geriatric Society Beers Criteria Update Expert Panel, 2019) CYP450 Many medications are metabolized through the liver enzyme system called cytochrome P450 (CYP450). Metabolization can be inhibited or induced by drugs and once this happens drug-drug interactions can occur. VISA credit card dept Inhibits Spending on CK and GQ Valproate I-soniazid S-ulfamids A-miodarone C-hloramphenical Ketoconazole G-rapefruit Juice Q-uinidine CYP450 Inhibitors - Decreases the CYP450 which keeps the medication in your body longer which can cause toxicity CYP450 INDUCERS Increase CYP450 to work faster causes Drugs to leave your body faster. Inducers for PY450 Chronic Alcholics Steal Phen Phen and Never Refuse Greasy Carbs Chronic Alcoholics St. Johns Wort Phenytoin Phenobarbital Nevirapine Refiampin Griseofalvin Carbamazepine · What happens when someone has a poor metabolism phenotype? Metabolizes to slow or to fast. How is absorption of intramuscular medication different in neonates? •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? Delayed gastric emptying (adult values reached by 6-8 months) What are some medications that should be avoided in the pediatric patient? glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus with sulfonamides •What should be included in medication administration patient education? 1. dosage size and timing 2. route and technique of administration 3. duration of treatment storage e and time course of desired responses 6. nature and time course of adverse responses •What are some of the Physiologic changes that occur in the body when a woman is pregnant that can change the pharmacodynamic and pharmacokinetic properties of many drugs? - Increased GFR= Increased drug excretion - Increased hepatic metabolism for some drugs. - Decreased tone and mobility of bowel - Increased drug absorption. •During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long-term consequences? 1 trimester •What are some medications that we know to be teratogenic? •Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES). •How can we as healthcare providers decrease the likelihood of a elderly patient experiencing an adverse drug reaction? •- obtaining a thorough drug history that includes over-the-counter medications •considering pharmacokinetic and pharmacodynamic 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 Why do Nitrates need to be taken no later than 4 pm? Need nitrate free interval so tolerance doesn't develop •What are the nine factors that impact the outcome of medication according to Rosenthal & Burcham? •Gender and race •Genetics and pharmacogenomics •Variability in absorption •placebo effect •Tolerance •patho •age •bodyweight •What is the difference between NP practice authority and prescriptive authority? Practice authority refers to the nurse practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse practitioner's authority to prescribe medications independently and without limitations. •Who regulates prescription authority? The regulation of prescriptive authority is under the jurisdiction of a health professional board. This may be the State Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state. Although the federal government controls drug regulation, it has no control over prescriptive authority. •What is scope of practice determined by? Nurse practitioner scope of practice is determined by state practice and licensure laws. •What is full-practice authority? Nurse practitioners have the autonomy to evaluate patients, diagnose, order and interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without physician oversight.