· Beer's Criteria - correct answer-•potentially Inappropriate Medication (PIM) use 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 (American Geriatric Society Beers Criteria Update Expert Panel, 2019)
· How does limited prescriptive authority impact patients within the healthcare system? -
correct answer-limited authority creates problems for the patient. The patient is not able to
get the care they need
· What are the key responsibilities of prescribing? - correct answer-1. Be prudent and
deliberate in your decision-making process
2. Have a documented provider-patient relationship with the person for whom you are
prescribing
3. Do not prescribe medications for family or friends or for yourself
4. Document a thorough history and physical examination in your records
5.Include any discussions you have with the patient regarding risk factors, side effects, or
therapy options
6. Have a documented plan regarding drug monitoring or titration, if applicable
· What happens when someone has a poor metabolism phenotype? - correct
answer-Metabolizes to slow or to fast.
· What should be used to make prescribing decisions? - correct answer-
· Who determines and regulates prescriptive authority? - correct answer-Nurse practitioner
scope of practice is determined by state practice and licensure laws.
·· Which schedule drugs can APRNs prescribe? - correct answer-Schedule II-V
•During what trimester is a pregnant woman most at risk for adverse drug reactions with
potential long-term consequences? - correct answer-1 trimester
•How can we as healthcare providers decrease the likelihood of a elderly patient
experiencing an adverse drug reaction? - correct answer-•- obtaining a thorough drug history
that includes over-the-counter medications
•considering pharmacokinetic and pharmacodynamic 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
•What are some medications that we know to be teratogenic? - correct answer-•Antiepileptic
drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large doses,
some anticoagulants, and hormonal medications such as diethylstilbestrol (DES).
•What are some of the Physiologic changes that occur in the body when a woman is
pregnant that can change the pharmacodynamic and pharmacokinetic properties of many
drugs? - correct answer-- Increased GFR= Increased drug excretion
- Increased hepatic metabolism for some drugs.
- Decreased tone and mobility of bowel
- Increased drug absorption.
•What are the nine factors that impact the outcome of medication according to Rosenthal &
Burcham? - correct answer-•Gender and race
•Genetics and pharmacogenomics
•Variability in absorption
•placebo effect
•Tolerance
•patho
•age
•bodyweight
•What is full-practice authority? - correct answer-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? - correct answer-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.
•What is scope of practice determined by? - correct answer-Nurse practitioner scope of
practice is determined by state practice and licensure laws.
•What is the difference between NP practice authority and prescriptive authority? - correct
answer-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.
•What should be included in medication administration patient education? - correct answer-1.
dosage size and timing
2. route and technique of administration
3. duration of treatment
4.drug storage
5.nature and time course of desired responses
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