Midterm Exam) NR 565 Midterm Exam : Study Guide: Questions
& Answers
Which Drugs can APRNS perscribe - ANSWER:DEA license will allow for prescribing schedules 2-5 there
can be restrictions as noted in collaborative agreement. maybe facility/state dependent.
Who determines and regulates prescriptive authority? - ANSWER:determines: APRNS can prescribe
without limitation and is state dependent. It is regulated by health professional board state board of
nursing or state board of medicine or pharmacy. federal government controls regulation but no control
over prescriptive authority.
How does limited prescriptive authority impact patients within the healthcare system? -
ANSWER:Creates numerous barriers to quality affordable and acessible patient care.
Key responsibilities to prescribing? - ANSWER:Do not prescribe to family/friends or yourself. document a
thorough history and physical examination. Include discussions with patient about risk factors and side
effects, medication monitoring or titration. if additional consults are made, know limitations, keep rx
pads in a safe place confirm allergies verify medication list dont let insurance dictate quality of RN
charting is key.
what should be used to make prescribing decisions? - ANSWER:Cost, availability, current practice
guidelines, medication interactions with food side effects need for monitoring how drug is metabolized.
special populations. ask if prescriptions are cost prohibitive.
Pharmacokinetics - ANSWER:what the body does to the drug
Pharmacodynamics - ANSWER:what the drug does to the body
physilogic changes that can affect the pharmaconetics in older adults. - ANSWER:absorption: inc gastric
PH decreased absorptive surface area and dec splanchnic blood flow. dec GI motility delayed gastric
emptying distribution: inc body fat dec lean body mass dec total body water serum albumin cardiac
output. metabolism: dec hepatic blood flow mass and activity of hepatic enzymes. excretion: decreased
renal blood flow GFR tubular secretion and number of nephrons.
reducing adverse drug reaction in older adults? - ANSWER:Thorough drug history go low and slow with
initiating drug therapy monitor clinical responses and plasma levels use simple medication regimen,
monitor drug interaction review drug therapy dispose old medications promote adherence use beers
criteria.
Beers Criteria - ANSWER:A list of medications that are generally considered inappropriate when given to
elderly people
impacts of polypharmacy - ANSWER:using 5 or more medications daily leads to possible drug
interactions.
CYP450 inhibitors - ANSWER:CRACK AMIGOS
, Chloramphenicol
Ritonavir (protease inhibitor)
Amiodarone
Ciprofloxacin
Ketocanazole (and other azoles)
Acute alcohol use
Valproate
Isoniazid
Grapefruit Juice
Sulfonamides
CYP450 inhibitors function - ANSWER:slow down the metabolic activity of specific enzymes, causing a
decrease in the rate/extent of metabolism of other drugs that are substrates for those same enzymes
this can cause drug toxicity.
CYP450 inducers - ANSWER:barbituates, griseofulvin, carbamazepine, rifampin, st. john wart, chronic
alcoholism, phenytoin (CRAP GPS)
CYP450 inducers function - ANSWER:increase medication metabolism. act on the liver to stimulate
enzyme synthesis
If CYP450 is induced, what is the effect on medication metabolism? - ANSWER:drug may not achieve
therapeutic effects
When patients have a poor metabolism phenotype? - ANSWER:slows or increases absorption ex; plavix
clots and inc platelets pregnancy hepatic metabolism increases and dec bowel motility increases
absorption of the drug. newborns the drug metabolizing capacity is low, children by the age of 1 are
similar to adults but they can be metabolized quickly an increase or reduction in dosing may be needed.
geriatric rates of hepatic drug metabolism tend to decline with age half life of drugs maybe increased
and prolong responses.
What does the FDA regulate when it comes to medication? - ANSWER:what pharmacies can sell, requires
special alerts and management guidelines ensures pharmaceutical companies test and ensure efficacy
patient adherence to directions of use for efficacy and patients need to know about potentially serious
side effects and which medications are safe for pregnant and breast feeding women to take.
Reasons for non-adherence - ANSWER:-unclear, misunderstood directions
-confusion over taking multiple medications
& Answers
Which Drugs can APRNS perscribe - ANSWER:DEA license will allow for prescribing schedules 2-5 there
can be restrictions as noted in collaborative agreement. maybe facility/state dependent.
Who determines and regulates prescriptive authority? - ANSWER:determines: APRNS can prescribe
without limitation and is state dependent. It is regulated by health professional board state board of
nursing or state board of medicine or pharmacy. federal government controls regulation but no control
over prescriptive authority.
How does limited prescriptive authority impact patients within the healthcare system? -
ANSWER:Creates numerous barriers to quality affordable and acessible patient care.
Key responsibilities to prescribing? - ANSWER:Do not prescribe to family/friends or yourself. document a
thorough history and physical examination. Include discussions with patient about risk factors and side
effects, medication monitoring or titration. if additional consults are made, know limitations, keep rx
pads in a safe place confirm allergies verify medication list dont let insurance dictate quality of RN
charting is key.
what should be used to make prescribing decisions? - ANSWER:Cost, availability, current practice
guidelines, medication interactions with food side effects need for monitoring how drug is metabolized.
special populations. ask if prescriptions are cost prohibitive.
Pharmacokinetics - ANSWER:what the body does to the drug
Pharmacodynamics - ANSWER:what the drug does to the body
physilogic changes that can affect the pharmaconetics in older adults. - ANSWER:absorption: inc gastric
PH decreased absorptive surface area and dec splanchnic blood flow. dec GI motility delayed gastric
emptying distribution: inc body fat dec lean body mass dec total body water serum albumin cardiac
output. metabolism: dec hepatic blood flow mass and activity of hepatic enzymes. excretion: decreased
renal blood flow GFR tubular secretion and number of nephrons.
reducing adverse drug reaction in older adults? - ANSWER:Thorough drug history go low and slow with
initiating drug therapy monitor clinical responses and plasma levels use simple medication regimen,
monitor drug interaction review drug therapy dispose old medications promote adherence use beers
criteria.
Beers Criteria - ANSWER:A list of medications that are generally considered inappropriate when given to
elderly people
impacts of polypharmacy - ANSWER:using 5 or more medications daily leads to possible drug
interactions.
CYP450 inhibitors - ANSWER:CRACK AMIGOS
, Chloramphenicol
Ritonavir (protease inhibitor)
Amiodarone
Ciprofloxacin
Ketocanazole (and other azoles)
Acute alcohol use
Valproate
Isoniazid
Grapefruit Juice
Sulfonamides
CYP450 inhibitors function - ANSWER:slow down the metabolic activity of specific enzymes, causing a
decrease in the rate/extent of metabolism of other drugs that are substrates for those same enzymes
this can cause drug toxicity.
CYP450 inducers - ANSWER:barbituates, griseofulvin, carbamazepine, rifampin, st. john wart, chronic
alcoholism, phenytoin (CRAP GPS)
CYP450 inducers function - ANSWER:increase medication metabolism. act on the liver to stimulate
enzyme synthesis
If CYP450 is induced, what is the effect on medication metabolism? - ANSWER:drug may not achieve
therapeutic effects
When patients have a poor metabolism phenotype? - ANSWER:slows or increases absorption ex; plavix
clots and inc platelets pregnancy hepatic metabolism increases and dec bowel motility increases
absorption of the drug. newborns the drug metabolizing capacity is low, children by the age of 1 are
similar to adults but they can be metabolized quickly an increase or reduction in dosing may be needed.
geriatric rates of hepatic drug metabolism tend to decline with age half life of drugs maybe increased
and prolong responses.
What does the FDA regulate when it comes to medication? - ANSWER:what pharmacies can sell, requires
special alerts and management guidelines ensures pharmaceutical companies test and ensure efficacy
patient adherence to directions of use for efficacy and patients need to know about potentially serious
side effects and which medications are safe for pregnant and breast feeding women to take.
Reasons for non-adherence - ANSWER:-unclear, misunderstood directions
-confusion over taking multiple medications
