NR565 Advanced Pharm Midterm
Exam Questions and Answers
Which schedule drugs can APRNs prescribe? - ANS-Schedule II-V
Prescriptive authority - ANS-2 components
(1) the right to prescribe independently
(2) the right to prescribe without limitation
Physicians have full prescriptive authority. APPs are limited depending on state laws
Who determines and regulates prescriptive authority? - ANS-State laws & State Board
of Nursing
How does limited prescriptive authority impact patients within the healthcare system? -
ANS-Limited prescriptive authority creates barriers to quality, affordable and accessible
healthcare
Ex. Restrictions on the distance of the APP from the MD providing
supervision/collaboration can prevent outreach to areas of greatest need
Ex. Needing a MD co-signature can cause delays in care.
Ex. Currently we have a physician shortage, so less are able to oversee APPs
What are the key responsibilities of prescribing? - ANS-Protect patients from harm
Know MOA, safety, efficacy, and select right med/dose to maximize outcome and
minimize adverse effects
What should be used to make prescribing decisions? - ANS-- Have a documented
provider-patient relationship
- Document H&P
- Discuss & document risk factors, side effects, and therapy options
- Document plan for monitoring and/or titration
- Consider cost, drug availability, and clinical practice guidelines
- Consider side effects, allergies, hepatic/renal function, need for monitoring, and
lifespan considerations
,Elements of a prescription - ANS-Prescriber name, license, contact info, and DEA (if
applicable)
Patient name, DOB, allergies
Medication name, indication, strength, dose, frequency, dispense quantity and number
of refills
May be telephone, written, e-script, or refill
-Schedule II cannot be prescribed or refilled by phone
-Written scripts must be legible, in ink, no abbreviations, and never sign a blank script
-Not all DEA drugs can be e-prescribed
-With refills, consider monitoring needs
Pharmacokinetics - ANS-How the drug moves ("kinetic") through the body (absorption,
distribution, metabolism, excretion)
Absorption - Drug entering blood (ex. Absorbed from GI tract)
Distribution - Drug moving from blood to tissues/cells of liver, kidneys or other site
Metabolism - Drug-structure altered by enzymes
Excretion - Drugs & their metabolites move out of the body via bile or urine
Pharmacodynamics - ANS-PharmacoDynamics
(What Drugs Do to the body)
MOA (interactions between drug and receptors or enzymes), dose, tolerance,
dependence, interactions, adverse effects; drugs affects individuals differently
Relates to agonists, antagonists
Agonists & Antagonists - ANS-Agonists mimic the body's own regulatory molecules and
activate receptors. Ex. Dobutamine (drug) mimics norepinephrine at receptors on the
heart, allowing it to bind and cause the heart rate to increase.
Antagonists block the actions of regulating molecules. They do not activate receptors.
Ex. Antihistamines suppress allergy symptoms by binding to the receptors of histamine
and preventing activation of these receptors by histamine released in response to
allergens.
Pharmacokinetic changes in older adults - ANS-Older adults have slower rates of
absorption and delayed gastric emptying, leading to delayed drug response.
, Older adults have less total body water so drug concentration can increase, causing
more intense effects.
Older adults have a decreased ability to metabolize drugs in the liver. meaning they can
stay in the body longer and increase risk for toxicity.
Older adults also have declining renal function, which caused a decrease in excretion of
drugs.
Drug dosages may need to be reduced to prevent toxicity.
Pharmacodynamic changes in older adults - ANS-Limited information currently - think
RECEPTORS and AFFINITY
Ex. Beta blockers are less effective in older adults. Possible explanations: there are
fewer beta receptors OR the receptors have a lesser affinity for the blocking agents
Ex. Warfarin and CNS depressants produce more intense effects in older adults.
Possible explanations: there are more receptors OR the receptors have an increased
affinity for the medication
What is Beer's Criteria and why is it important? - ANS-Providers should avoid
prescribing drugs in Beer's Criteria to older adults unless the benefits outweigh the risks
Drugs on this list are likely to cause adverse effects in older adults
Ex. Benzodiazepines, Methocarbamol, PPIs for >8 weeks
Impacts of polypharmacy - ANS-Polypharmacy - treatment with multiple drugs
Increases risk of drug interactions
Decreases drug adherence
Impacts quality of life
CYP450 - ANS-Enzyme family most important in metabolizing drugs
Available in the liver
Drugs may be inducers or inhibitors of these enzymes. Inducers increase rates of
metabolism and inhibitors decrease rates of metabolism.
CYP450 Inhibitors (what they do, what the patient experiences, and examples) - ANS-
P450 inhibitors are drugs that slows rates of drug metabolism in the liver. This can
Exam Questions and Answers
Which schedule drugs can APRNs prescribe? - ANS-Schedule II-V
Prescriptive authority - ANS-2 components
(1) the right to prescribe independently
(2) the right to prescribe without limitation
Physicians have full prescriptive authority. APPs are limited depending on state laws
Who determines and regulates prescriptive authority? - ANS-State laws & State Board
of Nursing
How does limited prescriptive authority impact patients within the healthcare system? -
ANS-Limited prescriptive authority creates barriers to quality, affordable and accessible
healthcare
Ex. Restrictions on the distance of the APP from the MD providing
supervision/collaboration can prevent outreach to areas of greatest need
Ex. Needing a MD co-signature can cause delays in care.
Ex. Currently we have a physician shortage, so less are able to oversee APPs
What are the key responsibilities of prescribing? - ANS-Protect patients from harm
Know MOA, safety, efficacy, and select right med/dose to maximize outcome and
minimize adverse effects
What should be used to make prescribing decisions? - ANS-- Have a documented
provider-patient relationship
- Document H&P
- Discuss & document risk factors, side effects, and therapy options
- Document plan for monitoring and/or titration
- Consider cost, drug availability, and clinical practice guidelines
- Consider side effects, allergies, hepatic/renal function, need for monitoring, and
lifespan considerations
,Elements of a prescription - ANS-Prescriber name, license, contact info, and DEA (if
applicable)
Patient name, DOB, allergies
Medication name, indication, strength, dose, frequency, dispense quantity and number
of refills
May be telephone, written, e-script, or refill
-Schedule II cannot be prescribed or refilled by phone
-Written scripts must be legible, in ink, no abbreviations, and never sign a blank script
-Not all DEA drugs can be e-prescribed
-With refills, consider monitoring needs
Pharmacokinetics - ANS-How the drug moves ("kinetic") through the body (absorption,
distribution, metabolism, excretion)
Absorption - Drug entering blood (ex. Absorbed from GI tract)
Distribution - Drug moving from blood to tissues/cells of liver, kidneys or other site
Metabolism - Drug-structure altered by enzymes
Excretion - Drugs & their metabolites move out of the body via bile or urine
Pharmacodynamics - ANS-PharmacoDynamics
(What Drugs Do to the body)
MOA (interactions between drug and receptors or enzymes), dose, tolerance,
dependence, interactions, adverse effects; drugs affects individuals differently
Relates to agonists, antagonists
Agonists & Antagonists - ANS-Agonists mimic the body's own regulatory molecules and
activate receptors. Ex. Dobutamine (drug) mimics norepinephrine at receptors on the
heart, allowing it to bind and cause the heart rate to increase.
Antagonists block the actions of regulating molecules. They do not activate receptors.
Ex. Antihistamines suppress allergy symptoms by binding to the receptors of histamine
and preventing activation of these receptors by histamine released in response to
allergens.
Pharmacokinetic changes in older adults - ANS-Older adults have slower rates of
absorption and delayed gastric emptying, leading to delayed drug response.
, Older adults have less total body water so drug concentration can increase, causing
more intense effects.
Older adults have a decreased ability to metabolize drugs in the liver. meaning they can
stay in the body longer and increase risk for toxicity.
Older adults also have declining renal function, which caused a decrease in excretion of
drugs.
Drug dosages may need to be reduced to prevent toxicity.
Pharmacodynamic changes in older adults - ANS-Limited information currently - think
RECEPTORS and AFFINITY
Ex. Beta blockers are less effective in older adults. Possible explanations: there are
fewer beta receptors OR the receptors have a lesser affinity for the blocking agents
Ex. Warfarin and CNS depressants produce more intense effects in older adults.
Possible explanations: there are more receptors OR the receptors have an increased
affinity for the medication
What is Beer's Criteria and why is it important? - ANS-Providers should avoid
prescribing drugs in Beer's Criteria to older adults unless the benefits outweigh the risks
Drugs on this list are likely to cause adverse effects in older adults
Ex. Benzodiazepines, Methocarbamol, PPIs for >8 weeks
Impacts of polypharmacy - ANS-Polypharmacy - treatment with multiple drugs
Increases risk of drug interactions
Decreases drug adherence
Impacts quality of life
CYP450 - ANS-Enzyme family most important in metabolizing drugs
Available in the liver
Drugs may be inducers or inhibitors of these enzymes. Inducers increase rates of
metabolism and inhibitors decrease rates of metabolism.
CYP450 Inhibitors (what they do, what the patient experiences, and examples) - ANS-
P450 inhibitors are drugs that slows rates of drug metabolism in the liver. This can
