Exam (elaborations)
Exam (solved) NR565 Advanced Pharmacology
This post covers Exam questions on advance pharmacology with answers provided for each question
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NR 565 - advanced pharmacologymidterm - Chamberlain
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? - 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
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