NR 565 - ADVANCED
PHARMACOLOGY MIDTERM -
CHAMBERLAIN
During65what65trimester65is65a65pregnant65woman65most65at65risk65for65adverse65drug65r
eactions65with65potential65long65term65consequences?65-65answer--
1st65trimester65(fetus65most65at65risk65d/t65rapid65growth)
What65is65BEERS65criteria?65-65answer--
Recommendations65of65medications65inappropriate65for65elderly65(6565and65older),65pre
scriber65ultimately65decides
What65is65the65CYP45065(cytochrome65P450)65-65answer--
liver65enzyme65system65where65medications65are65metabolized,65can65either65be65induc
ers65or65inhibitors65and65create65drug-drug65interactions
CYP45065inducers65-65answer--
Speed65up65metabolism65of65drugs65(drug65is65cleared65faster),65drug65has65lesser65effe
ct65(decrease65blood65levels65of65drug),65elevate65CYP45065enzymes
CYP45065inducers65pneumonic65-65answer--"Bullshit65Crap65GPS65INDUCES65rage"
CYP45065inducer65drug65names65-65answer--
Barbituates,65St65John65wort,65Carbamazepine,65rifampin,65alcohol,65phenytoin,65griseof
ulvin,65phenobarbital,65sulfonylureas
CYP45065inhibitors65-65answer--
inhibit65metabolism,65increase65blood65levels65of65medications
CYP45065pneumonic65-
65answer--"VISA65credit65card65debt65INHIBITS65spending65on65designers65like65CK65to6
5look65GQ"
CYP45065inhibitors65drug65names65-65answer--
Valproate,65isoniazid,65sulfonamides,65amiodarone,65chloramphenicol,65ketoconazole,65
grapefruit65juice,65quinidine
,Physiological65changes65during65pregnancy65that65impact65pharmacodynamics65and65p
harmacokinetic65properties65of65drugs?65-65answer--
increase65glomerular65filtration65rate65leads65to65increase65durg65excretion65
increase65hepatic65metabolism
decrease65tone65and65motility65of65bowel
increase65drug65absorption
Examples65of65medications65that65can65be65teratogenic65-65answer--
Antiepileptic65drugs,65antimicrobials65such65as65tetracyclines65and65fluoroquinolones,65vi
tamin65A65in65large65doses,65some65anticoagulants,65and65hormonal65medications65such
65as65diethylstilbestrol65(DES).
How65is65absorption65of65intramuscular65medications65different65in65neonates?65-
65answer--
slow65and65erratic65due65to65low65blood65flow65in65muscles65first65few65days65of65life
Why65is65absorption65of65medication65in65the65stomach65increased65in65infancy?65-
65answer--delayed65gastric65emptying
Some65medications65that65should65be65avoided65in65the65pediatric65patient?65-
65answer--
glucocorticoids,65discoloration65of65developing65teeth65with65tetracyclines,65and65kernict
erus65with65sulfonamides,65levofloxacin65(antibiotics)65
aspirin65(Severe65intoxication65from65acute65overdose)
what65should65be65included65in65medication65administration65patient65education?65-
65answer--dosage65size65and65timing
route65and65technique65of65administration
duration65of65treatment
drug65storage
nature65and65time65course65of65desired65responses
nature65and65time65course65of65adverse65responses
finish65taking65antibiotic
What65are65some65things65that65put65the65elderly65patient65at65higher65risk65for65adverse
65drug65reactions?65-65answer--reduced65renal65function65
polypharmacy65(the65use65of65five65or65more65medications65daily)
greater65severity65of65illness
presence65of65comorbidities
use65of65drugs65that65have65a65low65therapeutic65index65(e.g.,65digoxin)
increased65individual65variation65secondary65to65altered65pharmacokinetics
inadequate65supervision65of65long-term65therapy
poor65patient65adherence
, How65can65healthcare65providers65decrease65likelihood65of65an65elderly65patient65experi
encing65an65adverse65drug65reaction?65-65answer--
obtaining65a65thorough65drug65history65that65includes65over-the-counter65medications
considering65pharmacokinetic65and65pharmacodynamics65changes65due65to65age
monitoring65the65patient's65clinical65response65and65plasma65drug65levels
using65the65simplest65regimen65possible
monitoring65for65drug-drug65interactions65and65iatrogenic65illness
periodically65reviewing65the65need65for65continued65drug65therapy
encouraging65the65patient65to65dispose65of65old65medications
taking65steps65to65promote65adherence65and65to65avoid65drugs65on65the65Beers65list
How65can65we65promote65medication65adherence65with65elderly65patients?65-65answer--
simplifying65drug65regimens
providing65clear65and65concise65verbal65and65written65instructions
using65an65appropriate65dosage65form
clearly65labeling65and65dispensing65easy-to-open65containers
developing65daily65reminders
monitoring65frequently
affordability65of65drugs
support65systems
Why65do65nitrates65need65to65be65taken65no65later65than65465PM?65-65answer--
Need65nitrate65free65interval65so65tolerance65doesn't65develop
Nine65factors65that65impact65outcome65of65medication?65-65answer--Gender65and65race
Genetics65and65pharmacogenomics
Variability65in65absorption
placebo65effect
Tolerance
patho
age
bodyweight
Do65you65need65informed65consent65for65genetic65testing?65-65answer--yes
What65is65the65purpose65of65the65Genetic65Information65Non-Discriminatory65Act?65-
65answer--
Protects65patients65from65discrimination65by65employers65and65insurance65providers65ba
sed65on65genetic65information
Difference65between65practice65authority65and65prescriptive65authority?65-65answer--
Practice65authority65refers65to65the65nurse65practitioner's65ability65to65practice65without65
physician65oversight,65whereas65prescriptive65authority65refers65to65the65nurse65practitio
ner's65authority65to65prescribe65medications65independently65and65without65limitations.
PHARMACOLOGY MIDTERM -
CHAMBERLAIN
During65what65trimester65is65a65pregnant65woman65most65at65risk65for65adverse65drug65r
eactions65with65potential65long65term65consequences?65-65answer--
1st65trimester65(fetus65most65at65risk65d/t65rapid65growth)
What65is65BEERS65criteria?65-65answer--
Recommendations65of65medications65inappropriate65for65elderly65(6565and65older),65pre
scriber65ultimately65decides
What65is65the65CYP45065(cytochrome65P450)65-65answer--
liver65enzyme65system65where65medications65are65metabolized,65can65either65be65induc
ers65or65inhibitors65and65create65drug-drug65interactions
CYP45065inducers65-65answer--
Speed65up65metabolism65of65drugs65(drug65is65cleared65faster),65drug65has65lesser65effe
ct65(decrease65blood65levels65of65drug),65elevate65CYP45065enzymes
CYP45065inducers65pneumonic65-65answer--"Bullshit65Crap65GPS65INDUCES65rage"
CYP45065inducer65drug65names65-65answer--
Barbituates,65St65John65wort,65Carbamazepine,65rifampin,65alcohol,65phenytoin,65griseof
ulvin,65phenobarbital,65sulfonylureas
CYP45065inhibitors65-65answer--
inhibit65metabolism,65increase65blood65levels65of65medications
CYP45065pneumonic65-
65answer--"VISA65credit65card65debt65INHIBITS65spending65on65designers65like65CK65to6
5look65GQ"
CYP45065inhibitors65drug65names65-65answer--
Valproate,65isoniazid,65sulfonamides,65amiodarone,65chloramphenicol,65ketoconazole,65
grapefruit65juice,65quinidine
,Physiological65changes65during65pregnancy65that65impact65pharmacodynamics65and65p
harmacokinetic65properties65of65drugs?65-65answer--
increase65glomerular65filtration65rate65leads65to65increase65durg65excretion65
increase65hepatic65metabolism
decrease65tone65and65motility65of65bowel
increase65drug65absorption
Examples65of65medications65that65can65be65teratogenic65-65answer--
Antiepileptic65drugs,65antimicrobials65such65as65tetracyclines65and65fluoroquinolones,65vi
tamin65A65in65large65doses,65some65anticoagulants,65and65hormonal65medications65such
65as65diethylstilbestrol65(DES).
How65is65absorption65of65intramuscular65medications65different65in65neonates?65-
65answer--
slow65and65erratic65due65to65low65blood65flow65in65muscles65first65few65days65of65life
Why65is65absorption65of65medication65in65the65stomach65increased65in65infancy?65-
65answer--delayed65gastric65emptying
Some65medications65that65should65be65avoided65in65the65pediatric65patient?65-
65answer--
glucocorticoids,65discoloration65of65developing65teeth65with65tetracyclines,65and65kernict
erus65with65sulfonamides,65levofloxacin65(antibiotics)65
aspirin65(Severe65intoxication65from65acute65overdose)
what65should65be65included65in65medication65administration65patient65education?65-
65answer--dosage65size65and65timing
route65and65technique65of65administration
duration65of65treatment
drug65storage
nature65and65time65course65of65desired65responses
nature65and65time65course65of65adverse65responses
finish65taking65antibiotic
What65are65some65things65that65put65the65elderly65patient65at65higher65risk65for65adverse
65drug65reactions?65-65answer--reduced65renal65function65
polypharmacy65(the65use65of65five65or65more65medications65daily)
greater65severity65of65illness
presence65of65comorbidities
use65of65drugs65that65have65a65low65therapeutic65index65(e.g.,65digoxin)
increased65individual65variation65secondary65to65altered65pharmacokinetics
inadequate65supervision65of65long-term65therapy
poor65patient65adherence
, How65can65healthcare65providers65decrease65likelihood65of65an65elderly65patient65experi
encing65an65adverse65drug65reaction?65-65answer--
obtaining65a65thorough65drug65history65that65includes65over-the-counter65medications
considering65pharmacokinetic65and65pharmacodynamics65changes65due65to65age
monitoring65the65patient's65clinical65response65and65plasma65drug65levels
using65the65simplest65regimen65possible
monitoring65for65drug-drug65interactions65and65iatrogenic65illness
periodically65reviewing65the65need65for65continued65drug65therapy
encouraging65the65patient65to65dispose65of65old65medications
taking65steps65to65promote65adherence65and65to65avoid65drugs65on65the65Beers65list
How65can65we65promote65medication65adherence65with65elderly65patients?65-65answer--
simplifying65drug65regimens
providing65clear65and65concise65verbal65and65written65instructions
using65an65appropriate65dosage65form
clearly65labeling65and65dispensing65easy-to-open65containers
developing65daily65reminders
monitoring65frequently
affordability65of65drugs
support65systems
Why65do65nitrates65need65to65be65taken65no65later65than65465PM?65-65answer--
Need65nitrate65free65interval65so65tolerance65doesn't65develop
Nine65factors65that65impact65outcome65of65medication?65-65answer--Gender65and65race
Genetics65and65pharmacogenomics
Variability65in65absorption
placebo65effect
Tolerance
patho
age
bodyweight
Do65you65need65informed65consent65for65genetic65testing?65-65answer--yes
What65is65the65purpose65of65the65Genetic65Information65Non-Discriminatory65Act?65-
65answer--
Protects65patients65from65discrimination65by65employers65and65insurance65providers65ba
sed65on65genetic65information
Difference65between65practice65authority65and65prescriptive65authority?65-65answer--
Practice65authority65refers65to65the65nurse65practitioner's65ability65to65practice65without65
physician65oversight,65whereas65prescriptive65authority65refers65to65the65nurse65practitio
ner's65authority65to65prescribe65medications65independently65and65without65limitations.
