NR 565 - advanced pharmacology midterm - Chamberlain
1. During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term
consequences?: 1st trimester (fetus most at risk d/t rapid growth)
2. What is BEERS criteria?: Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately
decides
3. What is the CYP450 (cytochrome P450): liver enzyme system where medications are metabolized, can either be
inducers or inhibitors and create drug-drug interactions
4. CYP450 inducers: Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blood levels of
drug), elevate CYP450 enzymes
5. CYP450 inducers pneumonic: "Bullshit Crap GPS INDUCES rage"
6. CYP450 inducer drug names: Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
phenobarbital, sulfonylureas
7. CYP450 inhibitors: inhibit metabolism, increase blood levels of medications 8. CYP450 pneumonic: "VISA credit card
debt INHIBITS spending on designers like CK to look GQ"
9. CYP450 inhibitors drug names: Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole,
grapefruit juice, quinidine
10. Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties
of drugs?: increase glomerular filtration rate leads to increase durg excretion increase hepatic metabolism decrease tone
and motility of bowel increase drug absorption
11. Examples of medications that can be teratogenic: Antiepileptic drugs, antimicrobials such as tetracyclines and
fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
12. How is absorption of intramuscular medications different in neonates?: slow and erratic due to low blood flow
in muscles first few days of life
13. Why is absorption of medication in the stomach increased in infancy?: delayed gastric emptying
14. Some medications that should be avoided in the pediatric patient?: glucocorticoids, discoloration of developing
teeth with tetracyclines, and kernicterus with sulfonamides, levofloxacin (antibiotics) aspirin (Severe intoxication from acute
overdose)
15. what should be included in medication administration patient education?: dosage size and timing
route and technique of administration duration of treatment
drug storage nature and time course of desired responses nature and
time course of adverse responses finish taking antibiotic
16. What are some things that put the elderly patient at higher risk for adverse drug reactions?: reduced renal
function
polypharmacy (the use of five or more medications daily) greater severity of illness
presence of comorbidities
, NR 565 - advanced pharmacology midterm - Chamberlain
use of drugs that have a low therapeutic index (e.g., digoxin) increased individual variation secondary to
altered pharmacokinetics inadequate supervision of long-term therapy poor patient adherence
17. How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug
reaction?: obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness periodically reviewing the need for
continued drug therapy encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
18. How can we promote medication adherence with elderly patients?: simplifying drug regimens
providing clear and concise verbal and written instructions using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers developing daily reminders
monitoring frequently affordability of drugs support systems
19. Why do nitrates need to be taken no later than 4 PM?: Need nitrate free interval so tolerance doesn't develop
20. Nine factors that impact outcome of medication?: Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho age
bodyweight
21. Do you need informed consent for genetic testing?: yes
22. What is the purpose of the Genetic Information Non-Discriminatory Act?: Protects patients from discrimination
by employers and insurance providers based on genetic information
23. Difference between practice authority and prescriptive authority?: Practice authority refers to the nurse
practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse practitioner's
authority to prescribe medications independently and without limitations.
24. Who regulates prescriptive authority?: the jurisdiction of a health professional board. This may be the State Board of
Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state.
25. What is scope of practice determined by?: is determined by state practice and licensure laws.
26. What is full practice authority?: Nurse practitioners have the autonomy to evaluate patients, diagnose, order and
interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without
physician oversight.
27. What is reduced practice authority?: Nurse practitioners are limited in at least one element of practice. The state
requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient
care. ex/ physician involvement for 5 yrs than independent
28. What is restricted practice authority?: Nurse practitioners are limited in at least one element of practice by requiring
supervision, delegation, or team management by an outside health discipline for the nurse practitioner to provide patient
care.- typically doctor on site
, NR 565 - advanced pharmacology midterm - Chamberlain
29. What are components of Rx?: Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
DOB
Date
Allergies
Medication name
Strength
Quantity
Indication for use
Direction for use
Refills
Signature
30. What are some potential problems that arise with written prescriptions?: Must contain all elements
May have pre-populated information
Write legibly
Avoid error prone abbreviations
Tamper resistant scripts are often required
31. Reasons for monitoring drug therapy: determining therapeutic dosage evaluating medication adequacy identifying
adverse effects serious or life-threatening risks.
32. Which schedules of drugs can APRNs prescribe?: depends on state - most
II-V
33. How does limited prescriptive authority impact patients within the healthcare system?: longer wait times to
sign a prescription limits practitioners that are needed in rural areas unequal relationships between providers. Ex. one has
more power high need for providers due to lack of providers and high amounts of patients. Independent practitioners=
more patients being seen= lessens the patient/provider load
34. Provider key responsibilities when prescribing?: safe and competent prac-
tice
understanding of the drugs, reactions, and pharmacology
Be aware of the age group you are prescribing to
Ex. Children vs older adults
35. What should be used to make prescribing decisions?: documented provider-patient relationship, not prescribing
for family or friends, documenting a thorough H&P, including discussions with the patient, drug monitoring/titrating.
cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal function, need for monitoring, and special
populations
36. What happens when someone has a poor metabolism phenotype?: med-
ications metabolized slower, medication might not work or put them at risk for side-effects
1. During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term
consequences?: 1st trimester (fetus most at risk d/t rapid growth)
2. What is BEERS criteria?: Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately
decides
3. What is the CYP450 (cytochrome P450): liver enzyme system where medications are metabolized, can either be
inducers or inhibitors and create drug-drug interactions
4. CYP450 inducers: Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blood levels of
drug), elevate CYP450 enzymes
5. CYP450 inducers pneumonic: "Bullshit Crap GPS INDUCES rage"
6. CYP450 inducer drug names: Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin,
phenobarbital, sulfonylureas
7. CYP450 inhibitors: inhibit metabolism, increase blood levels of medications 8. CYP450 pneumonic: "VISA credit card
debt INHIBITS spending on designers like CK to look GQ"
9. CYP450 inhibitors drug names: Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole,
grapefruit juice, quinidine
10. Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties
of drugs?: increase glomerular filtration rate leads to increase durg excretion increase hepatic metabolism decrease tone
and motility of bowel increase drug absorption
11. Examples of medications that can be teratogenic: Antiepileptic drugs, antimicrobials such as tetracyclines and
fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
12. How is absorption of intramuscular medications different in neonates?: slow and erratic due to low blood flow
in muscles first few days of life
13. Why is absorption of medication in the stomach increased in infancy?: delayed gastric emptying
14. Some medications that should be avoided in the pediatric patient?: glucocorticoids, discoloration of developing
teeth with tetracyclines, and kernicterus with sulfonamides, levofloxacin (antibiotics) aspirin (Severe intoxication from acute
overdose)
15. what should be included in medication administration patient education?: dosage size and timing
route and technique of administration duration of treatment
drug storage nature and time course of desired responses nature and
time course of adverse responses finish taking antibiotic
16. What are some things that put the elderly patient at higher risk for adverse drug reactions?: reduced renal
function
polypharmacy (the use of five or more medications daily) greater severity of illness
presence of comorbidities
, NR 565 - advanced pharmacology midterm - Chamberlain
use of drugs that have a low therapeutic index (e.g., digoxin) increased individual variation secondary to
altered pharmacokinetics inadequate supervision of long-term therapy poor patient adherence
17. How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug
reaction?: obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness periodically reviewing the need for
continued drug therapy encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
18. How can we promote medication adherence with elderly patients?: simplifying drug regimens
providing clear and concise verbal and written instructions using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers developing daily reminders
monitoring frequently affordability of drugs support systems
19. Why do nitrates need to be taken no later than 4 PM?: Need nitrate free interval so tolerance doesn't develop
20. Nine factors that impact outcome of medication?: Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho age
bodyweight
21. Do you need informed consent for genetic testing?: yes
22. What is the purpose of the Genetic Information Non-Discriminatory Act?: Protects patients from discrimination
by employers and insurance providers based on genetic information
23. Difference between practice authority and prescriptive authority?: Practice authority refers to the nurse
practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse practitioner's
authority to prescribe medications independently and without limitations.
24. Who regulates prescriptive authority?: the jurisdiction of a health professional board. This may be the State Board of
Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state.
25. What is scope of practice determined by?: is determined by state practice and licensure laws.
26. What is full practice authority?: Nurse practitioners have the autonomy to evaluate patients, diagnose, order and
interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without
physician oversight.
27. What is reduced practice authority?: Nurse practitioners are limited in at least one element of practice. The state
requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient
care. ex/ physician involvement for 5 yrs than independent
28. What is restricted practice authority?: Nurse practitioners are limited in at least one element of practice by requiring
supervision, delegation, or team management by an outside health discipline for the nurse practitioner to provide patient
care.- typically doctor on site
, NR 565 - advanced pharmacology midterm - Chamberlain
29. What are components of Rx?: Prescriber Contact info
Prescribers name
NPI
DEA
Patient name
DOB
Date
Allergies
Medication name
Strength
Quantity
Indication for use
Direction for use
Refills
Signature
30. What are some potential problems that arise with written prescriptions?: Must contain all elements
May have pre-populated information
Write legibly
Avoid error prone abbreviations
Tamper resistant scripts are often required
31. Reasons for monitoring drug therapy: determining therapeutic dosage evaluating medication adequacy identifying
adverse effects serious or life-threatening risks.
32. Which schedules of drugs can APRNs prescribe?: depends on state - most
II-V
33. How does limited prescriptive authority impact patients within the healthcare system?: longer wait times to
sign a prescription limits practitioners that are needed in rural areas unequal relationships between providers. Ex. one has
more power high need for providers due to lack of providers and high amounts of patients. Independent practitioners=
more patients being seen= lessens the patient/provider load
34. Provider key responsibilities when prescribing?: safe and competent prac-
tice
understanding of the drugs, reactions, and pharmacology
Be aware of the age group you are prescribing to
Ex. Children vs older adults
35. What should be used to make prescribing decisions?: documented provider-patient relationship, not prescribing
for family or friends, documenting a thorough H&P, including discussions with the patient, drug monitoring/titrating.
cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal function, need for monitoring, and special
populations
36. What happens when someone has a poor metabolism phenotype?: med-
ications metabolized slower, medication might not work or put them at risk for side-effects
