NR565 Advanced Pharm Midterm
1. What is used to calculate a patient's overdose risk? (An actual
calculation won't be done on the exam):
2. Which schedule drugs can APRNs prescribe?: DEA license will allow for
prescribing of Schedules 2-5. There can be restrictions as noted in collaborative
agreement. May be facility/state dependent.
3. Who determines and regulates prescriptive authority?: 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. 4. How does limited prescriptive authority impact patients within
the healthcare system?: 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.
5. What are the key responsibilities of prescribing?: 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.
6. What should be used to make prescribing decisions?: 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)
, NR565 Advanced Pharm Midterm
7. Be familiar with pharmacokinetic and pharmacodynamic changes of
older adults and how that would translate to baseline information needed to
prescribe: 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. 8. Beer's criteria: 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.
9. Why is Beer's criteria important?: 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.
10. Impacts/outcomes of polypharmacy: 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.
11. CYP450: 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.
12. What are the CYP450 inhibitors?: 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.
, NR565 Advanced Pharm Midterm
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
13. What do they cause if not used correctly (CYP450)?(aka:What would the
patient experience?): Toxicity. drug build up
14. Examples of CYP450 inducers?: barbiturates, St Johns wart,
carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
15. What do CYP450 inducers do?: 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.
16. What happens when someone has a poor metabolism phenotype?: 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.
17. What does the U.S. Food and Drug Administration regulate when it
comes to medications?: Regulates what the pharmacies can sell, requires
special alerts and management guidelines, for drugs that cause serious
adverse effects. Ensuring pharmaceutical companies thoroughly test new
products for efficacy and safety with an aim towards minimizing side effects.
They approve or disapprove drugs
18. Reasons for medication non-adherence: 1. patient feels not needed
2. affordability
3. side effects
4. forgetfulness
5. lack of info
1. What is used to calculate a patient's overdose risk? (An actual
calculation won't be done on the exam):
2. Which schedule drugs can APRNs prescribe?: DEA license will allow for
prescribing of Schedules 2-5. There can be restrictions as noted in collaborative
agreement. May be facility/state dependent.
3. Who determines and regulates prescriptive authority?: 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. 4. How does limited prescriptive authority impact patients within
the healthcare system?: 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.
5. What are the key responsibilities of prescribing?: 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.
6. What should be used to make prescribing decisions?: 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)
, NR565 Advanced Pharm Midterm
7. Be familiar with pharmacokinetic and pharmacodynamic changes of
older adults and how that would translate to baseline information needed to
prescribe: 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. 8. Beer's criteria: 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.
9. Why is Beer's criteria important?: 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.
10. Impacts/outcomes of polypharmacy: 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.
11. CYP450: 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.
12. What are the CYP450 inhibitors?: 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.
, NR565 Advanced Pharm Midterm
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
13. What do they cause if not used correctly (CYP450)?(aka:What would the
patient experience?): Toxicity. drug build up
14. Examples of CYP450 inducers?: barbiturates, St Johns wart,
carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital,
sulfonylureas
15. What do CYP450 inducers do?: 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.
16. What happens when someone has a poor metabolism phenotype?: 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.
17. What does the U.S. Food and Drug Administration regulate when it
comes to medications?: Regulates what the pharmacies can sell, requires
special alerts and management guidelines, for drugs that cause serious
adverse effects. Ensuring pharmaceutical companies thoroughly test new
products for efficacy and safety with an aim towards minimizing side effects.
They approve or disapprove drugs
18. Reasons for medication non-adherence: 1. patient feels not needed
2. affordability
3. side effects
4. forgetfulness
5. lack of info
