NR 567 ADVANCED PHARM MIDTERM EXAM
ACTUAL EXAM COMPLETE 300 QUESTIONS WITH
DETAILED VERIFIED ANSWERS (100% CORRECT
ANSWERS) /ALREADY GRADED A+
What is used to calculate a patient's overdose risk? (An actual calculation won't be done
on the exam) - ANSWER
Which schedule drugs can APRNs prescribe? - ANSWERDEA license will allow for
prescribing of Schedules 2-5. There can be restrictions as noted in collaborative
agreement. May be facility/state dependent.
Who determines and regulates prescriptive authority? - ANSWERDetermines: Also
known as independent prescribing. APRNS can prescribe without limitation and is state
dependent. Includes "legend" (prescription) and controlled drugs, health/medical
services, DME, etc.
Regulates: State board of nursing, regulated by health professional board. Federal
government controls drug regulations but has no control over prescriptive authority.
How does limited prescriptive authority impact patients within the healthcare system? -
ANSWERLimited prescriptive authority creates numerous barriers to quality, affordable,
and accessible patient care. For example, restrictions on the distance of the APRN or
PA from the physician providing supervision or collaboration may prevent outreach to
area of greatest need. An increase in patient waits.
What are the key responsibilities of prescribing? - ANSWERThe ability to prescribe
medications is both a privilege and a burden. Have a documented provider-patient
relationship, do not prescribe medications to family or friends or yourself, Document a
thorough history and physical examination, include any discussions you have with the
patient about risk factors, side effects, or therapy options, have documented plan
regarding drug monitoring or titration, if you consult additional providers not that you did
so. Use the references provided in the following boxes to assist in safely and rationally
choosing one medication over another.
Be sensible, accept responsibility, do not fear it, know constraints and limitations,
always learn and update, keep Rx pads in safe place, confirm allergies, verify
medication list with patient, do not let insurance dictate quantity of Rx, Charting is key
(particularly with off label use), Provide use and rationale.
What should be used to make prescribing decisions? - ANSWERThe best way to keep
your patients (and yourself) safe is to be prudent and deliberate in your decision-making
process. Cost, availability, current practice guidelines, medication interactions including
,interactions with food, side effects, need for monitoring, how drug is metabolized
(hepatic or renal), special populations (pregnancy, nursing, older adults)
Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and
how that would translate to baseline information needed to prescribe -
ANSWERPharmacokinetic is the study of drug absorption, distribution, metabolism, and
excretion in the body. The ability of older adults to metabolize drugs is commonly
decreased. Drug dosages may need to be reduced to prevent drug toxicity.
Beer's criteria - ANSWERGuidelines for prescribing medications to patients 65 & older.
Drugs on the list should be avoided in patients over 65 expect when the benefits
significantly outweigh the risks. The Beers Criteria includes five lists that describe
certain medications and situations and include: potentially inappropriate medication
(PIM) us in older adults, PIM use in older adults due to medication-disease or
medication-syndrome interactions that may exacerbate the disease or syndrome,
medications to be used cautiously in older adults, clinically significant drug interactions
that should be avoided in older adults, medications to be avoided or dosage decreased
in the presence of impaired kidney function in older adults.
Why is Beer's criteria important? - ANSWERIt provides a list of medications that are
potentially harmful in elderly. List that identifies drugs with a high likelihood of causing
adverse effects in older adults. Beers Criteria are recommendations; ultimately
prescribers must determine whether a medication is appropriate for use or not. These
guidelines are not intended to limit the use of medications or apply to all older adults.
Safe and judicious prescribing is crucial in the older adult to optimize pharmacotherapy.
Impacts/outcomes of polypharmacy - ANSWERPolypharmacy greatly increases the risk
for interactions. Drug interactions with mild side effects to life-threatening
consequences. Elderly is at a higher risk of polypharmacy due to taking five or more
medications daily.
CYP450 - ANSWERmetabolic pathway, involved in metabolism of drugs in the liver.
Metabolism can be inhibited or induced by drugs and once this happens drug-drug
interaction can occur.
What are the CYP450 inhibitors? - ANSWERLiver enzymes. It's not just a single
molecular entity but rather a group of 12 closely related enzyme families.
Examples: Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol,
Ketoconazole, Grapefruit juice, Quinidine
What do they do? Slows down metabolism of medications. Inhibitors are medications
that inhibit activity of one or more of the CYP450 enzymes. Medications that inhibit an
enzyme can potentially slow that enzymes activity required for metabolism of other
medications, thereby increasing the levels of medications dependent on that particular
enzyme for biotransformation. This inhibition prolongs the pharmacalogical effects,
,which may result in toxicity. Factors that affect the inhibition include the dose and the
capacity to bind to the enzyme
What do they cause if not used correctly (CYP450)?(aka:What would the patient
experience?) - ANSWERToxicity. drug build up
Examples of CYP450 inducers? - ANSWERbarbiturates, St Johns wart, carbamazepine,
rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
What do CYP450 inducers do? - ANSWERIncrease medication metabolism.
Inducers are xenobiotics that elevate the CYP450 enzyme activity by increasing the
enzyme synthesis. This action leads to additional sites available for biotransformation.
The increased number of sites enhances the medication metabolism, decreasing the
concentration of the "parent drug" while increasing the metabolite production. The half-
life of the inducing drug may cause a delay before enzyme activity increases. A
decease in concentration of a medication metabolized by CYP2C9 (responsible for 10%
of drug metabolism) usually occurs within 24 hours after the administration of the
medication.
What happens when someone has a poor metabolism phenotype? - ANSWERSlow or
increase absorption, slow the metabolism, keep drug in body longer and increase
toxicity. Poor metabolisms affect a high or low therapeutic index: increase drug toxicity,
Ex: Plavix: Clots and increase platelets.
What does the U.S. Food and Drug Administration regulate when it comes to
medications? - ANSWERRegulates what the pharmacies can sell, requires special
alerts and management guidelines, for drugs that cause serious adverse effects.
Ensuring pharmaceutical companies thoroughly test new products for efficacy and
safety with an aim towards minimizing side effects. They approve or disapprove drugs
Reasons for medication non-adherence - ANSWER1. patient feels not needed
2. affordability
3. side effects
4. forgetfulness
5. lack of info
6. lack of disease concern
7. poor social support
8. low reaction satisfaction
9. poor physician relationship
What are black box warnings? - ANSWERConcise summaries of adverse effects of
concern in a box surrounded by a thick black line.
Why are black box warnings issued? - ANSWER-Neonate and infant drug absorption
, -Purpose is to alert the provider to potentially severe side effects and ways to prevent or
reduce harm. Provides a concise summary of the adverse effects of concerns. The FDA
requires a boxed warning on drugs with serious or life- threatening risks.
Be familiar with general development and when absorption would reach adult levels -
ANSWERThe drug-metabolizing of infants is limited. The liver does not develop its full
capacity to metabolize drugs until approximately 1 year after birth. During the time
before hepatic maturation, infants are especially sensitive to drugs, and care must be
taken to avoid injury.
Examples of pure opioid agonists - ANSWER- agonist is a drug that binds to the
receptor, producing a similar response to the intended chemical and receptor
How would you know when to refer someone to a pain specialist for pain management?
Prescription Drug Monitoring Program (PDMP)
What is it?
Why is it important? - ANSWERare secure, online,
state-based databases that contain information about controlled substance
prescriptions written by clinicians and dispensed by pharmacists within a
state or jurisdiction
PDMPs store patient-specific prescription information in a central repository. The
information
in accordance with state or jurisdictional laws.
PDMPs are valuable tools that facilitate safer opioid prescribing, inform clinical practice,
and improve patient safety.
Schedule I Drugs: Opioids, Acetylmethadol, Heroin, Normethadone,marijuana, any
otherso Schedule II Drugs: Opioids, Alfentanil, Codeine, Fentanyl, Hydrocodone,
Methamphetamine, Barbiturates, Cocaineo Schedule III Drugs: Opioids, Buprenorphine,
Paregoric,Cannabinoids,Dronabinol (THC), Stimulants, Testosterone, Ketamineo
Schedule IV Drugs:Opioids,Benzodiazepines,Alprazolam,
Chlordiazepoxide, Clonazepam, Lorazepam, Midazolamo
Schedule V Drugs: Opioids, Diphenoxylate plus atropine, Pregabalin - ANSWER
Know how what type of evidence prescribers should use to make treatment
recommendations - ANSWERCost, guidelines, availability, interactions, side effects,
allergies
hepatic and renal function, need for monitoring, special populations
Schedule II drugs
-rules and prescribing
examples - ANSWEROpioids, Alfentanil, Codeine, Fentanyl, Hydrocodone,
Methamphetamine, Barbiturates, Cocaine
-All prescriptions for
Alternatively, prescribers may submit prescriptions using an electronic prescribing
procedure. Oral prescriptions may be called in but only in emergencies, and a written
