1st trimester (fetus most at risk d/t rapid growth)
During what trimester is a pregnant woman
most at risk for adverse drug reactions with
potential long term consequences?
Recommendations of medications inappropriate for elderly (65 and older), prescriber
What is BEERS criteria? ultimately decides
liver enzyme system where medications are metabolized, can either be inducers or
What is the CYP450 (cytochrome P450) inhibitors and create drug-drug interactions
Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect
CYP450 inducers (decrease blood levels of drug), elevate CYP450 enzymes
CYP450 inducers pneumonic "Bullshit Crap GPS INDUCES rage"
Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
CYP450 inducer drug names phenobarbital, sulfonylureas
CYP450 inhibitors inhibit metabolism, increase blood levels of medications
CYP450 pneumonic "VISA credit card debt INHIBITS spending on designers like CK to look GQ"
Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole,
CYP450 inhibitors drug names grapefruit juice, quinidine
increase glomerular filtration rate leads to increase durg excretion
Physiological changes during pregnancy that increase hepatic metabolism
impact pharmacodynamics and decrease tone and motility of bowel
pharmacokinetic properties of drugs? increase drug absorption
Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A
Examples of medications that can be in large doses, some anticoagulants, and hormonal medications such as
teratogenic diethylstilbestrol (DES).
slow and erratic due to low blood flow in muscles first few days of life
How is absorption of intramuscular
medications different in neonates?
Why is absorption of medication in the delayed gastric emptying
stomach increased in infancy?
glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus
Some medications that should be avoided in with sulfonamides, levofloxacin (antibiotics)
the pediatric patient? aspirin (Severe intoxication from acute overdose)
dosage size and timing
route and technique of administration
duration of treatment
drug storage
what should be included in medication nature and time course of desired responses
administration patient education? nature and time course of adverse responses
finish taking antibiotic
reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
What are some things that put the elderly use of drugs that have a low therapeutic index (e.g., digoxin)
patient at higher risk for adverse drug increased individual variation secondary to altered pharmacokinetics
reactions? inadequate supervision of long-term therapy
poor patient adherence
, obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
How can healthcare providers decrease monitoring for drug-drug interactions and iatrogenic illness
likelihood of an elderly patient experiencing periodically reviewing the need for continued drug therapy
an adverse drug reaction? encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
simplifying drug regimens
providing clear and concise verbal and written instructions
using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
How can we promote medication adherence monitoring frequently
with elderly patients? affordability of drugs
support systems
Why do nitrates need to be taken no later Need nitrate free interval so tolerance doesn't develop
than 4 PM?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
Nine factors that impact outcome of patho
medication? age
bodyweight
Do you need informed consent for genetic yes
testing?
What is the purpose of the Genetic Protects patients from discrimination by employers and insurance providers based on
genetic information
Information Non-Discriminatory Act?
Practice authority refers to the nurse practitioner's ability to practice without physician
Difference between practice authority and oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescriptive authority? prescribe medications independently and without limitations.
the jurisdiction of a health professional board. This may be the State Board of Nursing,
the State Board of Medicine, or the State Board of Pharmacy, as determined by each
Who regulates prescriptive authority? state.
What is scope of practice determined by? is determined by state practice and licensure laws.
Nurse practitioners have the autonomy to evaluate patients, diagnose, order and
interpret tests, initiate and manage treatments and prescribe medications, including
What is full practice authority? controlled substances without physician oversight.
Nurse practitioners are limited in at least one element of practice. The state requires a
formal collaborative agreement with an outside health discipline for the nurse
What is reduced practice authority? practitioner to provide patient care. ex/ physician involvement for 5 yrs than
independent
Nurse practitioners are limited in at least one element of practice by requiring
supervision, delegation, or team management by an outside health discipline for the
What is restricted practice authority? nurse practitioner to provide patient care.- typically doctor on site
, Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
DOB
Date
Allergies
Medication name
Strength
What are components of Rx? Quantity
Indication for use
Direction for use
Refills
Signature
Must contain all elements
May have pre-populated information
Write legibly
What are some potential problems that arise Avoid error prone abbreviations
with written prescriptions? Tamper resistant scripts are often required
determining therapeutic dosage
evaluating medication adequacy
Reasons for monitoring drug therapy identifying adverse effects
serious or life-threatening risks.
depends on state - most II-V
Which schedules of drugs can APRNs
prescribe?
longer wait times to sign a prescription
limits practitioners that are needed in rural areas
unequal relationships between providers. Ex. one has more power
How does limited prescriptive authority high need for providers due to lack of providers and high amounts of patients.
impact patients within the healthcare Independent practitioners= more patients being seen= lessens the patient/provider
system? load
safe and competent practice
understanding of the drugs, reactions, and pharmacology
Provider key responsibilities when Be aware of the age group you are prescribing to
prescribing? Ex. Children vs older adults
documented provider-patient relationship, not prescribing for family or friends,
documenting a thorough H&P, including discussions with the patient, drug
monitoring/titrating.
What should be used to make prescribing cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal
decisions? function, need for monitoring, and special populations
medications metabolized slower, medication might not work or put them at risk for side-
What happens when someone has a poor
effects
metabolism phenotype?
Whether the drug is safe, effective, and benefits of a drug outweigh the risks
What does the US food and drug
administration regulate when it comes to
medications?
During what trimester is a pregnant woman
most at risk for adverse drug reactions with
potential long term consequences?
Recommendations of medications inappropriate for elderly (65 and older), prescriber
What is BEERS criteria? ultimately decides
liver enzyme system where medications are metabolized, can either be inducers or
What is the CYP450 (cytochrome P450) inhibitors and create drug-drug interactions
Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect
CYP450 inducers (decrease blood levels of drug), elevate CYP450 enzymes
CYP450 inducers pneumonic "Bullshit Crap GPS INDUCES rage"
Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
CYP450 inducer drug names phenobarbital, sulfonylureas
CYP450 inhibitors inhibit metabolism, increase blood levels of medications
CYP450 pneumonic "VISA credit card debt INHIBITS spending on designers like CK to look GQ"
Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole,
CYP450 inhibitors drug names grapefruit juice, quinidine
increase glomerular filtration rate leads to increase durg excretion
Physiological changes during pregnancy that increase hepatic metabolism
impact pharmacodynamics and decrease tone and motility of bowel
pharmacokinetic properties of drugs? increase drug absorption
Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A
Examples of medications that can be in large doses, some anticoagulants, and hormonal medications such as
teratogenic diethylstilbestrol (DES).
slow and erratic due to low blood flow in muscles first few days of life
How is absorption of intramuscular
medications different in neonates?
Why is absorption of medication in the delayed gastric emptying
stomach increased in infancy?
glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus
Some medications that should be avoided in with sulfonamides, levofloxacin (antibiotics)
the pediatric patient? aspirin (Severe intoxication from acute overdose)
dosage size and timing
route and technique of administration
duration of treatment
drug storage
what should be included in medication nature and time course of desired responses
administration patient education? nature and time course of adverse responses
finish taking antibiotic
reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
What are some things that put the elderly use of drugs that have a low therapeutic index (e.g., digoxin)
patient at higher risk for adverse drug increased individual variation secondary to altered pharmacokinetics
reactions? inadequate supervision of long-term therapy
poor patient adherence
, obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
using the simplest regimen possible
How can healthcare providers decrease monitoring for drug-drug interactions and iatrogenic illness
likelihood of an elderly patient experiencing periodically reviewing the need for continued drug therapy
an adverse drug reaction? encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
simplifying drug regimens
providing clear and concise verbal and written instructions
using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
How can we promote medication adherence monitoring frequently
with elderly patients? affordability of drugs
support systems
Why do nitrates need to be taken no later Need nitrate free interval so tolerance doesn't develop
than 4 PM?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
Nine factors that impact outcome of patho
medication? age
bodyweight
Do you need informed consent for genetic yes
testing?
What is the purpose of the Genetic Protects patients from discrimination by employers and insurance providers based on
genetic information
Information Non-Discriminatory Act?
Practice authority refers to the nurse practitioner's ability to practice without physician
Difference between practice authority and oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescriptive authority? prescribe medications independently and without limitations.
the jurisdiction of a health professional board. This may be the State Board of Nursing,
the State Board of Medicine, or the State Board of Pharmacy, as determined by each
Who regulates prescriptive authority? state.
What is scope of practice determined by? is determined by state practice and licensure laws.
Nurse practitioners have the autonomy to evaluate patients, diagnose, order and
interpret tests, initiate and manage treatments and prescribe medications, including
What is full practice authority? controlled substances without physician oversight.
Nurse practitioners are limited in at least one element of practice. The state requires a
formal collaborative agreement with an outside health discipline for the nurse
What is reduced practice authority? practitioner to provide patient care. ex/ physician involvement for 5 yrs than
independent
Nurse practitioners are limited in at least one element of practice by requiring
supervision, delegation, or team management by an outside health discipline for the
What is restricted practice authority? nurse practitioner to provide patient care.- typically doctor on site
, Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
DOB
Date
Allergies
Medication name
Strength
What are components of Rx? Quantity
Indication for use
Direction for use
Refills
Signature
Must contain all elements
May have pre-populated information
Write legibly
What are some potential problems that arise Avoid error prone abbreviations
with written prescriptions? Tamper resistant scripts are often required
determining therapeutic dosage
evaluating medication adequacy
Reasons for monitoring drug therapy identifying adverse effects
serious or life-threatening risks.
depends on state - most II-V
Which schedules of drugs can APRNs
prescribe?
longer wait times to sign a prescription
limits practitioners that are needed in rural areas
unequal relationships between providers. Ex. one has more power
How does limited prescriptive authority high need for providers due to lack of providers and high amounts of patients.
impact patients within the healthcare Independent practitioners= more patients being seen= lessens the patient/provider
system? load
safe and competent practice
understanding of the drugs, reactions, and pharmacology
Provider key responsibilities when Be aware of the age group you are prescribing to
prescribing? Ex. Children vs older adults
documented provider-patient relationship, not prescribing for family or friends,
documenting a thorough H&P, including discussions with the patient, drug
monitoring/titrating.
What should be used to make prescribing cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal
decisions? function, need for monitoring, and special populations
medications metabolized slower, medication might not work or put them at risk for side-
What happens when someone has a poor
effects
metabolism phenotype?
Whether the drug is safe, effective, and benefits of a drug outweigh the risks
What does the US food and drug
administration regulate when it comes to
medications?
