NR 565 - advanced pharmacology midterm
- Chamberlain
During what trimester is a pregnant woman most at risk for adverse drug reactions with potential
long term consequences? - ANS 1st trimester (fetus most at risk d/t rapid growth)
What is BEERS criteria? - ANS Recommendations of medications inappropriate for elderly (65
and older), prescriber ultimately decides
What is the CYP450 (cytochrome P450) - ANS liver enzyme system where medications are
metabolized, can either be inducers or inhibitors and create drug-drug interactions
CYP450 inducers - ANS Speed up metabolism of drugs (drug is cleared faster), drug has lesser
effect (decrease blood levels of drug), elevate CYP450 enzymes
CYP450 inducers pneumonic - ANS "Bullshit Crap GPS INDUCES rage"
CYP450 inducer drug names - ANS Barbituates, St John wort, Carbamazepine, rifampin,
alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
CYP450 inhibitors - ANS inhibit metabolism, increase blood levels of medications
CYP450 pneumonic - ANS "VISA credit card debt INHIBITS spending on designers like CK to
look GQ"
CYP450 inhibitors drug names - ANS Valproate, isoniazid, sulfonamides, amiodarone,
chloramphenicol, ketoconazole, grapefruit juice, quinidine
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic
properties of drugs? - ANS increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
Examples of medications that can be teratogenic - ANS Antiepileptic drugs, antimicrobials such
as tetracyclines and fluoroquinolones, vitamin A in large doses, some anticoagulants, and
hormonal medications such as diethylstilbestrol (DES).
,How is absorption of intramuscular medications different in neonates? - ANS 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? - ANS delayed gastric
emptying
Some medications that should be avoided in the pediatric patient? - ANS glucocorticoids,
discoloration of developing teeth with tetracyclines, and kernicterus with sulfonamides,
levofloxacin (antibiotics)
aspirin (Severe intoxication from acute overdose)
what should be included in medication administration patient education? - ANS dosage size
and timing
route and technique of administration
duration of treatment
drug storage
nature and time course of desired responses
nature and time course of adverse responses
finish taking antibiotic
What are some things that put the elderly patient at higher risk for adverse drug reactions? -
ANS 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
How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse
drug reaction? - ANS obtaining a thorough drug history that includes over-the-counter
medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness
periodically reviewing the need for continued drug therapy
encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
How can we promote medication adherence with elderly patients? - ANS simplifying drug
regimens
providing clear and concise verbal and written instructions
, using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
monitoring frequently
affordability of drugs
support systems
Why do nitrates need to be taken no later than 4 PM? - ANS Need nitrate free interval so
tolerance doesn't develop
Nine factors that impact outcome of medication? - ANS Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - ANS yes
What is the purpose of the Genetic Information Non-Discriminatory Act? - ANS Protects
patients from discrimination by employers and insurance providers based on genetic information
Difference between practice authority and prescriptive authority? - ANS Practice authority refers
to the nurse practitioner's ability to practice without physician oversight, whereas prescriptive
authority refers to the nurse practitioner's authority to prescribe medications independently and
without limitations.
Who regulates prescriptive authority? - ANS the jurisdiction of a health professional board. This
may be the State Board of Nursing, the State Board of Medicine, or the State Board of
Pharmacy, as determined by each state.
What is scope of practice determined by? - ANS is determined by state practice and licensure
laws.
What is full practice authority? - ANS Nurse practitioners have the autonomy to evaluate
patients, diagnose, order and interpret tests, initiate and manage treatments and prescribe
medications, including controlled substances without physician oversight.
What is reduced practice authority? - ANS Nurse practitioners are limited in at least one
element of practice. The state requires a formal collaborative agreement with an outside health
discipline for the nurse practitioner to provide patient care. ex/ physician involvement for 5 yrs
than independent
- Chamberlain
During what trimester is a pregnant woman most at risk for adverse drug reactions with potential
long term consequences? - ANS 1st trimester (fetus most at risk d/t rapid growth)
What is BEERS criteria? - ANS Recommendations of medications inappropriate for elderly (65
and older), prescriber ultimately decides
What is the CYP450 (cytochrome P450) - ANS liver enzyme system where medications are
metabolized, can either be inducers or inhibitors and create drug-drug interactions
CYP450 inducers - ANS Speed up metabolism of drugs (drug is cleared faster), drug has lesser
effect (decrease blood levels of drug), elevate CYP450 enzymes
CYP450 inducers pneumonic - ANS "Bullshit Crap GPS INDUCES rage"
CYP450 inducer drug names - ANS Barbituates, St John wort, Carbamazepine, rifampin,
alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
CYP450 inhibitors - ANS inhibit metabolism, increase blood levels of medications
CYP450 pneumonic - ANS "VISA credit card debt INHIBITS spending on designers like CK to
look GQ"
CYP450 inhibitors drug names - ANS Valproate, isoniazid, sulfonamides, amiodarone,
chloramphenicol, ketoconazole, grapefruit juice, quinidine
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic
properties of drugs? - ANS increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
Examples of medications that can be teratogenic - ANS Antiepileptic drugs, antimicrobials such
as tetracyclines and fluoroquinolones, vitamin A in large doses, some anticoagulants, and
hormonal medications such as diethylstilbestrol (DES).
,How is absorption of intramuscular medications different in neonates? - ANS 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? - ANS delayed gastric
emptying
Some medications that should be avoided in the pediatric patient? - ANS glucocorticoids,
discoloration of developing teeth with tetracyclines, and kernicterus with sulfonamides,
levofloxacin (antibiotics)
aspirin (Severe intoxication from acute overdose)
what should be included in medication administration patient education? - ANS dosage size
and timing
route and technique of administration
duration of treatment
drug storage
nature and time course of desired responses
nature and time course of adverse responses
finish taking antibiotic
What are some things that put the elderly patient at higher risk for adverse drug reactions? -
ANS 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
How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse
drug reaction? - ANS obtaining a thorough drug history that includes over-the-counter
medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness
periodically reviewing the need for continued drug therapy
encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
How can we promote medication adherence with elderly patients? - ANS simplifying drug
regimens
providing clear and concise verbal and written instructions
, using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
monitoring frequently
affordability of drugs
support systems
Why do nitrates need to be taken no later than 4 PM? - ANS Need nitrate free interval so
tolerance doesn't develop
Nine factors that impact outcome of medication? - ANS Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - ANS yes
What is the purpose of the Genetic Information Non-Discriminatory Act? - ANS Protects
patients from discrimination by employers and insurance providers based on genetic information
Difference between practice authority and prescriptive authority? - ANS Practice authority refers
to the nurse practitioner's ability to practice without physician oversight, whereas prescriptive
authority refers to the nurse practitioner's authority to prescribe medications independently and
without limitations.
Who regulates prescriptive authority? - ANS the jurisdiction of a health professional board. This
may be the State Board of Nursing, the State Board of Medicine, or the State Board of
Pharmacy, as determined by each state.
What is scope of practice determined by? - ANS is determined by state practice and licensure
laws.
What is full practice authority? - ANS Nurse practitioners have the autonomy to evaluate
patients, diagnose, order and interpret tests, initiate and manage treatments and prescribe
medications, including controlled substances without physician oversight.
What is reduced practice authority? - ANS Nurse practitioners are limited in at least one
element of practice. The state requires a formal collaborative agreement with an outside health
discipline for the nurse practitioner to provide patient care. ex/ physician involvement for 5 yrs
than independent
