Nr 565 Midterm Exam Questions With Correct Answers

Nr 565 Midterm Exam Questions With Correct Answers Which Drugs can APRNS perscribe - answerDEA license will allow for prescribing schedules 2-5 there can be restrictions as noted in collaborative agreement. maybe facility/state dependent. Who determines and regulates prescriptive authority? - answerdetermines: APRNS can prescribe without limitation and is state dependent. It is regulated by health professional board state board of nursing or state board of medicine or pharmacy. federal government controls regulation but no control over prescriptive authority. How does limited prescriptive authority impact patients within the healthcare system? - answerCreates numerous barriers to quality affordable and acessible patient care. Key responsibilities to prescribing? - answerDo not prescribe to family/friends or yourself. document a thorough history and physical examination. Include discussions with patient about risk factors and side effects, medication monitoring or titration. if additional consults are made, know limitations, keep rx pads in a safe place confirm allergies verify medication list dont let insurance dictate quality of RN charting is key. what should be used to make prescribing decisions? - answerCost, availability, current practice guidelines, medication interactions with food side effects need for monitoring how drug is metabolized. special populations. ask if prescriptions are cost prohibitive. Pharmacokinetics - answerwhat the body does to the drug Pharmacodynamics - answerwhat the drug does to the body physilogic changes that can affect the pharmaconetics in older adults. - answerabsorption: inc gastric PH decreased absorptive surface area and dec splanchnic blood flow. dec GI motility delayed gastric emptying distribution: inc body fat dec lean body mass dec total body water serum albumin cardiac output. metabolism: dec hepatic blood flow mass and activity of hepatic enzymes. excretion: decreased renal blood flow GFR tubular secretion and number of nephrons. reducing adverse drug reaction in older adults? - answerThorough drug history go low and slow with initiating drug therapy monitor clinical responses and plasma levels use simple medication regimen, monitor drug interaction review drug therapy dispose old medications promote adherence use beers criteria. EXAM STUDY MATERIALS July 29, 2024 12:59 PM Beers Criteria - answerA list of medications that are generally considered inappropriate when given to elderly people impacts of polypharmacy - answerusing 5 or more medications daily leads to possible drug interactions. CYP450 inhibitors - answerCRACK AMIGOS Chloramphenicol Ritonavir (protease inhibitor) Amiodarone Ciprofloxacin Ketocanazole (and other azoles) Acute alcohol use Valproate Isoniazid Grapefruit Juice Sulfonamides CYP450 inhibitors function - answerslow down the metabolic activity of specific enzymes, causing a decrease in the rate/extent of metabolism of other drugs that are substrates for those same enzymes this can cause drug toxicity. CYP450 inducers - answerbarbituates, griseofulvin, carbamazepine, rifampin, st. john wart, chronic alcoholism, phenytoin (CRAP GPS) CYP450 inducers function - answerincrease medication metabolism. act on the liver to stimulate enzyme synthesis If CYP450 is induced, what is the effect on medication metabolism? - answerdrug may not achieve therapeutic effects When patients have a poor metabolism phenotype? - answerslows or increases absorption ex; plavix clots and inc platelets pregnancy hepatic metabolism increases and dec bowel motility increases absorption of the drug. newborns the drug metabolizing capacity is low, children by the age of 1 are similar to adults but they can be metabolized quickly an increase or reduction in dosing may be needed. geriatric rates of hepatic drug