Nr565 midterm study guide 0
71322 2 pharmacology
NR565 Midterm Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 1
• Which schedule drugs can APRNs prescribe? Scheduled II- V
• Who determines and regulates prescriptive authority? Federal government controls
drugs regulation. State law
• How does limited prescriptive authority impact patients within the healthcare system?
Limited prescriptive authority creates numerous barriers to quality, affordable,
and accessible patient care. For example, a requirement to obtain the physician’s
cosignature on prescription can increase patient waits. Increases patient wait time.
• What are the key responsibilities of prescribing? The ability to prescribe medications is
both a Privilege and a burden. The best way to keep your patients and yourself safe is to be
prudent and deliberate in your decision making process. Have a documented provider-
patient relationship with the person for whom you are prescribing. Do not prescribe for family
or friends or for yourself. Document a thorough history and physical examination in your
records.
• What should be used to make prescribing decisions? Cost, availability, drug guidelines,
interactions, side effects, allergies, hepatic and renal function, monitoring, special
populations.
• Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and
how that would translate to baseline information needed to prescribe.
• Beer’s Criteria
potentially Inappropriate Medication (PIM) use in older adults
potentially Inappropriate Medication (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
o What is it? guidelines addressing inappropriate prescribing practices for adults,
aged 65 and older.
o Why is it important? These guidelines include a safety component aimed to
protect older adults by helping prescribers avoid medications that are or can be
harmful to older adults.
• Impacts/outcomes of polypharmacy
• CYP450 inhibitors
o Examples: valproate, Isoniazid, sulfonamides, amiodarone, chloramphenicol,
ketoconazole, grapefruit, Quinidine. Sertraline, erythromycin, terbinafine.
o What do they do? Inhibitors are medications that inhibit the metabolic activity of
one or more of the CYP450 enzymes.
o What do they cause if not used correctly? (aka: What would the patient
experience?) drug toxicity
amurimi
, NR565 Midterm Study Guide
• Examples of CYP450 inducers
o Examples: carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
phenobarbital, sulfonylureas
o What do they do? inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis.
This action leads to additional sites available for biotransformation. The
increased number of sites enhances medication metabolism, decreasing the
concentration of the "parent drug" while increasing metabolite production.
o What do they cause if not used correctly? (aka: What would the patient
experience?)
• What happens when someone has a poor metabolism phenotype? poor metabolizers
have markedly reduced or absent enzyme activity. A person who is a “Poor Metabolizer” for
a medicine will process that medicine very slowly. The medicine might not work if it is
processed slowly, or it could put them at risk for side-effects.
• Alters the patients response to drugs. Some drugs need to be converted into the active
form to be used. This is done through metabolization. Other drugs use metabolization only
for drug clearance. Those drugs become less effective as metabolization occurs. Depending
on the medication, and the therapeutic index whether high or low, poor metabolism would
impact therapeutic index in different ways. For instance if a drug needs to be converted into
its active form to produce its effects, and that drug has a high therapeutic index, the patient
would struggle to get to a therapeutic level of the drug. However if a patient has a
medication that starts in its active form and is metabolized to break down, but with a low
therapeutic index, the patient would be at a very high risk of overdose as the drug is not
being cleared effectively.
• What does the U.S. Food and Drug Administration regulate when it comes to
medications?
• Reasons for medication non-adherence
1. Medication excessive cost
2. Forgetfulness
3. Lack of planning
4. Dissatisfaction
5. Altered dosing
6. Ran out
7. Med not working
• Black Box Warnings
o What are they? Black box warnings are issued when a drug is found to have
serious or life-threatening risks. These drugs remain eligible for prescribing, but
their risk must be carefully considered
o Why are they issued? The purpose of the warning is to alert providers to:
o (1) potentially severe side effects (e.g., life-threatening dysrhythmias, suicidality,
major fetal harm) as well as
o (2) ways to prevent or reduce harm (e.g., avoiding a teratogenic drug during
pregnancy).
o 3. Drugs that have a boxed warning must also have a MedGuide.
amurimi
, NR565 Midterm Study Guide
o 4. An example of a drug with a boxed warning is promethazine (Phenergan).
Promethazine is contraindicated in patients less than 2-years-old because it can
cause respiratory depression. Additionally, when administered by injection, there
is a risk for severe tissue injury and necrosis.
• Neonate and infant drug absorption
o Be familiar with general development and when absorption would reach
adult levels
• Common fears with genetic testing
amurimi
71322 2 pharmacology
NR565 Midterm Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 1
• Which schedule drugs can APRNs prescribe? Scheduled II- V
• Who determines and regulates prescriptive authority? Federal government controls
drugs regulation. State law
• How does limited prescriptive authority impact patients within the healthcare system?
Limited prescriptive authority creates numerous barriers to quality, affordable,
and accessible patient care. For example, a requirement to obtain the physician’s
cosignature on prescription can increase patient waits. Increases patient wait time.
• What are the key responsibilities of prescribing? The ability to prescribe medications is
both a Privilege and a burden. The best way to keep your patients and yourself safe is to be
prudent and deliberate in your decision making process. Have a documented provider-
patient relationship with the person for whom you are prescribing. Do not prescribe for family
or friends or for yourself. Document a thorough history and physical examination in your
records.
• What should be used to make prescribing decisions? Cost, availability, drug guidelines,
interactions, side effects, allergies, hepatic and renal function, monitoring, special
populations.
• Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and
how that would translate to baseline information needed to prescribe.
• Beer’s Criteria
potentially Inappropriate Medication (PIM) use in older adults
potentially Inappropriate Medication (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
o What is it? guidelines addressing inappropriate prescribing practices for adults,
aged 65 and older.
o Why is it important? These guidelines include a safety component aimed to
protect older adults by helping prescribers avoid medications that are or can be
harmful to older adults.
• Impacts/outcomes of polypharmacy
• CYP450 inhibitors
o Examples: valproate, Isoniazid, sulfonamides, amiodarone, chloramphenicol,
ketoconazole, grapefruit, Quinidine. Sertraline, erythromycin, terbinafine.
o What do they do? Inhibitors are medications that inhibit the metabolic activity of
one or more of the CYP450 enzymes.
o What do they cause if not used correctly? (aka: What would the patient
experience?) drug toxicity
amurimi
, NR565 Midterm Study Guide
• Examples of CYP450 inducers
o Examples: carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
phenobarbital, sulfonylureas
o What do they do? inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis.
This action leads to additional sites available for biotransformation. The
increased number of sites enhances medication metabolism, decreasing the
concentration of the "parent drug" while increasing metabolite production.
o What do they cause if not used correctly? (aka: What would the patient
experience?)
• What happens when someone has a poor metabolism phenotype? poor metabolizers
have markedly reduced or absent enzyme activity. A person who is a “Poor Metabolizer” for
a medicine will process that medicine very slowly. The medicine might not work if it is
processed slowly, or it could put them at risk for side-effects.
• Alters the patients response to drugs. Some drugs need to be converted into the active
form to be used. This is done through metabolization. Other drugs use metabolization only
for drug clearance. Those drugs become less effective as metabolization occurs. Depending
on the medication, and the therapeutic index whether high or low, poor metabolism would
impact therapeutic index in different ways. For instance if a drug needs to be converted into
its active form to produce its effects, and that drug has a high therapeutic index, the patient
would struggle to get to a therapeutic level of the drug. However if a patient has a
medication that starts in its active form and is metabolized to break down, but with a low
therapeutic index, the patient would be at a very high risk of overdose as the drug is not
being cleared effectively.
• What does the U.S. Food and Drug Administration regulate when it comes to
medications?
• Reasons for medication non-adherence
1. Medication excessive cost
2. Forgetfulness
3. Lack of planning
4. Dissatisfaction
5. Altered dosing
6. Ran out
7. Med not working
• Black Box Warnings
o What are they? Black box warnings are issued when a drug is found to have
serious or life-threatening risks. These drugs remain eligible for prescribing, but
their risk must be carefully considered
o Why are they issued? The purpose of the warning is to alert providers to:
o (1) potentially severe side effects (e.g., life-threatening dysrhythmias, suicidality,
major fetal harm) as well as
o (2) ways to prevent or reduce harm (e.g., avoiding a teratogenic drug during
pregnancy).
o 3. Drugs that have a boxed warning must also have a MedGuide.
amurimi
, NR565 Midterm Study Guide
o 4. An example of a drug with a boxed warning is promethazine (Phenergan).
Promethazine is contraindicated in patients less than 2-years-old because it can
cause respiratory depression. Additionally, when administered by injection, there
is a risk for severe tissue injury and necrosis.
• Neonate and infant drug absorption
o Be familiar with general development and when absorption would reach
adult levels
• Common fears with genetic testing
amurimi
