NR 565 - ADVANCED PHARMACOLOGY
MIDTERM - CHAMBERLAIN
During9what9trimester9is9a9pregnant9woman9most9at9risk9for9adverse9drug9reactions9with9
potential9long9term9consequences?9-9ans--
1st9trimester9(fetus9most9at9risk9d/t9rapid9growth)
What9is9BEERS9criteria?9-9ans--
Recommendations9of9medications9inappropriate9for9elderly9(659and9older),9prescriber9ulti
mately9decides
What9is9the9CYP4509(cytochrome9P450)9-9ans--
liver9enzyme9system9where9medications9are9metabolized,9can9either9be9inducers9or9inhi
bitors9and9create9drug-drug9interactions
CYP4509inducers9-9ans--
Speed9up9metabolism9of9drugs9(drug9is9cleared9faster),9drug9has9lesser9effect9(decrease9
blood9levels9of9drug),9elevate9CYP4509enzymes
CYP4509inducers9pneumonic9-9ans--"Bullshit9Crap9GPS9INDUCES9rage"
CYP4509inducer9drug9names9-9ans--
Barbituates,9St9John9wort,9Carbamazepine,9rifampin,9alcohol,9phenytoin,9griseofulvin,9ph
enobarbital,9sulfonylureas
CYP4509inhibitors9-9ans--inhibit9metabolism,9increase9blood9levels9of9medications
CYP4509pneumonic9-
9ans--"VISA9credit9card9debt9INHIBITS9spending9on9designers9like9CK9to9look9GQ"
CYP4509inhibitors9drug9names9-9ans--
Valproate,9isoniazid,9sulfonamides,9amiodarone,9chloramphenicol,9ketoconazole,9grapef
ruit9juice,9quinidine
Physiological9changes9during9pregnancy9that9impact9pharmacodynamics9and9pharmaco
kinetic9properties9of9drugs?9-9ans--
increase9glomerular9filtration9rate9leads9to9increase9durg9excretion9
increase9hepatic9metabolism
decrease9tone9and9motility9of9bowel
increase9drug9absorption
,Examples9of9medications9that9can9be9teratogenic9-9ans--
Antiepileptic9drugs,9antimicrobials9such9as9tetracyclines9and9fluoroquinolones,9vitamin9A9
in9large9doses,9some9anticoagulants,9and9hormonal9medications9such9as9diethylstilbestr
ol9(DES).
How9is9absorption9of9intramuscular9medications9different9in9neonates?9-9ans--
slow9and9erratic9due9to9low9blood9flow9in9muscles9first9few9days9of9life
Why9is9absorption9of9medication9in9the9stomach9increased9in9infancy?9-9ans--
delayed9gastric9emptying
Some9medications9that9should9be9avoided9in9the9pediatric9patient?9-9ans--
glucocorticoids,9discoloration9of9developing9teeth9with9tetracyclines,9and9kernicterus9with
9sulfonamides,9levofloxacin9(antibiotics)9
aspirin9(Severe9intoxication9from9acute9overdose)
what9should9be9included9in9medication9administration9patient9education?9-9ans--
dosage9size9and9timing
route9and9technique9of9administration
duration9of9treatment
drug9storage
nature9and9time9course9of9desired9responses
nature9and9time9course9of9adverse9responses
finish9taking9antibiotic
What9are9some9things9that9put9the9elderly9patient9at9higher9risk9for9adverse9drug9reaction
s?9-9ans--reduced9renal9function9
polypharmacy9(the9use9of9five9or9more9medications9daily)
greater9severity9of9illness
presence9of9comorbidities
use9of9drugs9that9have9a9low9therapeutic9index9(e.g.,9digoxin)
increased9individual9variation9secondary9to9altered9pharmacokinetics
inadequate9supervision9of9long-term9therapy
poor9patient9adherence
How9can9healthcare9providers9decrease9likelihood9of9an9elderly9patient9experiencing9an9
adverse9drug9reaction?9-9ans--obtaining9a9thorough9drug9history9that9includes9over-the-
counter9medications
considering9pharmacokinetic9and9pharmacodynamics9changes9due9to9age
monitoring9the9patient's9clinical9response9and9plasma9drug9levels
using9the9simplest9regimen9possible
monitoring9for9drug-drug9interactions9and9iatrogenic9illness
periodically9reviewing9the9need9for9continued9drug9therapy
encouraging9the9patient9to9dispose9of9old9medications
taking9steps9to9promote9adherence9and9to9avoid9drugs9on9the9Beers9list
, How9can9we9promote9medication9adherence9with9elderly9patients?9-9ans--
simplifying9drug9regimens
providing9clear9and9concise9verbal9and9written9instructions
using9an9appropriate9dosage9form
clearly9labeling9and9dispensing9easy-to-open9containers
developing9daily9reminders
monitoring9frequently
affordability9of9drugs
support9systems
Why9do9nitrates9need9to9be9taken9no9later9than949PM?9-9ans--
Need9nitrate9free9interval9so9tolerance9doesn't9develop
Nine9factors9that9impact9outcome9of9medication?9-9ans--Gender9and9race
Genetics9and9pharmacogenomics
Variability9in9absorption
placebo9effect
Tolerance
patho
age
bodyweight
Do9you9need9informed9consent9for9genetic9testing?9-9ans--yes
What9is9the9purpose9of9the9Genetic9Information9Non-Discriminatory9Act?9-9ans--
Protects9patients9from9discrimination9by9employers9and9insurance9providers9based9on9g
enetic9information
Difference9between9practice9authority9and9prescriptive9authority?9-9ans--
Practice9authority9refers9to9the9nurse9practitioner's9ability9to9practice9without9physician9o
versight,9whereas9prescriptive9authority9refers9to9the9nurse9practitioner's9authority9to9pre
scribe9medications9independently9and9without9limitations.
Who9regulates9prescriptive9authority?9-9ans--
the9jurisdiction9of9a9health9professional9board.9This9may9be9the9State9Board9of9Nursing,9t
he9State9Board9of9Medicine,9or9the9State9Board9of9Pharmacy,9as9determined9by9each9sta
te.
What9is9scope9of9practice9determined9by?9-9ans--
is9determined9by9state9practice9and9licensure9laws.
What9is9full9practice9authority?9-9ans--
Nurse9practitioners9have9the9autonomy9to9evaluate9patients,9diagnose,9order9and9interpr
et9tests,9initiate9and9manage9treatments9and9prescribe9medications,9including9controlled9
substances9without9physician9oversight.
MIDTERM - CHAMBERLAIN
During9what9trimester9is9a9pregnant9woman9most9at9risk9for9adverse9drug9reactions9with9
potential9long9term9consequences?9-9ans--
1st9trimester9(fetus9most9at9risk9d/t9rapid9growth)
What9is9BEERS9criteria?9-9ans--
Recommendations9of9medications9inappropriate9for9elderly9(659and9older),9prescriber9ulti
mately9decides
What9is9the9CYP4509(cytochrome9P450)9-9ans--
liver9enzyme9system9where9medications9are9metabolized,9can9either9be9inducers9or9inhi
bitors9and9create9drug-drug9interactions
CYP4509inducers9-9ans--
Speed9up9metabolism9of9drugs9(drug9is9cleared9faster),9drug9has9lesser9effect9(decrease9
blood9levels9of9drug),9elevate9CYP4509enzymes
CYP4509inducers9pneumonic9-9ans--"Bullshit9Crap9GPS9INDUCES9rage"
CYP4509inducer9drug9names9-9ans--
Barbituates,9St9John9wort,9Carbamazepine,9rifampin,9alcohol,9phenytoin,9griseofulvin,9ph
enobarbital,9sulfonylureas
CYP4509inhibitors9-9ans--inhibit9metabolism,9increase9blood9levels9of9medications
CYP4509pneumonic9-
9ans--"VISA9credit9card9debt9INHIBITS9spending9on9designers9like9CK9to9look9GQ"
CYP4509inhibitors9drug9names9-9ans--
Valproate,9isoniazid,9sulfonamides,9amiodarone,9chloramphenicol,9ketoconazole,9grapef
ruit9juice,9quinidine
Physiological9changes9during9pregnancy9that9impact9pharmacodynamics9and9pharmaco
kinetic9properties9of9drugs?9-9ans--
increase9glomerular9filtration9rate9leads9to9increase9durg9excretion9
increase9hepatic9metabolism
decrease9tone9and9motility9of9bowel
increase9drug9absorption
,Examples9of9medications9that9can9be9teratogenic9-9ans--
Antiepileptic9drugs,9antimicrobials9such9as9tetracyclines9and9fluoroquinolones,9vitamin9A9
in9large9doses,9some9anticoagulants,9and9hormonal9medications9such9as9diethylstilbestr
ol9(DES).
How9is9absorption9of9intramuscular9medications9different9in9neonates?9-9ans--
slow9and9erratic9due9to9low9blood9flow9in9muscles9first9few9days9of9life
Why9is9absorption9of9medication9in9the9stomach9increased9in9infancy?9-9ans--
delayed9gastric9emptying
Some9medications9that9should9be9avoided9in9the9pediatric9patient?9-9ans--
glucocorticoids,9discoloration9of9developing9teeth9with9tetracyclines,9and9kernicterus9with
9sulfonamides,9levofloxacin9(antibiotics)9
aspirin9(Severe9intoxication9from9acute9overdose)
what9should9be9included9in9medication9administration9patient9education?9-9ans--
dosage9size9and9timing
route9and9technique9of9administration
duration9of9treatment
drug9storage
nature9and9time9course9of9desired9responses
nature9and9time9course9of9adverse9responses
finish9taking9antibiotic
What9are9some9things9that9put9the9elderly9patient9at9higher9risk9for9adverse9drug9reaction
s?9-9ans--reduced9renal9function9
polypharmacy9(the9use9of9five9or9more9medications9daily)
greater9severity9of9illness
presence9of9comorbidities
use9of9drugs9that9have9a9low9therapeutic9index9(e.g.,9digoxin)
increased9individual9variation9secondary9to9altered9pharmacokinetics
inadequate9supervision9of9long-term9therapy
poor9patient9adherence
How9can9healthcare9providers9decrease9likelihood9of9an9elderly9patient9experiencing9an9
adverse9drug9reaction?9-9ans--obtaining9a9thorough9drug9history9that9includes9over-the-
counter9medications
considering9pharmacokinetic9and9pharmacodynamics9changes9due9to9age
monitoring9the9patient's9clinical9response9and9plasma9drug9levels
using9the9simplest9regimen9possible
monitoring9for9drug-drug9interactions9and9iatrogenic9illness
periodically9reviewing9the9need9for9continued9drug9therapy
encouraging9the9patient9to9dispose9of9old9medications
taking9steps9to9promote9adherence9and9to9avoid9drugs9on9the9Beers9list
, How9can9we9promote9medication9adherence9with9elderly9patients?9-9ans--
simplifying9drug9regimens
providing9clear9and9concise9verbal9and9written9instructions
using9an9appropriate9dosage9form
clearly9labeling9and9dispensing9easy-to-open9containers
developing9daily9reminders
monitoring9frequently
affordability9of9drugs
support9systems
Why9do9nitrates9need9to9be9taken9no9later9than949PM?9-9ans--
Need9nitrate9free9interval9so9tolerance9doesn't9develop
Nine9factors9that9impact9outcome9of9medication?9-9ans--Gender9and9race
Genetics9and9pharmacogenomics
Variability9in9absorption
placebo9effect
Tolerance
patho
age
bodyweight
Do9you9need9informed9consent9for9genetic9testing?9-9ans--yes
What9is9the9purpose9of9the9Genetic9Information9Non-Discriminatory9Act?9-9ans--
Protects9patients9from9discrimination9by9employers9and9insurance9providers9based9on9g
enetic9information
Difference9between9practice9authority9and9prescriptive9authority?9-9ans--
Practice9authority9refers9to9the9nurse9practitioner's9ability9to9practice9without9physician9o
versight,9whereas9prescriptive9authority9refers9to9the9nurse9practitioner's9authority9to9pre
scribe9medications9independently9and9without9limitations.
Who9regulates9prescriptive9authority?9-9ans--
the9jurisdiction9of9a9health9professional9board.9This9may9be9the9State9Board9of9Nursing,9t
he9State9Board9of9Medicine,9or9the9State9Board9of9Pharmacy,9as9determined9by9each9sta
te.
What9is9scope9of9practice9determined9by?9-9ans--
is9determined9by9state9practice9and9licensure9laws.
What9is9full9practice9authority?9-9ans--
Nurse9practitioners9have9the9autonomy9to9evaluate9patients,9diagnose,9order9and9interpr
et9tests,9initiate9and9manage9treatments9and9prescribe9medications,9including9controlled9
substances9without9physician9oversight.
