NR 565 VERIFIED EXAM QUESTIONS AND ANSWERS
ADVANCED PHARMACY MIDTERM
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
4.drug storage
5.nature 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.
ADVANCED PHARMACY MIDTERM
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
4.drug storage
5.nature 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.
