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NR 565-ADVANCED PHARMACOLOGY MIDTERM
EXAM|2025-2026|240QUESTIONS AND
ANSWERS|A+GRADE
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) What is BEERS criteria? Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately decides What is the CYP450 (cytochrome P450) liver enzyme system where medications are metabolized, can either be inducers or inhibitors and create drug-drug interactions CYP450 inducers Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blood levels of drug), elevate CYP450 enzymes CYP450 inducers pneumonic
"Bullshit Crap GPS INDUCES rage" CYP450 inducer drug names Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas CYP450 inhibitors inhibit metabolism, increase blood levels of medications CYP450 pneumonic " VISA credit card debt INHIBITS spending on designers like CK to look GQ" CYP450 inhibitors drug names Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole, grapefruit juice, quinidine Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties of drugs?
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 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 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
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 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 Why do nitrates need to be taken no later than 4 PM?
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. 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. What is scope of practice determined by? is determined by state practice and licensure laws. 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. 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
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 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
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 Provider key responsibilities when prescribing? safe and competent practice understanding of the drugs, reactions, and pharmacology Be aware of the age group you are prescribing to Ex. Children vs older adults 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 What happens when someone has a poor metabolism phenotype? medications metabolized slower, medication might not work or put them at risk for side-effects
What does the US food and drug administration regulate when it comes to medications? Whether the drug is safe, effective, and benefits of a drug outweigh the risks reasons for medication non-adherence patients never filling/refilling prescriptions (resulting in therapeutic failure) multiple chronic disorders multiple prescription medications multiple doses per day for each medication drug packaging that is difficult to open multiple prescribers changes in the regimen (adding meds, changes in dose or timing) cognitive or physical impairment (reduction in memory, hearing, visual, color, or manual dexterity) living alone recent discharge from hospital low literacy inability to pay for meds personal conviction that a drug is unnecessary or the dosage is too high presence of side effects
After age one what happens to pharmacokinetic parameters, including drug sensitivity? mirror adult parameters Children under two have fast metabolism true How is absorption of transdermal medications different in neonates? more rapid and complete in infants than in older children and adults. the skin is very thin and blood flow is great in infants How is absorption of oral medications different in neonates? absorption may be enhanced or impeded depending on the properties of the drug. gastric emptying is irregular, drugs absrobed in the intestine are absorbed slower. Common fears with genetic testing Lack of education - many health care providers do not possess the knowledge or comfort to interpret the tesgin financial cost - many insurance plans do not cover this. cost can be from $100-
discrimination from employers, insurance companies or providers
12 CDC guidelines for prescribing opioids Opioids are not first line therapy establish goals for pain and function Discuss risks and benefits Use immediate release opioids when starting Use the lowest effective dose Prescribe short durations for acute pain Evaluate benefits and harms frequently Use strategies to migrate risk Review PDMP data Use urine drug testing Avoid concurrent opioid and benzo prescribing Offer treatment for opioid use disorder Pure opioid agonist activate opioid receptors in brain resulting in opioid effect examples of pure opioid agonist morphine, methadone, fentanyl, heroin, oxycodone, hydrocodone, opium
examples of opioid agonist-antagonist Buprenorphine, Pentazocine, Butorphanol, Nalbuphine pure opioid antagonist reverse and blocks opioid effects example opioid antagonist naloxone When to refer a patient to a pain specialist? required for patients who take 120 mme per day of morphine milligram equivalents What is used to calculate pt's overdose risk? total morphine milligram equivalent (MME) per day to help assess the patient's overdose risk. If it is high (≥50 MME/day and especially ≥90 MME/day) Calculate total daily dose: 1. daily amount of each opioid that patient takes 2. convert to MME, multiply dose for each opioid by conversion factor 3. add them together
What is MME and when to use? morphine milligram equivalent, represents the potency of an opioid in comparison to morphine, used to identify opioid prescription burden of a person What is the prescription drug monitoring program? electronic databases enable providers to access information regarding a patient's prescription history of controlled substances. Nearly all states have implemented PDMPs, and some states require providers to check the PDMP before prescribing controlled substances. When should PDMP be used? anytime a controlled substance is prescribed, refilled, or filled Why is PDMP important? identify those at risk for overdose Assess someone for possible drug diversion? Urine test at least yearly PDMP routinely
In regards to dosage, why do we need to be cautious when giving naloxone? Dosage must be titrated carefully bc if too much is given the patient will swing from a state of intoxication to withdrawal What is the half-life of naloxone? Short- naloxone must be administered every few hours until opioid concentrations have dropped to nontoxic levels US Drug Enforcement Administration description of the scheduled drugs The DEA enacted the Controlled Substances Act (CSA) in 1970 to regulate drugs and other substances based on their potential for abuse and dependency. Five schedules of controlled substances were created that are updated annually. Classes of scheduled substances include narcotics, depressants, stimulants, hallucinogens, and anabolic steroids. The DEA issues eligible providers with a registration number to write prescriptions for controlled substances. Schedule I high potential for abuse and no current accepted medical use example of schedule I Heroin, Lysergic Acid Diethylamide (LSD), Marijuana (cannabis), 3,4- Methylenedioxymethamphetamine (ecstasy), Methaqualone, and Peyote
Schedule II substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence Examples of schedule II Combination products with less than 15 milligrams of Hydrocodone per dosage unit (Vicodin), Cocaine, Methamphetamine, Methadone, Hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (OxyContin), Fentanyl, Dexedrine, Adderall, and Ritalin Schedule III substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Abuse potential is less than schedule I and II drugs, but more than schedule IV examples of schedule III Products containing less than 90 milligrams of Codeine per dosage unit (Tylenol with codeine), Ketamine, Anabolic steroids, Testosterone Schedule IV
