NR 565 - ADVANCED PHARMACOLOGY
MIDTERM - CHAMBERLAIN
Duringoowhatootrimesterooisooaoopregnantoowomanoomostooatooriskooforooadverseoodrugoor
eactionsoowithoopotentialoolongootermooconsequences?oo-ooans--
1stootrimesteroo(fetusoomostooatooriskood/toorapidoogrowth)
WhatooisooBEERSoocriteria?oo-ooans--
Recommendationsooofoomedicationsooinappropriateooforooelderlyoo(65ooandooolder),oopre
scriberooultimatelyoodecides
WhatooisootheooCYP450oo(cytochromeooP450)oo-ooans--
liverooenzymeoosystemoowhereoomedicationsooareoometabolized,oocanooeitheroobeooinduc
ersooorooinhibitorsooandoocreateoodrug-drugoointeractions
CYP450ooinducersoo-ooans--
Speedooupoometabolismooofoodrugsoo(drugooisooclearedoofaster),oodrugoohasoolesserooeffe
ctoo(decreaseoobloodoolevelsooofoodrug),ooelevateooCYP450ooenzymes
CYP450ooinducersoopneumonicoo-ooans--"BullshitooCrapooGPSooINDUCESoorage"
CYP450ooinduceroodrugoonamesoo-ooans--
Barbituates,ooStooJohnoowort,ooCarbamazepine,oorifampin,ooalcohol,oophenytoin,oogriseof
ulvin,oophenobarbital,oosulfonylureas
CYP450ooinhibitorsoo-ooans--
inhibitoometabolism,ooincreaseoobloodoolevelsooofoomedications
CYP450oopneumonicoo-
ooans--"VISAoocreditoocardoodebtooINHIBITSoospendingooonoodesignersoolikeooCKootoooloo
kooGQ"
CYP450ooinhibitorsoodrugoonamesoo-ooans--
Valproate,ooisoniazid,oosulfonamides,ooamiodarone,oochloramphenicol,ooketoconazole,oo
grapefruitoojuice,ooquinidine
Physiologicaloochangesooduringoopregnancyoothatooimpactoopharmacodynamicsooandoop
harmacokineticoopropertiesooofoodrugs?oo-ooans--
increaseooglomerularoofiltrationoorateooleadsootoooincreaseoodurgooexcretionoo
increaseoohepaticoometabolism
,decreaseootoneooandoomotilityooofoobowel
increaseoodrugooabsorption
Examplesooofoomedicationsoothatoocanoobeooteratogenicoo-ooans--
Antiepilepticoodrugs,ooantimicrobialsoosuchooasootetracyclinesooandoofluoroquinolones,oovi
taminooAooinoolargeoodoses,oosomeooanticoagulants,ooandoohormonaloomedicationsoosuch
ooasoodiethylstilbestroloo(DES).
Howooisooabsorptionooofoointramuscularoomedicationsoodifferentooinooneonates?oo-ooans--
slowooandooerraticoodueootooolowoobloodooflowooinoomusclesoofirstoofewoodaysooofoolife
Whyooisooabsorptionooofoomedicationooinootheoostomachooincreasedooinooinfancy?oo-
ooans--delayedoogastricooemptying
Someoomedicationsoothatooshouldoobeooavoidedooinootheoopediatricoopatient?oo-ooans--
glucocorticoids,oodiscolorationooofoodevelopingooteethoowithootetracyclines,ooandookernict
erusoowithoosulfonamides,oolevofloxacinoo(antibiotics)oo
aspirinoo(Severeoointoxicationoofromooacuteoooverdose)
whatooshouldoobeooincludedooinoomedicationooadministrationoopatientooeducation?oo-
ooans--dosageoosizeooandootiming
routeooandootechniqueooofooadministration
durationooofootreatment
drugoostorage
natureooandootimeoocourseooofoodesiredooresponses
natureooandootimeoocourseooofooadverseooresponses
finishootakingooantibiotic
Whatooareoosomeoothingsoothatooputootheooelderlyoopatientooatoohigherooriskooforooadverse
oodrugooreactions?oo-ooans--reducedoorenaloofunctionoo
polypharmacyoo(theoouseooofoofiveoooroomoreoomedicationsoodaily)
greaterooseverityooofooillness
presenceooofoocomorbidities
useooofoodrugsoothatoohaveooaoolowootherapeuticooindexoo(e.g.,oodigoxin)
increasedooindividualoovariationoosecondaryootoooalteredoopharmacokinetics
inadequateoosupervisionooofoolong-termootherapy
pooroopatientooadherence
Howoocanoohealthcareooprovidersoodecreaseoolikelihoodooofooanooelderlyoopatientooexperi
encingooanooadverseoodrugooreaction?oo-ooans--
obtainingooaoothoroughoodrugoohistoryoothatooincludesooover-the-counteroomedications
consideringoopharmacokineticooandoopharmacodynamicsoochangesoodueootoooage
monitoringootheoopatient'sooclinicalooresponseooandooplasmaoodrugoolevels
usingootheoosimplestooregimenoopossible
monitoringooforoodrug-drugoointeractionsooandooiatrogenicooillness
periodicallyooreviewingootheooneedooforoocontinuedoodrugootherapy
, encouragingootheoopatientootooodisposeooofoooldoomedications
takingoostepsootooopromoteooadherenceooandootoooavoidoodrugsooonootheooBeersoolist
Howoocanooweoopromoteoomedicationooadherenceoowithooelderlyoopatients?oo-ooans--
simplifyingoodrugooregimens
providingooclearooandooconciseooverbalooandoowrittenooinstructions
usingooanooappropriateoodosageooform
clearlyoolabelingooandoodispensingooeasy-to-openoocontainers
developingoodailyooreminders
monitoringoofrequently
affordabilityooofoodrugs
supportoosystems
Whyoodooonitratesooneedootooobeootakenoonooolateroothanoo4ooPM?oo-ooans--
Needoonitrateoofreeoointervaloosoootoleranceoodoesn'toodevelop
Nineoofactorsoothatooimpactoooutcomeooofoomedication?oo-ooans--Genderooandoorace
Geneticsooandoopharmacogenomics
Variabilityooinooabsorption
placeboooeffect
Tolerance
patho
age
bodyweight
Doooyouooneedooinformedooconsentooforoogeneticootesting?oo-ooans--yes
WhatooisootheoopurposeooofootheooGeneticooInformationooNon-DiscriminatoryooAct?oo-
ooans--
Protectsoopatientsoofromoodiscriminationoobyooemployersooandooinsuranceooprovidersooba
sedooonoogeneticooinformation
Differenceoobetweenoopracticeooauthorityooandooprescriptiveooauthority?oo-ooans--
Practiceooauthorityoorefersootoootheoonurseoopractitioner'sooabilityootooopracticeoowithoutoo
physicianoooversight,oowhereasooprescriptiveooauthorityoorefersootoootheoonurseoopractitio
ner'sooauthorityootoooprescribeoomedicationsooindependentlyooandoowithoutoolimitations.
Whoooregulatesooprescriptiveooauthority?oo-ooans--
theoojurisdictionooofooaoohealthooprofessionalooboard.ooThisoomayoobeootheooStateooBoard
ooofooNursing,ootheooStateooBoardooofooMedicine,ooorootheooStateooBoardooofooPharmacy,o
oasoodeterminedoobyooeachoostate.
Whatooisooscopeooofoopracticeoodeterminedooby?oo-ooans--
isoodeterminedoobyoostateoopracticeooandoolicensureoolaws.
MIDTERM - CHAMBERLAIN
Duringoowhatootrimesterooisooaoopregnantoowomanoomostooatooriskooforooadverseoodrugoor
eactionsoowithoopotentialoolongootermooconsequences?oo-ooans--
1stootrimesteroo(fetusoomostooatooriskood/toorapidoogrowth)
WhatooisooBEERSoocriteria?oo-ooans--
Recommendationsooofoomedicationsooinappropriateooforooelderlyoo(65ooandooolder),oopre
scriberooultimatelyoodecides
WhatooisootheooCYP450oo(cytochromeooP450)oo-ooans--
liverooenzymeoosystemoowhereoomedicationsooareoometabolized,oocanooeitheroobeooinduc
ersooorooinhibitorsooandoocreateoodrug-drugoointeractions
CYP450ooinducersoo-ooans--
Speedooupoometabolismooofoodrugsoo(drugooisooclearedoofaster),oodrugoohasoolesserooeffe
ctoo(decreaseoobloodoolevelsooofoodrug),ooelevateooCYP450ooenzymes
CYP450ooinducersoopneumonicoo-ooans--"BullshitooCrapooGPSooINDUCESoorage"
CYP450ooinduceroodrugoonamesoo-ooans--
Barbituates,ooStooJohnoowort,ooCarbamazepine,oorifampin,ooalcohol,oophenytoin,oogriseof
ulvin,oophenobarbital,oosulfonylureas
CYP450ooinhibitorsoo-ooans--
inhibitoometabolism,ooincreaseoobloodoolevelsooofoomedications
CYP450oopneumonicoo-
ooans--"VISAoocreditoocardoodebtooINHIBITSoospendingooonoodesignersoolikeooCKootoooloo
kooGQ"
CYP450ooinhibitorsoodrugoonamesoo-ooans--
Valproate,ooisoniazid,oosulfonamides,ooamiodarone,oochloramphenicol,ooketoconazole,oo
grapefruitoojuice,ooquinidine
Physiologicaloochangesooduringoopregnancyoothatooimpactoopharmacodynamicsooandoop
harmacokineticoopropertiesooofoodrugs?oo-ooans--
increaseooglomerularoofiltrationoorateooleadsootoooincreaseoodurgooexcretionoo
increaseoohepaticoometabolism
,decreaseootoneooandoomotilityooofoobowel
increaseoodrugooabsorption
Examplesooofoomedicationsoothatoocanoobeooteratogenicoo-ooans--
Antiepilepticoodrugs,ooantimicrobialsoosuchooasootetracyclinesooandoofluoroquinolones,oovi
taminooAooinoolargeoodoses,oosomeooanticoagulants,ooandoohormonaloomedicationsoosuch
ooasoodiethylstilbestroloo(DES).
Howooisooabsorptionooofoointramuscularoomedicationsoodifferentooinooneonates?oo-ooans--
slowooandooerraticoodueootooolowoobloodooflowooinoomusclesoofirstoofewoodaysooofoolife
Whyooisooabsorptionooofoomedicationooinootheoostomachooincreasedooinooinfancy?oo-
ooans--delayedoogastricooemptying
Someoomedicationsoothatooshouldoobeooavoidedooinootheoopediatricoopatient?oo-ooans--
glucocorticoids,oodiscolorationooofoodevelopingooteethoowithootetracyclines,ooandookernict
erusoowithoosulfonamides,oolevofloxacinoo(antibiotics)oo
aspirinoo(Severeoointoxicationoofromooacuteoooverdose)
whatooshouldoobeooincludedooinoomedicationooadministrationoopatientooeducation?oo-
ooans--dosageoosizeooandootiming
routeooandootechniqueooofooadministration
durationooofootreatment
drugoostorage
natureooandootimeoocourseooofoodesiredooresponses
natureooandootimeoocourseooofooadverseooresponses
finishootakingooantibiotic
Whatooareoosomeoothingsoothatooputootheooelderlyoopatientooatoohigherooriskooforooadverse
oodrugooreactions?oo-ooans--reducedoorenaloofunctionoo
polypharmacyoo(theoouseooofoofiveoooroomoreoomedicationsoodaily)
greaterooseverityooofooillness
presenceooofoocomorbidities
useooofoodrugsoothatoohaveooaoolowootherapeuticooindexoo(e.g.,oodigoxin)
increasedooindividualoovariationoosecondaryootoooalteredoopharmacokinetics
inadequateoosupervisionooofoolong-termootherapy
pooroopatientooadherence
Howoocanoohealthcareooprovidersoodecreaseoolikelihoodooofooanooelderlyoopatientooexperi
encingooanooadverseoodrugooreaction?oo-ooans--
obtainingooaoothoroughoodrugoohistoryoothatooincludesooover-the-counteroomedications
consideringoopharmacokineticooandoopharmacodynamicsoochangesoodueootoooage
monitoringootheoopatient'sooclinicalooresponseooandooplasmaoodrugoolevels
usingootheoosimplestooregimenoopossible
monitoringooforoodrug-drugoointeractionsooandooiatrogenicooillness
periodicallyooreviewingootheooneedooforoocontinuedoodrugootherapy
, encouragingootheoopatientootooodisposeooofoooldoomedications
takingoostepsootooopromoteooadherenceooandootoooavoidoodrugsooonootheooBeersoolist
Howoocanooweoopromoteoomedicationooadherenceoowithooelderlyoopatients?oo-ooans--
simplifyingoodrugooregimens
providingooclearooandooconciseooverbalooandoowrittenooinstructions
usingooanooappropriateoodosageooform
clearlyoolabelingooandoodispensingooeasy-to-openoocontainers
developingoodailyooreminders
monitoringoofrequently
affordabilityooofoodrugs
supportoosystems
Whyoodooonitratesooneedootooobeootakenoonooolateroothanoo4ooPM?oo-ooans--
Needoonitrateoofreeoointervaloosoootoleranceoodoesn'toodevelop
Nineoofactorsoothatooimpactoooutcomeooofoomedication?oo-ooans--Genderooandoorace
Geneticsooandoopharmacogenomics
Variabilityooinooabsorption
placeboooeffect
Tolerance
patho
age
bodyweight
Doooyouooneedooinformedooconsentooforoogeneticootesting?oo-ooans--yes
WhatooisootheoopurposeooofootheooGeneticooInformationooNon-DiscriminatoryooAct?oo-
ooans--
Protectsoopatientsoofromoodiscriminationoobyooemployersooandooinsuranceooprovidersooba
sedooonoogeneticooinformation
Differenceoobetweenoopracticeooauthorityooandooprescriptiveooauthority?oo-ooans--
Practiceooauthorityoorefersootoootheoonurseoopractitioner'sooabilityootooopracticeoowithoutoo
physicianoooversight,oowhereasooprescriptiveooauthorityoorefersootoootheoonurseoopractitio
ner'sooauthorityootoooprescribeoomedicationsooindependentlyooandoowithoutoolimitations.
Whoooregulatesooprescriptiveooauthority?oo-ooans--
theoojurisdictionooofooaoohealthooprofessionalooboard.ooThisoomayoobeootheooStateooBoard
ooofooNursing,ootheooStateooBoardooofooMedicine,ooorootheooStateooBoardooofooPharmacy,o
oasoodeterminedoobyooeachoostate.
Whatooisooscopeooofoopracticeoodeterminedooby?oo-ooans--
isoodeterminedoobyoostateoopracticeooandoolicensureoolaws.
