NR 546 STUDY GUIDE|
NR 546 MIDTERM EXAM A QUESTIONS AND
CORRECT ANSWERS TESTED AND
VERIFIED!!!
Pharmacokinetics -- ANSWER--the study of what happens to a drug from the
time of administration until the parent drug and all metabolites leave the body
CYP450 -- ANSWER--CYP450 enzymes in the gut wall or liver convert drug
substrate into a biotransformed product in the bloodstream, responsible for
degradating of a large # of psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes, determined with
pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major
CYP450 enzymes and are said to be "extensive metabolizers", most drug doses
are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra rapid
metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
Page 1 of 132
,ultra rapid metabolizers -- ANSWER--elevated enzyme activity subtherapeutic
drug levels poor efficacy with standard doses
genotyping -- ANSWER--the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used to
predict which patients might need to have dosage adjustments
-measurement of genes for drug metabolism
most common targets of psychotropic drugs -- ANSWER--G-protein receptors
-Drug actions at these receptors occur in a spectrum, from full agonist actions,
to partial agonist actions, to antagonism, and even to inverse agonism.
Pharmacokinetics concepts -- ANSWER--absorption distribution metabolism
excretion
Flockhart Table -- ANSWER--drug interactions that are mediated by
cytochrome P450 enzymes
comprehensive list of drugs and the interactions related to the cytochrome P450
system
What should the PMHNP consider when prescribing chemical restraints? --
ANSWER--allergy status
Page 2 of 132
,-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint -state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint? -- ANSWER--No.
The client has been court-ordered to take the prescribed medications and the
standing order for chemical restraints is approved. The PMHNP and other staff
are not liable if the patient has an allergic reaction or adverse side effects.
How does reviewing the genetic makeup of a client help guide the PMHNP in
selecting medication for clients? -- ANSWER---Genetic testing can assist by
providing more information on how clients may respond to certain psychotropic
medications
-provides information on how a client may break down and metabolize
medications based on the cytochrome P450 system.
How does epigenetics impact a person's mental health? -- ANSWER--internal or
external factors activate portions of the genome that result in the manifestation
of mental health symptoms
-activation is often a result of a stressful event, which, when combined with the
genetic risk, results in the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of an abnormal gene
or of normal genes being "on" when they should be "off."
Page 3 of 132
, Types of epigenetic changes: -- ANSWER--DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must
also be taken into account, including: -- ANSWER---informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent -- ANSWER--Clients have the right to receive enough
information to make decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be
forcibly medicated if they are violent toward themselves or others and when less
restrictive methods have failed
Compliance -- ANSWER--A court order may be issued for a client to receive
treatment against their wishes if they are considered a danger to themselves or
others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive
capabilities or are incompetent to make decisions
Page 4 of 132
NR 546 MIDTERM EXAM A QUESTIONS AND
CORRECT ANSWERS TESTED AND
VERIFIED!!!
Pharmacokinetics -- ANSWER--the study of what happens to a drug from the
time of administration until the parent drug and all metabolites leave the body
CYP450 -- ANSWER--CYP450 enzymes in the gut wall or liver convert drug
substrate into a biotransformed product in the bloodstream, responsible for
degradating of a large # of psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes, determined with
pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major
CYP450 enzymes and are said to be "extensive metabolizers", most drug doses
are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra rapid
metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
Page 1 of 132
,ultra rapid metabolizers -- ANSWER--elevated enzyme activity subtherapeutic
drug levels poor efficacy with standard doses
genotyping -- ANSWER--the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used to
predict which patients might need to have dosage adjustments
-measurement of genes for drug metabolism
most common targets of psychotropic drugs -- ANSWER--G-protein receptors
-Drug actions at these receptors occur in a spectrum, from full agonist actions,
to partial agonist actions, to antagonism, and even to inverse agonism.
Pharmacokinetics concepts -- ANSWER--absorption distribution metabolism
excretion
Flockhart Table -- ANSWER--drug interactions that are mediated by
cytochrome P450 enzymes
comprehensive list of drugs and the interactions related to the cytochrome P450
system
What should the PMHNP consider when prescribing chemical restraints? --
ANSWER--allergy status
Page 2 of 132
,-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint -state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint? -- ANSWER--No.
The client has been court-ordered to take the prescribed medications and the
standing order for chemical restraints is approved. The PMHNP and other staff
are not liable if the patient has an allergic reaction or adverse side effects.
How does reviewing the genetic makeup of a client help guide the PMHNP in
selecting medication for clients? -- ANSWER---Genetic testing can assist by
providing more information on how clients may respond to certain psychotropic
medications
-provides information on how a client may break down and metabolize
medications based on the cytochrome P450 system.
How does epigenetics impact a person's mental health? -- ANSWER--internal or
external factors activate portions of the genome that result in the manifestation
of mental health symptoms
-activation is often a result of a stressful event, which, when combined with the
genetic risk, results in the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of an abnormal gene
or of normal genes being "on" when they should be "off."
Page 3 of 132
, Types of epigenetic changes: -- ANSWER--DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must
also be taken into account, including: -- ANSWER---informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent -- ANSWER--Clients have the right to receive enough
information to make decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be
forcibly medicated if they are violent toward themselves or others and when less
restrictive methods have failed
Compliance -- ANSWER--A court order may be issued for a client to receive
treatment against their wishes if they are considered a danger to themselves or
others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive
capabilities or are incompetent to make decisions
Page 4 of 132
