NR 565 MIDTERM EXAM QUESTIONS
& DETAILED COMPLETE SOLUTIONS
Which schedule drugs can APRNs prescribe? - correct answer ✔✔Varies state by state
May include schedule II-V, but never schedule I
Who determines and regulates prescriptive authority? - correct answer ✔✔The state's health
professional board
How does limited prescriptive authority impact patients within the healthcare system? - correct
answer ✔✔Creates numerous barriers to quality, affordable, and accessible patient care
May prevent outreach to areas of greatest need
Physician approval of prescriptions can increase patient waits
What are the key responsibilities of prescribing? - correct answer ✔✔A sound understanding of
drugs and the conditions that they are used to manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions? - correct answer ✔✔Cost, follow current
guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for
monitoring, special populations
PK and PD changes in older adults and how that affects how you prescribe? - correct answer
✔✔Very high risk of adverse drug reactions and drug-drug interactions
,D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence
Beer's Criteria - correct answer ✔✔List of potentially inappropriate medications to use in the
older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
Impacts/outcomes of polypharmacy? - correct answer ✔✔Increased ADRs and drug-drug
interactions
What are CYP450? - correct answer ✔✔Enzymes responsible for drug metabolism
(biotransformation)-oxidization, reduction, hydrolyzed to promote renal dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do? - correct answer ✔✔Promote drug excretion by making them
more "excretable"--hydrophilic/water soluble and charged (ion)
Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease
drug toxicity
CYP450 inhibitor examples? - correct answer ✔✔VISA credit card debt inhibits spending on
designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
, Quinidine
What do CYP450 inhibitors do? - correct answer ✔✔Decrease the rate of metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation which can lead to adverse
reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly? - correct answer ✔✔Can lead to adverse
effects and drug toxicity
What happens when someone has a poor metabolism phenotype? - correct answer
✔✔Associated with accumulation of drugs in the body and they may experience drug toxicity
What does the US FDA regulate when it comes to medications? - correct answer ✔✔Regulates
safety and effectiveness of drugs sold in US
Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA
approval
Once drug is on market, FDA continues oversight of drug safety and effectiveness
Reasons for medication nonadherence? - correct answer ✔✔Forgetfulness, lack of planning,
cost, dissatisfaction, altered dosing
Black Box Warnings - correct answer ✔✔Strongest safety warning a drug can carry and still
remain on the market
Required by the FDA on drugs with serious or life-threatening risks
Neonate and infant drug absorption - correct answer ✔✔Drug sensitivity d/t organ immaturity-
increased risk of ADRs
Drug action unusually intense and prolonged
& DETAILED COMPLETE SOLUTIONS
Which schedule drugs can APRNs prescribe? - correct answer ✔✔Varies state by state
May include schedule II-V, but never schedule I
Who determines and regulates prescriptive authority? - correct answer ✔✔The state's health
professional board
How does limited prescriptive authority impact patients within the healthcare system? - correct
answer ✔✔Creates numerous barriers to quality, affordable, and accessible patient care
May prevent outreach to areas of greatest need
Physician approval of prescriptions can increase patient waits
What are the key responsibilities of prescribing? - correct answer ✔✔A sound understanding of
drugs and the conditions that they are used to manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions? - correct answer ✔✔Cost, follow current
guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for
monitoring, special populations
PK and PD changes in older adults and how that affects how you prescribe? - correct answer
✔✔Very high risk of adverse drug reactions and drug-drug interactions
,D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence
Beer's Criteria - correct answer ✔✔List of potentially inappropriate medications to use in the
older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
Impacts/outcomes of polypharmacy? - correct answer ✔✔Increased ADRs and drug-drug
interactions
What are CYP450? - correct answer ✔✔Enzymes responsible for drug metabolism
(biotransformation)-oxidization, reduction, hydrolyzed to promote renal dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do? - correct answer ✔✔Promote drug excretion by making them
more "excretable"--hydrophilic/water soluble and charged (ion)
Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease
drug toxicity
CYP450 inhibitor examples? - correct answer ✔✔VISA credit card debt inhibits spending on
designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
, Quinidine
What do CYP450 inhibitors do? - correct answer ✔✔Decrease the rate of metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation which can lead to adverse
reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly? - correct answer ✔✔Can lead to adverse
effects and drug toxicity
What happens when someone has a poor metabolism phenotype? - correct answer
✔✔Associated with accumulation of drugs in the body and they may experience drug toxicity
What does the US FDA regulate when it comes to medications? - correct answer ✔✔Regulates
safety and effectiveness of drugs sold in US
Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA
approval
Once drug is on market, FDA continues oversight of drug safety and effectiveness
Reasons for medication nonadherence? - correct answer ✔✔Forgetfulness, lack of planning,
cost, dissatisfaction, altered dosing
Black Box Warnings - correct answer ✔✔Strongest safety warning a drug can carry and still
remain on the market
Required by the FDA on drugs with serious or life-threatening risks
Neonate and infant drug absorption - correct answer ✔✔Drug sensitivity d/t organ immaturity-
increased risk of ADRs
Drug action unusually intense and prolonged
