NR565 ADVANCED PHARM MIDTERM EXAM | QUESTIONS AND
ANSWERS | VERIFIED ANSWERS GRADED A+ | LATEST UPDATE
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.
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.
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 happens when someone has a poor metabolism phenotype? - CORRECT
ANSWER - Slow or increase absorption, slow the metabolism, keep drug in
body longer and increase toxicity. Poor metabolisms affect a high or low
therapeutic index: increase drug toxicity, Ex: Plavix: Clots and increase
platelets.
What does the U.S. Food and Drug Administration regulate when it comes to
medications? - CORRECT ANSWER - Regulates what the pharmacies can
sell, requires special alerts and management guidelines, for drugs that cause
serious adverse effects. Ensuring pharmaceutical companies thoroughly test new
products for efficacy and safety with an aim towards minimizing side effects.
They approve or disapprove drugs
Reasons for medication non-adherence - CORRECT ANSWER - 1. patient
feels not needed
2. affordability
ANSWERS | VERIFIED ANSWERS GRADED A+ | LATEST UPDATE
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.
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.
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 happens when someone has a poor metabolism phenotype? - CORRECT
ANSWER - Slow or increase absorption, slow the metabolism, keep drug in
body longer and increase toxicity. Poor metabolisms affect a high or low
therapeutic index: increase drug toxicity, Ex: Plavix: Clots and increase
platelets.
What does the U.S. Food and Drug Administration regulate when it comes to
medications? - CORRECT ANSWER - Regulates what the pharmacies can
sell, requires special alerts and management guidelines, for drugs that cause
serious adverse effects. Ensuring pharmaceutical companies thoroughly test new
products for efficacy and safety with an aim towards minimizing side effects.
They approve or disapprove drugs
Reasons for medication non-adherence - CORRECT ANSWER - 1. patient
feels not needed
2. affordability
