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Midterm
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Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
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?
- They can prescribe schedule II-V drugs
Who determines and regulates prescriptive authority?
- Is regulated by the state (not the federal level).
- Authorized by state boards of nursing, boards of medicine, boards of pharmacy
How does limited prescriptive authority impact patients within the healthcare
system?
- Creates barriers to quality, affordability, and accessibility to patients.
What are the key responsibilities of prescribing?
documentation of a provider-patient relationship for the recipient of the
prescribed medications
documentation of a thorough history and physical examination for the recipient
documentation of discussions regarding risk factors, side effects, or therapy
options
documentation of drug monitoring or titration plan, if applicable
documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
What should be used to make prescribing decisions?
o Consider cost
o Keep abreast of guidelines
o Availability knowledge
o Knowledge of drug interactions
o Common side effects
o Patient allergies
o Needs for monitoring
o Patient’s hepatic or renal function
Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and
how that would translate to baseline information needed to prescribe.
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Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
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Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
- The RATE of GI absorption not the percentage may be slowed
- Increased body fat creates storage for lipid soluble drugs = reduced plasma levels
- Decrease in lean body mass AND total body water = increased concentrations of
drugs
- Decreased albumin levels = less sites for protein binding drugs = increased free drug
levels
- Hepatic blood flow, liver mass, and activity of hepatic enzymes decreases =
decreased drug metabolism
- Decline in renal function can decrease excretion and cause drug accumulation. NEED
TO MONITOR creatinine CLEARENCE
- Reduction in beta receptors and affinity for beta receptors = less effective beta -
adrenergic blocking agents
- Comorbidities
- Poor adherence to drugs (taking too few or too many)
- Medications that have a low therapeutic index – drug must be dosed carefully and
monitored for toxicity (ex: digoxin)
- Patients need to take nitrates no later than 4pm to give them a nitrate free cycle and
so we can avoid toxicity
Beer’s Criteria
o What is it?
o Why is it important?
- evidence-based guidelines addressing inappropriate prescribing practices for adults,
aged 65 and older.
- 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
The Beers Criteria includes five lists that describe certain medications and situations
and include:
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 (American Geriatric Society Beers Criteria
Update Expert Panel, 2019)
Impacts/outcomes of polypharmacy
- Very few medications do NOT interact with other drugs
- Polypharmacy = taking 5 or more drugs
- Greatly impacts the elderly
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Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
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Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
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?
- They can prescribe schedule II-V drugs
Who determines and regulates prescriptive authority?
- Is regulated by the state (not the federal level).
- Authorized by state boards of nursing, boards of medicine, boards of pharmacy
How does limited prescriptive authority impact patients within the healthcare
system?
- Creates barriers to quality, affordability, and accessibility to patients.
What are the key responsibilities of prescribing?
documentation of a provider-patient relationship for the recipient of the
prescribed medications
documentation of a thorough history and physical examination for the recipient
documentation of discussions regarding risk factors, side effects, or therapy
options
documentation of drug monitoring or titration plan, if applicable
documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
What should be used to make prescribing decisions?
o Consider cost
o Keep abreast of guidelines
o Availability knowledge
o Knowledge of drug interactions
o Common side effects
o Patient allergies
o Needs for monitoring
o Patient’s hepatic or renal function
Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and
how that would translate to baseline information needed to prescribe.
!@#()*$*(&@&(*%*&((%UNR565
!@#()*$*(&@&(*%*&((%UNR565
!@#()*$*(&@&(*%*&((%UNR565
Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
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Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
- The RATE of GI absorption not the percentage may be slowed
- Increased body fat creates storage for lipid soluble drugs = reduced plasma levels
- Decrease in lean body mass AND total body water = increased concentrations of
drugs
- Decreased albumin levels = less sites for protein binding drugs = increased free drug
levels
- Hepatic blood flow, liver mass, and activity of hepatic enzymes decreases =
decreased drug metabolism
- Decline in renal function can decrease excretion and cause drug accumulation. NEED
TO MONITOR creatinine CLEARENCE
- Reduction in beta receptors and affinity for beta receptors = less effective beta -
adrenergic blocking agents
- Comorbidities
- Poor adherence to drugs (taking too few or too many)
- Medications that have a low therapeutic index – drug must be dosed carefully and
monitored for toxicity (ex: digoxin)
- Patients need to take nitrates no later than 4pm to give them a nitrate free cycle and
so we can avoid toxicity
Beer’s Criteria
o What is it?
o Why is it important?
- evidence-based guidelines addressing inappropriate prescribing practices for adults,
aged 65 and older.
- 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
The Beers Criteria includes five lists that describe certain medications and situations
and include:
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 (American Geriatric Society Beers Criteria
Update Expert Panel, 2019)
Impacts/outcomes of polypharmacy
- Very few medications do NOT interact with other drugs
- Polypharmacy = taking 5 or more drugs
- Greatly impacts the elderly
!@#()*$*(&@&(*%*&((%UNR565
!@#()*$*(&@&(*%*&((%UNR565
!@#()*$*(&@&(*%*&((%UNR565
Midterm
Midterm
Study
Midterm
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Study
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
Guide.pdfhttps://www.stuvia.com/user/docstudent96https://www.stuvia.com/user/docstudent96
