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 deci...
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
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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
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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?
increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
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).
How is absorption of intramuscular medications different in neonates?
,slow and erratic due to low blood flow in muscles first few days of
life
Why is absorption of medication in the stomach increased in infancy?
delayed gastric emptying
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)
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?
Need nitrate free interval so tolerance doesn't develop
Nine factors that impact outcome of medication?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
Do you need informed consent for genetic testing?
yes
What is the purpose of the Genetic Information Non-Discriminatory Act?
Protects patients from discrimination by employers and insurance
providers based on genetic information
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.
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
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