Download 2025 NR 565 MIDTERM EXAM WITH CORRECT UPDATED ANSWERS and more Exams Nursing in PDF only on Docsity!
2025 NR 565 MIDTERM EXAM
WITH CORRECT UPDATED
ANSWERS
What are the key responsibilities of prescribing? - CORRECT ANSWERS-A sound understanding of drugs and the conditions that they are used to manage Be deliberate in decision-making process Do not prescribe for family or friends Document thorough history and physical for the records, including education provided on drug Have a documented plan for monitoring and titration What should be co-administered with febuxostat? - CORRECT ANSWERS- Colchine or NSAIDs for the first six months since initiating febuxostat can induce a flare Which schedule drugs can APRNs prescribe? - CORRECT ANSWERS- Varies state by state May include schedule II-V, but never schedule I Who determines and regulates prescriptive authority? - CORRECT ANSWERS- The state's health professional board How does limited prescriptive authority impact patients within the healthcare system? - CORRECT ANSWERS-Creates numerous barriers to quality, affordable, and accessible patient care May prevent outreach to areas of greatest need Physician approval of prescriptions can increase patient waits Colchine Side Effects - CORRECT ANSWERS-GI toxicity, N/V/D
Colchine Contraindications - CORRECT ANSWERS-Pregnancy category C Colchine - CORRECT ANSWERS-Alternative to NSAID for treating gout NSAIDs - CORRECT ANSWERS-ibuprofen, naproxen, diclofenac potassium, meloxicam, indomethacin, celecoxib
(12 tab daily) 7.5/325 1 tab Q4-6 hrs (6 tabs daily) 10/325 1 tab Q4-6 hrs (6 tabs daily)
What should be used in making prescribing decisions? - CORRECT ANSWERS- Cost, follow current guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for monitoring, special populations PK and PD changes in older adults and how that affects how you prescribe? - CORRECT ANSWERS-Very high risk of adverse drug reactions and drug-drug interactions D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence Beer's Criteria - CORRECT ANSWERS-List of potentially inappropriate medications to use in the older populations Updated annually Prescribers ultimately decide whether to prescribe or not Impacts/outcomes of polypharmacy? - CORRECT ANSWERS-Increased ADRs and drug-drug interactions What are CYP450? - CORRECT ANSWERS-Enzymes responsible for drug metabolism (biotransformation)-oxidization, reduction, hydrolyzed to promote renal dug excretion Hepatic enzyme system, composed of 12 enzyme families What do CYP450 enzymes do? - CORRECT ANSWERS-Promote drug excretion by making them more "excretable"--hydrophilic/water soluble and charged (ion) Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease drug toxicity CYP450 inhibitor examples? - CORRECT ANSWERS-VISA credit card debt inhibits spending on designers like CK to look GQ Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconzaole Grapefruit juice Quinidine What do CYP450 inhibitors do? - CORRECT ANSWERS-Decrease the
What do CYP450 inhibitors do if not used correctly? - CORRECT ANSWERS- Can lead to adverse effects and drug toxicity What happens when someone has a poor metabolism phenotype? - CORRECT ANSWERS-Associated with accumulation of drugs in the body and they may experience drug toxicity What does the US FDA regulate when it comes to medications? - CORRECT ANSWERS-Regulates safety and effectiveness of drugs sold in US Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA approval Once drug is on market, FDA continues oversight of drug safety and effectiveness Reasons for medication nonadherence? - CORRECT ANSWERS- Forgetfulness, lack of planning, cost, dissatisfaction, altered dosing Black Box Warnings - CORRECT ANSWERS-Strongest safety warning a drug can carry and still remain on the market Required by the FDA on drugs with serious or life-threatening risks Neonate and infant drug absorption - CORRECT ANSWERS-Drug sensitivity d/t organ immaturity-increased risk of ADRs Drug action unusually intense and prolonged Transdermal absorption in neonates? - CORRECT ANSWERS-Infants have thin skin with high blood flow- increased absoprtion and increased risk of toxicity IM absorption in neonates and infants? - CORRECT ANSWERS-Neonate- absorption is slow and erratic d/t low blood flow through muscle in first days of life Early infancy- absorption is faster d/t increased blood flow PO absorption in neonates and infants? - CORRECT ANSWERS-Gastric emptying delayed (adult emptying by 6-8mos) Increased absorption of drugs absorbed in stomach, decreased for those absorbed in intestines Low gastric acid for first 24 hours, adult acidity by 24 months--increased absorption of acid-labile drugs When does absorption reach adult level? - CORRECT ANSWERS-Generally
by 1 year Metabolism is faster in kids <2yo and gradually declines til puberty Long-term dosing may need adjusting
Concern in >= 50 MME/day
How would you know when to refer someone to a pain specialist for pain management? - CORRECT ANSWERS-Required for patients taking 120 mg per day of MMEs Prescription Drug Monitoring Program - CORRECT ANSWERS-Electronic database that enables provides to access information regarding patients' history of controlled substances Nearly all states have it Shown results in changing prescribing behaviors, decreases use of multiple prescribers, decreases substance abuse treatment admissions How do renal and hepatic function impact opioid medication levels in the body? - CORRECT ANSWERS-Decrease function leads to less ability to metabolize and excrete drugs Pts can experience greater peak effects and longer duration of action Lowers threshold for res depression and OD to occur How to assess someone for possible drug diversion? - CORRECT ANSWERS- Occurs when medication is redirected from its intended destination for personal use, sale, or distribution to others Signs=Frequent med/wasting errors, patients complaining of lack of meds, altering med orders, changes in behavior, etc When should naloxone be prescribed for a patient? - CORRECT ANSWERS- History of OD, history of substance use disorder, >= 50 MME/day, concurrent benzo use Schedule II Drugs - CORRECT ANSWERS-Drugs with HIGH potential for abuse, with use potentially leading to severe psychological or physical dependence Cocaine, methamphetamine, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (Oxycontin), fentanyl, Dexedrine, Adderall, Ritalin Combination drugs with less than 15 mg of hydrocodone per dosage unit (Vicodin) Schedule I Drugs - CORRECT ANSWERS-Drugs with no current acceptable medical use and HIGH potential for abuse Heroin, LSD, marijuana, ecstasy, methaqualone, peyote Schedule III Drugs - CORRECT ANSWERS-Drugs with a MODERATE TO LOW potential for psychological or physical dependence Ketamine, anabolic steroids, testosterone Products with less than 90 mg of codeine per dosage unit (Tylenol with codeine)
Xanax, soma, darvon, darvocet, valium, ativan, talwin, ambien, tramadol Schedule V Drugs - CORRECT ANSWERS-LOWER potential for abuse and dependence and consist of preparations containing limited quantities of certain narcotics Lomotil, motofen, lyrica, parepectolin Cough preparations with less than 200 mg of codeine or per 100ml (Robitussin) Treatment of Chronic Pain - CORRECT ANSWERS-Pain control to the extent possible; focus on enhancing function and quality of life Opioid Use Disorder - CORRECT ANSWERS-Pattern of use that is marked by unsuccessful attempts to reduce or control use resulting in inability to fulfill daily responsibilities Different from drug tolerance and physical dependence Diagnosed by DSM-5 criteria and must be documented that way Can lead to severe withdrawal symptoms, uncontrolled pain, psychological distress and SI What are risk factors for Opioid Use Disorder? - CORRECT ANSWERS- Family or personal history of addiction or substance abuse, pts with hx of trauma, pre-existing psych disorders, pregnancy, 65+, COPD and resp disorders, renal or hepatic insufficiency Risk Evaluation and Mitigation Strategies (REMS) - CORRECT ANSWERS- Program from FDA to reinforce safe medication use Ensures opioids used according to FDA-approved prescribing, benefits outweigh risk of misuse and abuse, and prescribing naloxone when appropriate Methadone - CORRECT ANSWERS-Opioid properties similar to morphine BBW-prolongs QT interval and can cause a potentially fatal dysrhythmia, also causes resp depression used in MAT for opioid use disorder Buprenorphine and Naloxone combination - CORRECT ANSWERS-Used in treating opioid use disorder Pretreatment with naloxone can prevent toxicity from buprenorphine Lowers severity of withdrawal symptoms and lowers craving for opioids
Pregabalin in Chronic Pain Treatment - CORRECT ANSWERS-Effective in diabetic neuropathy, postherpetic neuralgia, central neuropathic pain, and fibromyalgia Side effects=sedation, dizziness, ataxia, GI bleeding
Contraindications of Thiazide Diuretics - CORRECT ANSWERS-Patients with allergies to sulfa drugs Sensitivity to thiazides Caution in renal dysfunction
Diuretic Monitoring Needs - CORRECT ANSWERS-Monitor electrolytes, uric acid and lipid panel Monitor urine output Effects of Cardiac Glycosides - CORRECT ANSWERS- Heart Failure Order of Treatment - CORRECT ANSWERS-ACEI or ARB first line Plus BB, diuretics and others PRN Quinidine and Digoxin - CORRECT ANSWERS- Atherosclerotic Cardiovascular Disease Risk Score (ASCVD) - CORRECT ANSWERS- Hyperlipidemia Order of Treatment-Non pharm - CORRECT ANSWERS- Lifestyle changes (wt loss, exercise, improve diet, stop smoking) DASH diet (low sodium, low sat fat) Increase dietary soluble fiber (lowers LDL by block absorption) Statin drugs and LDL - CORRECT ANSWERS-High intensity-lowers LDL by
=50% Moderate-intensity- lowers by 30- 49% Low-intensity-lowers by <30% Ezetimibe (Zetia) - CORRECT ANSWERS-Cholesterol absorption inhibitor Non-statin, most commonly used Lowers LDL-C by average of 13-20% Can be used in monotherapy or as adjunct to statin or fibrate DO NOT USE in patients with severe hepatic impairment Nitroglycerin - CORRECT ANSWERS-Organic nitrates Reduces cardiac ischemia and associated pain by promoting smooth muscle vasodilation Cheapest option for angina treatment Loop Diuretics - CORRECT ANSWERS-Helps relieve acute symptoms of HF Furosemide, bumetanide, torsemide Side effects-dry mouth, tinnitus, hypotension, blurry vision, HA Thiazide Diuretics - CORRECT ANSWERS-Preferred for stage I HTN and preferred initial therapy in AA
Hypo- kalemia, natremia, magnesemia Contraindications to thiazide diuretics - CORRECT ANSWERS-Intolerance to tartrazine Anuria Angiotensin Receptor Neprilysin Inhibitors (ARNIs) - CORRECT ANSWERS- Play critical role in reducing risk of CV deaths and hospitalizations- increased diruesis, vasodilation Sacubitril/valsartan (Entresto) Often given in place of an ACEI or ARB-NOT together Side effects of ARNIs - CORRECT ANSWERS-Angioedema, hypotension, hyperkalemia, impaired renal function Not administered within 36 hours of an ACEI Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) - CORRECT ANSWERS-Spironolactone (Aldactone), eplerenone (Inspra) Block effects of aldosterone , enhance action of thiazides and loops, counterract K+ loss Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Side Effects - CORRECT ANSWERS-Hyperkalemia, arrhythmias, amennorrhea, gynecomastia, deepening voice, increased hair, muscle cramps, agranulocytosis Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Special Considerations - CORRECT ANSWERS- Hepatic dysfunction DM d/t increase risk of hyperkalemia Aldosterone Receptor Antagonists/Mineralcorticoid Receptor Antagonists (MRAs) Contraindications - CORRECT ANSWERS-Anuria, ARF, renal impairment, hyperkalemia, Addison's disease, concurrent use with eplerenone ACEI and ARBs MoA - CORRECT ANSWERS-Inhibition of angiotensin- converting enzyme decreases formation of angiotensin II resulting in prevention of vasoconstriction and aldosterone-mediated volume expansion Drug of choice in DM and CKD d/t renal protection ACEI and ARB BBW - CORRECT ANSWERS-Category C during 1st trimester, D during 2nd and 3rd
Cause fetal kidney malformation and fetal hypotension
