NR565 Advanced Pharm Midterm
What is used to calculate a patient's overdose risk? (An actual calculation won't be done
on the exam) - correct answer
Which schedule drugs can APRNs prescribe? - correct answer DEA license will allow for
prescribing of Schedules 2-5. There can be restrictions as noted in collaborative agreement. May
be facility/state dependent.
Who determines and regulates prescriptive authority? - correct answer Determines: Also known
as independent prescribing. APRNS can prescribe without limitation and is state dependent.
Includes "legend" (prescription) and controlled drugs, health/medical services, DME, etc.
Regulates: State board of nursing, regulated by health professional board. Federal government
controls drug regulations but has no control over prescriptive authority.
How does limited prescriptive authority impact patients within the healthcare system? - correct
answer Limited prescriptive authority creates numerous barriers to quality, affordable, and
accessible patient care. For example, restrictions on the distance of the APRN or PA from the
physician providing supervision or collaboration may prevent outreach to area of greatest need.
An increase in patient waits.
What are the key responsibilities of prescribing? - correct answer The ability to prescribe
medications is both a privilege and a burden. Have a documented provider-patient relationship,
do not prescribe medications to family or friends or yourself, Document a thorough history and
physical examination, include any discussions you have with the patient about risk factors, side
effects, or therapy options, have documented plan regarding drug monitoring or titration, if you
consult additional providers not that you did so. Use the references provided in the following
boxes to assist in safely and rationally choosing one medication over another.
Be sensible, accept responsibility, do not fear it, know constraints and limitations, always learn
and update, keep Rx pads in safe place, confirm allergies, verify medication list with patient, do
not let insurance dictate quantity of Rx, Charting is key (particularly with off label use), Provide
use and rationale.
,NR565 Advanced Pharm Midterm
What should be used to make prescribing decisions? - correct answer The best way to keep your
patients (and yourself) safe is to be prudent and deliberate in your decision-making process.
Cost, availability, current practice guidelines, medication interactions including interactions with
food, side effects, need for monitoring, how drug is metabolized (hepatic or renal), special
populations (pregnancy, nursing, older adults)
Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how that
would translate to baseline information needed to prescribe - correct answer Pharmacokinetic
is the study of drug absorption, distribution, metabolism, and excretion in the body. The ability
of older adults to metabolize drugs is commonly decreased. Drug dosages may need to be
reduced to prevent drug toxicity.
Beer's criteria - correct answer Guidelines for prescribing medications to patients 65 & older.
Drugs on the list should be avoided in patients over 65 expect when the benefits significantly
outweigh the risks. The Beers Criteria includes five lists that describe certain medications and
situations and include: potentially inappropriate medication (PIM) us 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.
Why is Beer's criteria important? - correct answer It provides a list of medications that are
potentially harmful in elderly. List that identifies drugs with a high likelihood of causing adverse
effects in older adults. Beers Criteria are recommendations; ultimately prescribers must
determine whether a medication is appropriate for use or not. These guidelines are not
intended to limit the use of medications or apply to all older adults. Safe and judicious
prescribing is crucial in the older adult to optimize pharmacotherapy.
Impacts/outcomes of polypharmacy - correct answer Polypharmacy greatly increases the risk
for interactions. Drug interactions with mild side effects to life-threatening consequences.
Elderly is at a higher risk of polypharmacy due to taking five or more medications daily.
, NR565 Advanced Pharm Midterm
CYP450 - correct answer metabolic pathway, involved in metabolism of drugs in the liver.
Metabolism can be inhibited or induced by drugs and once this happens drug-drug interaction
can occur.
What are the CYP450 inhibitors? - correct answer Liver enzymes. It's not just a single molecular
entity but rather a group of 12 closely related enzyme families.
Examples: Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole,
Grapefruit juice, Quinidine
What do they do? Slows down metabolism of medications. Inhibitors are medications that
inhibit activity of one or more of the CYP450 enzymes. Medications that inhibit an enzyme can
potentially slow that enzymes activity required for metabolism of other medications, thereby
increasing the levels of medications dependent on that particular enzyme for
biotransformation. This inhibition prolongs the pharmacalogical effects, which may result in
toxicity. Factors that affect the inhibition include the dose and the capacity to bind to the
enzyme
What do they cause if not used correctly (CYP450)?(aka:What would the patient experience?) -
correct answer Toxicity. drug build up
Examples of CYP450 inducers? - correct answer barbiturates, St Johns wart, carbamazepine,
rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
What do CYP450 inducers do? - correct answer Increase medication metabolism.
Inducers are xenobiotics that elevate the CYP450 enzyme activity by increasing the enzyme
synthesis. This action leads to additional sites available for biotransformation. The increased
number of sites enhances the medication metabolism, decreasing the concentration of the
"parent drug" while increasing the metabolite production. The half-life of the inducing drug may
cause a delay before enzyme activity increases. A decease in concentration of a medication
metabolized by CYP2C9 (responsible for 10% of drug metabolism) usually occurs within 24 hours
after the administration of the medication.
What is used to calculate a patient's overdose risk? (An actual calculation won't be done
on the exam) - correct answer
Which schedule drugs can APRNs prescribe? - correct answer DEA license will allow for
prescribing of Schedules 2-5. There can be restrictions as noted in collaborative agreement. May
be facility/state dependent.
Who determines and regulates prescriptive authority? - correct answer Determines: Also known
as independent prescribing. APRNS can prescribe without limitation and is state dependent.
Includes "legend" (prescription) and controlled drugs, health/medical services, DME, etc.
Regulates: State board of nursing, regulated by health professional board. Federal government
controls drug regulations but has no control over prescriptive authority.
How does limited prescriptive authority impact patients within the healthcare system? - correct
answer Limited prescriptive authority creates numerous barriers to quality, affordable, and
accessible patient care. For example, restrictions on the distance of the APRN or PA from the
physician providing supervision or collaboration may prevent outreach to area of greatest need.
An increase in patient waits.
What are the key responsibilities of prescribing? - correct answer The ability to prescribe
medications is both a privilege and a burden. Have a documented provider-patient relationship,
do not prescribe medications to family or friends or yourself, Document a thorough history and
physical examination, include any discussions you have with the patient about risk factors, side
effects, or therapy options, have documented plan regarding drug monitoring or titration, if you
consult additional providers not that you did so. Use the references provided in the following
boxes to assist in safely and rationally choosing one medication over another.
Be sensible, accept responsibility, do not fear it, know constraints and limitations, always learn
and update, keep Rx pads in safe place, confirm allergies, verify medication list with patient, do
not let insurance dictate quantity of Rx, Charting is key (particularly with off label use), Provide
use and rationale.
,NR565 Advanced Pharm Midterm
What should be used to make prescribing decisions? - correct answer The best way to keep your
patients (and yourself) safe is to be prudent and deliberate in your decision-making process.
Cost, availability, current practice guidelines, medication interactions including interactions with
food, side effects, need for monitoring, how drug is metabolized (hepatic or renal), special
populations (pregnancy, nursing, older adults)
Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how that
would translate to baseline information needed to prescribe - correct answer Pharmacokinetic
is the study of drug absorption, distribution, metabolism, and excretion in the body. The ability
of older adults to metabolize drugs is commonly decreased. Drug dosages may need to be
reduced to prevent drug toxicity.
Beer's criteria - correct answer Guidelines for prescribing medications to patients 65 & older.
Drugs on the list should be avoided in patients over 65 expect when the benefits significantly
outweigh the risks. The Beers Criteria includes five lists that describe certain medications and
situations and include: potentially inappropriate medication (PIM) us 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.
Why is Beer's criteria important? - correct answer It provides a list of medications that are
potentially harmful in elderly. List that identifies drugs with a high likelihood of causing adverse
effects in older adults. Beers Criteria are recommendations; ultimately prescribers must
determine whether a medication is appropriate for use or not. These guidelines are not
intended to limit the use of medications or apply to all older adults. Safe and judicious
prescribing is crucial in the older adult to optimize pharmacotherapy.
Impacts/outcomes of polypharmacy - correct answer Polypharmacy greatly increases the risk
for interactions. Drug interactions with mild side effects to life-threatening consequences.
Elderly is at a higher risk of polypharmacy due to taking five or more medications daily.
, NR565 Advanced Pharm Midterm
CYP450 - correct answer metabolic pathway, involved in metabolism of drugs in the liver.
Metabolism can be inhibited or induced by drugs and once this happens drug-drug interaction
can occur.
What are the CYP450 inhibitors? - correct answer Liver enzymes. It's not just a single molecular
entity but rather a group of 12 closely related enzyme families.
Examples: Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole,
Grapefruit juice, Quinidine
What do they do? Slows down metabolism of medications. Inhibitors are medications that
inhibit activity of one or more of the CYP450 enzymes. Medications that inhibit an enzyme can
potentially slow that enzymes activity required for metabolism of other medications, thereby
increasing the levels of medications dependent on that particular enzyme for
biotransformation. This inhibition prolongs the pharmacalogical effects, which may result in
toxicity. Factors that affect the inhibition include the dose and the capacity to bind to the
enzyme
What do they cause if not used correctly (CYP450)?(aka:What would the patient experience?) -
correct answer Toxicity. drug build up
Examples of CYP450 inducers? - correct answer barbiturates, St Johns wart, carbamazepine,
rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
What do CYP450 inducers do? - correct answer Increase medication metabolism.
Inducers are xenobiotics that elevate the CYP450 enzyme activity by increasing the enzyme
synthesis. This action leads to additional sites available for biotransformation. The increased
number of sites enhances the medication metabolism, decreasing the concentration of the
"parent drug" while increasing the metabolite production. The half-life of the inducing drug may
cause a delay before enzyme activity increases. A decease in concentration of a medication
metabolized by CYP2C9 (responsible for 10% of drug metabolism) usually occurs within 24 hours
after the administration of the medication.
