NR 565 - advanced pharmacology midterm – Chamberlain
questions and solutions
During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term
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consequences? - answers1st trimester (fetus most at risk d/t rapid growth)
ak ak ak ak ak ak ak ak ak ak ak
What is BEERS criteria? - answersRecommendations of medications inappropriate for elderly (65 and older), prescribe
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
ultimately decides
ak ak
What is the CYP450 (cytochrome P450) - answersliver enzyme system where medications are metabolized, can either
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
be inducers or inhibitors and create drug-drug interactions
ak ak ak ak ak ak ak ak
CYP450 inducers - answersSpeed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blo
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
levels of drug), elevate CYP450 enzymes
ak ak ak ak ak ak
CYP450 inducers pneumonic - answers"Bullshit Crap GPS INDUCES rage"
ak ak ak ak ak ak ak ak
CYP450 inducer drug names - answersBarbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin,
ak ak ak ak ak ak ak ak ak ak ak ak
griseofulvin, phenobarbital, sulfonylureas
ak ak ak
CYP450 inhibitors - answersinhibit metabolism, increase blood levels of medications
ak ak ak ak ak ak ak ak ak
CYP450 pneumonic - answers"VISA credit card debt INHIBITS spending on designers like CK to look GQ"
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
CYP450 inhibitors drug names - answersValproate, isoniazid, sulfonamides, amiodarone, chloramphenicol,
ak ak ak ak ak ak ak ak ak
ketoconazole, grapefruit juice, quinidine
ak ak ak ak
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties of drugs? -
ak ak ak ak ak ak ak ak ak ak ak ak
answersincrease glomerular filtration rate leads to increase durg excretion
ak ak ak ak ak ak ak ak ak ak
increase hepatic metabolism ak ak
decrease tone and motility of bowel ak ak ak ak ak
increase drug absorption ak ak
Examples of medications that can be teratogenic - answersAntiepileptic drugs, antimicrobials such as tetracyclines an
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
(DES).
ak
How is absorption of intramuscular medications different in neonates? - answersslow and erratic due to low blood flow in
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
muscles first few days of life
ak ak ak ak ak ak
Why is absorption of medication in the stomach increased in infancy? - answersdelayed gastric emptying
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Some medications that should be avoided in the pediatric patient? - answersglucocorticoids, discoloration of developin
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
teeth with tetracyclines, and kernicterus with sulfonamides, levofloxacin (antibiotics)
ak ak ak ak ak ak ak ak ak ak
aspirin (Severe intoxication from acute overdose)
ak ak ak ak ak
what should be included in medication administration patient education? - answersdosage size and timing
ak ak ak ak ak ak ak ak ak ak ak ak ak
1/18 ak ak
,route and technique of administration
ak ak ak ak
duration of treatment ak ak
drug storage ak
nature and time course of desired responses ak ak ak ak ak ak
nature and time course of adverse responses ak ak ak ak ak ak
finish taking antibiotic ak ak
What are some things that put the elderly patient at higher risk for adverse drug reactions? - answersreduced renal
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
function
ak ak
polypharmacy (the use of five or more medications daily) ak ak ak ak ak ak ak ak
greater severity of illness ak ak ak
presence of comorbidities ak ak
use of drugs that have a low therapeutic index (e.g., digoxin)
ak ak ak ak ak ak ak ak ak ak
increased individual variation secondary to altered pharmacokinetics ak ak ak ak ak ak
inadequate supervision of long-term therapy ak ak ak ak
poor patient adherence
ak ak
How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? -
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
answersobtaining a thorough drug history that includes over-the-counter medications
ak ak ak ak ak ak ak ak ak
considering pharmacokinetic and pharmacodynamics changes due to age ak ak ak ak ak ak ak
monitoring the patient's clinical response and plasma drug levels ak ak ak ak ak ak ak ak
using the simplest regimen possible
ak ak ak ak
monitoring for drug-drug interactions and iatrogenic illness ak ak ak ak ak ak
periodically reviewing the need for continued drug therapy ak ak ak ak ak ak ak
encouraging the patient to dispose of old medications ak ak ak ak ak ak ak
taking steps to promote adherence and to avoid drugs on the Beers list
ak ak ak ak ak ak ak ak ak ak ak ak
How can we promote medication adherence with elderly patients? - answerssimplifying drug regimens
ak ak ak ak ak ak ak ak ak ak ak ak
providing clear and concise verbal and written instructions ak ak ak ak ak ak ak
using an appropriate dosage form
ak ak ak ak
clearly labeling and dispensing easy-to-open containers
ak ak ak ak ak
developing daily reminders ak ak
monitoring frequently ak
affordability of drugs ak ak
support systems ak
Why do nitrates need to be taken no later than 4 PM? - answersNeed nitrate free interval so tolerance doesn't develop
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Nine factors that impact outcome of medication? - answersGender and race
ak ak ak ak ak ak ak ak ak ak
Genetics and pharmacogenomics ak ak
Variability in absorption ak ak
placebo effect ak
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - answersyes
ak ak ak ak ak ak ak ak ak
What is the purpose of the Genetic Information Non-Discriminatory Act? - answersProtects patients from discrimination
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
by employers and insurance providers based on genetic information
ak ak ak ak ak ak ak ak ak
2/18
ak ak
,Difference between practice authority and prescriptive authority? - answersPractice authority refers to the nurse
ak ak ak ak ak ak ak ak ak ak ak ak ak
practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
practitioner's authority to prescribe medications independently and without limitations.
ak ak ak ak ak ak ak ak ak
Who regulates prescriptive authority? - answersthe jurisdiction of a health professional board. This may be the State
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
What is scope of practice determined by? - answersis determined by state practice and licensure laws.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
What is full practice authority? - answersNurse practitioners have the autonomy to evaluate patients, diagnose, order a
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without
ak ak ak ak ak ak ak ak ak ak ak ak ak
physician oversight.
ak ak
What is reduced practice authority? - answersNurse practitioners are limited in at least one element of practice. The sta
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
care. ex/ physician involvement for 5 yrs than independent
ak ak ak ak ak ak ak ak ak
What is restricted practice authority? - answersNurse practitioners are limited in at least one element of practice by
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
provide patient care.- typically doctor on site
ak ak ak ak ak ak ak
What are components of Rx? - answersPrescriber Contact info
ak ak ak ak ak ak ak ak
Prescribers name ak
NPI
DEA
Patient name ak
DOB
Date
Allergies
Medication name ak
Strength
Quantity
Indication for use ak ak
Direction for use ak ak
Refills
Signature
What are some potential problems that arise with written prescriptions? - answersMust contain all elements
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
May have pre-populated information ak ak ak
Write legibly ak
Avoid error prone abbreviations ak ak ak
Tamper resistant scripts are often required ak ak ak ak ak
Reasons for monitoring drug therapy - answersdetermining therapeutic dosage ak ak ak ak ak ak ak ak
evaluating medication adequacy ak ak
identifying adverse effects ak ak
serious or life-threatening risks. ak ak ak
Which schedules of drugs can APRNs prescribe? - answersdepends on state - most II-V
ak ak ak ak ak ak ak ak ak ak ak ak ak
3/18 ak ak
questions and solutions
During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
consequences? - answers1st trimester (fetus most at risk d/t rapid growth)
ak ak ak ak ak ak ak ak ak ak ak
What is BEERS criteria? - answersRecommendations of medications inappropriate for elderly (65 and older), prescribe
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
ultimately decides
ak ak
What is the CYP450 (cytochrome P450) - answersliver enzyme system where medications are metabolized, can either
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
be inducers or inhibitors and create drug-drug interactions
ak ak ak ak ak ak ak ak
CYP450 inducers - answersSpeed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blo
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
levels of drug), elevate CYP450 enzymes
ak ak ak ak ak ak
CYP450 inducers pneumonic - answers"Bullshit Crap GPS INDUCES rage"
ak ak ak ak ak ak ak ak
CYP450 inducer drug names - answersBarbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin,
ak ak ak ak ak ak ak ak ak ak ak ak
griseofulvin, phenobarbital, sulfonylureas
ak ak ak
CYP450 inhibitors - answersinhibit metabolism, increase blood levels of medications
ak ak ak ak ak ak ak ak ak
CYP450 pneumonic - answers"VISA credit card debt INHIBITS spending on designers like CK to look GQ"
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
CYP450 inhibitors drug names - answersValproate, isoniazid, sulfonamides, amiodarone, chloramphenicol,
ak ak ak ak ak ak ak ak ak
ketoconazole, grapefruit juice, quinidine
ak ak ak ak
Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties of drugs? -
ak ak ak ak ak ak ak ak ak ak ak ak
answersincrease glomerular filtration rate leads to increase durg excretion
ak ak ak ak ak ak ak ak ak ak
increase hepatic metabolism ak ak
decrease tone and motility of bowel ak ak ak ak ak
increase drug absorption ak ak
Examples of medications that can be teratogenic - answersAntiepileptic drugs, antimicrobials such as tetracyclines an
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
(DES).
ak
How is absorption of intramuscular medications different in neonates? - answersslow and erratic due to low blood flow in
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
muscles first few days of life
ak ak ak ak ak ak
Why is absorption of medication in the stomach increased in infancy? - answersdelayed gastric emptying
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Some medications that should be avoided in the pediatric patient? - answersglucocorticoids, discoloration of developin
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
teeth with tetracyclines, and kernicterus with sulfonamides, levofloxacin (antibiotics)
ak ak ak ak ak ak ak ak ak ak
aspirin (Severe intoxication from acute overdose)
ak ak ak ak ak
what should be included in medication administration patient education? - answersdosage size and timing
ak ak ak ak ak ak ak ak ak ak ak ak ak
1/18 ak ak
,route and technique of administration
ak ak ak ak
duration of treatment ak ak
drug storage ak
nature and time course of desired responses ak ak ak ak ak ak
nature and time course of adverse responses ak ak ak ak ak ak
finish taking antibiotic ak ak
What are some things that put the elderly patient at higher risk for adverse drug reactions? - answersreduced renal
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
function
ak ak
polypharmacy (the use of five or more medications daily) ak ak ak ak ak ak ak ak
greater severity of illness ak ak ak
presence of comorbidities ak ak
use of drugs that have a low therapeutic index (e.g., digoxin)
ak ak ak ak ak ak ak ak ak ak
increased individual variation secondary to altered pharmacokinetics ak ak ak ak ak ak
inadequate supervision of long-term therapy ak ak ak ak
poor patient adherence
ak ak
How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? -
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
answersobtaining a thorough drug history that includes over-the-counter medications
ak ak ak ak ak ak ak ak ak
considering pharmacokinetic and pharmacodynamics changes due to age ak ak ak ak ak ak ak
monitoring the patient's clinical response and plasma drug levels ak ak ak ak ak ak ak ak
using the simplest regimen possible
ak ak ak ak
monitoring for drug-drug interactions and iatrogenic illness ak ak ak ak ak ak
periodically reviewing the need for continued drug therapy ak ak ak ak ak ak ak
encouraging the patient to dispose of old medications ak ak ak ak ak ak ak
taking steps to promote adherence and to avoid drugs on the Beers list
ak ak ak ak ak ak ak ak ak ak ak ak
How can we promote medication adherence with elderly patients? - answerssimplifying drug regimens
ak ak ak ak ak ak ak ak ak ak ak ak
providing clear and concise verbal and written instructions ak ak ak ak ak ak ak
using an appropriate dosage form
ak ak ak ak
clearly labeling and dispensing easy-to-open containers
ak ak ak ak ak
developing daily reminders ak ak
monitoring frequently ak
affordability of drugs ak ak
support systems ak
Why do nitrates need to be taken no later than 4 PM? - answersNeed nitrate free interval so tolerance doesn't develop
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Nine factors that impact outcome of medication? - answersGender and race
ak ak ak ak ak ak ak ak ak ak
Genetics and pharmacogenomics ak ak
Variability in absorption ak ak
placebo effect ak
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing? - answersyes
ak ak ak ak ak ak ak ak ak
What is the purpose of the Genetic Information Non-Discriminatory Act? - answersProtects patients from discrimination
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
by employers and insurance providers based on genetic information
ak ak ak ak ak ak ak ak ak
2/18
ak ak
,Difference between practice authority and prescriptive authority? - answersPractice authority refers to the nurse
ak ak ak ak ak ak ak ak ak ak ak ak ak
practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
practitioner's authority to prescribe medications independently and without limitations.
ak ak ak ak ak ak ak ak ak
Who regulates prescriptive authority? - answersthe jurisdiction of a health professional board. This may be the State
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
What is scope of practice determined by? - answersis determined by state practice and licensure laws.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
What is full practice authority? - answersNurse practitioners have the autonomy to evaluate patients, diagnose, order a
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without
ak ak ak ak ak ak ak ak ak ak ak ak ak
physician oversight.
ak ak
What is reduced practice authority? - answersNurse practitioners are limited in at least one element of practice. The sta
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
care. ex/ physician involvement for 5 yrs than independent
ak ak ak ak ak ak ak ak ak
What is restricted practice authority? - answersNurse practitioners are limited in at least one element of practice by
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
provide patient care.- typically doctor on site
ak ak ak ak ak ak ak
What are components of Rx? - answersPrescriber Contact info
ak ak ak ak ak ak ak ak
Prescribers name ak
NPI
DEA
Patient name ak
DOB
Date
Allergies
Medication name ak
Strength
Quantity
Indication for use ak ak
Direction for use ak ak
Refills
Signature
What are some potential problems that arise with written prescriptions? - answersMust contain all elements
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
May have pre-populated information ak ak ak
Write legibly ak
Avoid error prone abbreviations ak ak ak
Tamper resistant scripts are often required ak ak ak ak ak
Reasons for monitoring drug therapy - answersdetermining therapeutic dosage ak ak ak ak ak ak ak ak
evaluating medication adequacy ak ak
identifying adverse effects ak ak
serious or life-threatening risks. ak ak ak
Which schedules of drugs can APRNs prescribe? - answersdepends on state - most II-V
ak ak ak ak ak ak ak ak ak ak ak ak ak
3/18 ak ak
