NR565 Advanced Pharm Midterm, NR
565 - advanced pharmacology
midterm - Chamberlain
What is used to calculate a patient's overdose risk? (An actual calculation won't be
done
on the exam) - ANSWER
Which schedule drugs can APRNs prescribe? - 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? - 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? - 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? - 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? - 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 -
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 - 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? - 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 - 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 - 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? - 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?) - ANSWER Toxicity. drug build up
Examples of CYP450 inducers? - ANSWER barbiturates, St Johns wart,
carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
What do CYP450 inducers do? - 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? - 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.
565 - advanced pharmacology
midterm - Chamberlain
What is used to calculate a patient's overdose risk? (An actual calculation won't be
done
on the exam) - ANSWER
Which schedule drugs can APRNs prescribe? - 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? - 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? - 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? - 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? - 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 -
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 - 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? - 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 - 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 - 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? - 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?) - ANSWER Toxicity. drug build up
Examples of CYP450 inducers? - ANSWER barbiturates, St Johns wart,
carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
What do CYP450 inducers do? - 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? - 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.
