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2025 NR565 ADVANCED
PHARM MIDTERM EXAM WITH
CORRECT ANSWERS
What are the key responsibilities of prescribing? - CORRECT ANSWERS- Protect patients from harm Know MOA, safety, efficacy, and select right med/dose to maximize outcome and minimize adverse effects What should be used to make prescribing decisions? - CORRECT ANSWERS-- Have a documented provider-patient relationship
- Document H&P
- Discuss & document risk factors, side effects, and therapy options
- Document plan for monitoring and/or titration
- Consider cost, drug availability, and clinical practice guidelines
- Consider side effects, allergies, hepatic/renal function, need for monitoring, and lifespan considerations Calcium supplementation varies with age. Current recommendations include
- CORRECT ANSWERS-adolescents 1300 mg daily; young adults 1000 mg daily; older adults 1200 mg daily Alendronate is prescribed for Loretta who has postmenopausal osteoporosis. What patient education information is important to share with Loretta? - CORRECT ANSWERS-take the medication with plenty of water and remain upright for at least 30 minutes Marta is postmenopausal and has a family history of breast cancer develops. At her annual visit, it is determined that Marta has osteoporosis. Which of the following medications is the best treatment for Marta? - CORRECT ANSWERS- raloxifene Use caution when combining ACEIs with potassium-sparing diuretics due to - CORRECT ANSWERS-increased risk of hyperkalemia
ACEIs and ARBS will precipitate acute renal failure when - CORRECT ANSWERS-bilateral renal artery stenosis is present
Elements of a prescription - CORRECT ANSWERS-Prescriber name, license, contact info, and DEA (if applicable)
Patient name, DOB, allergies Medication name, indication, strength, dose, frequency, dispense quantity and number of refills May be telephone, written, e-script, or refill -Schedule II cannot be prescribed or refilled by phone -Written scripts must be legible, in ink, no abbreviations, and never sign a blank script -Not all DEA drugs can be e-prescribed -With refills, consider monitoring needs Pharmacokinetics - CORRECT ANSWERS-How the drug moves ("kinetic") through the body (absorption, distribution, metabolism, excretion) Absorption - Drug entering blood (ex. Absorbed from GI tract) Distribution - Drug moving from blood to tissues/cells of liver, kidneys or other site Metabolism - Drug-structure altered by enzymes Excretion - Drugs & their metabolites move out of the body via bile or urine Pharmacodynamics - CORRECT ANSWERS-PharmacoDynamics (What Drugs Do to the body) MOA (interactions between drug and receptors or enzymes), dose, tolerance, dependence, interactions, adverse effects; drugs affects individuals differently Relates to agonists, antagonists Agonists & Antagonists - CORRECT ANSWERS-Agonists mimic the body's own regulatory molecules and activate receptors. Ex. Dobutamine (drug) mimics norepinephrine at receptors on the heart, allowing it to bind and cause the heart rate to increase. Antagonists block the actions of regulating molecules. They do not activate receptors. Ex. Antihistamines suppress allergy symptoms by binding to the receptors of histamine and preventing activation of these receptors by histamine released in response to allergens.
CYP450 - CORRECT ANSWERS-Enzyme family most important in metabolizing drugs
Available in the liver Drugs may be inducers or inhibitors of these enzymes. Inducers increase rates of metabolism and inhibitors decrease rates of metabolism. CYP450 Inhibitors (what they do, what the patient experiences, and examples) - CORRECT ANSWERS-P450 inhibitors are drugs that slows rates of drug metabolism in the liver. This can cause an INCREASE in the drug and cause an INCREASE in adverse affects and risk for toxicity. Examples: VISA debt inhibits spending for designers like Calvin Klein, Gucci, and Q V - valproate I - isoniazid S - sulfonamides A - amiodarone C - chloramphenicol K
- ketoconazole G - grapefruit juice Q - quinidine CYP450 Inducers (what they do, what the patient experiences, and examples) - CORRECT ANSWERS-P450 inducers are drugs that increase rates of metabolism in the liver. This causes DECREASED drug levels, so the drug may not reach the therapeutic level. When you drive fast, you can't have a CRAP GPS C - carbamazepine R - rifampin A - alcohol P - phenytoin G - griseofulvin P - phenobarbital S
- sulfonylurea What happens when someone has a poor metabolism phenotype? - CORRECT ANSWERS-Ex. Poor metabolizers of tamoxifen were almost 10x
Basically, poor metabolizers may not get the intended effect of the medication What does the FDA regulate when it comes to medications? - CORRECT ANSWERS-Ensuring the safety, efficacy, and security of drugs, biological products, and medical devices Reasons for medication non-adherence - CORRECT ANSWERS- forgetfulness lack of planning (ex. not getting refill in time) cost dissatisfaction (side effects, inconvenient dosing, drug isn't working) altered dosing (patients taking less than the prescribed dose for whatever reason) Black box warnings (what they are & why they are issued) - CORRECT ANSWERS-The strongest safety warning a drug can have while staying on the market. Required by FDA. Ex. NSAIDS can cause thromboembolic events and GI bleeding Ex. ACE inhibitors contraindicated in 2nd and 3rd trimesters of pregnancy because they can injure the fetus When does neonate/infant drug absorption reach adult levels? - CORRECT ANSWERS-Absorption mirrors adults after age 2 Common fears with genetic testing - CORRECT ANSWERS-Lack of education - many health care providers do not possess the knowledge or comfort to interpret the testing Financial cost - many insurance plans do not cover this. Discrimination from employers, insurance companies or providers Guiding principles for prescribing opioids - CORRECT ANSWERS-Released by CDC, 3 main principles:
- Determine when to initiate and/or continue opioids for chronic
pain. Nonpharmacologics and nonopioids are preferred if possible.
- Opioid selection, dose, duration, follow up and discontinuation. Make treatment goals before starting. Start with lowest dose and reassess.
Reluctance to cooperate (ex. saying they can't remember when they were last treated or suddenly leaving) Unusually high or low understanding of medications
Strange symptoms (may exaggerate or lie, claiming to have back pain, kidney stones, migraines, or toothaches) Specific drug requests When should naloxone be prescribed for a patient? - CORRECT ANSWERS- Offer to all patients who are at an increased risk for overdose. Also offer to family and caregivers and show them how to administer it. What behaviors predict controlled substance addiction? - CORRECT ANSWERS-Alcohol, nicotine or other substance use at an early age; family history; mental health disorders; taking a highly addictive drug for a long time; taking multiple medications including benzodiazepines. Rules for prescribing schedule II drugs - CORRECT ANSWERS-Written prescription required NO refills allowed No call-in Schedule I drugs - CORRECT ANSWERS-These drugs have NO accepted medical use in the United States. These drugs have the highest abuse potential Heroin, LSD, marijuana, ecstasy, methaqualone, peyote Schedule II drugs - CORRECT ANSWERS-- Drugs have high potential for abuse
- Drugs have currently accepted medical uses, although there may be serious restrictions
- Abuse of drug may lead to dependence Combination of products with <15mg hydrocodone/dose Cocaine, meth Vicodin, methadone, dilaudid, meperidine (Demerol), oxycodone, fentanyl, Adderall, Ritalin Schedule III drugs - CORRECT ANSWERS-- has potential for abuse, but to a lesser degree than schedules I + II
- may not be refilled more than 5 times
Ketamine, steroids, testosterone, Tylenol w/ codeine Schedule IV drugs - CORRECT ANSWERS--ZEPAM low potential for abuse and dependence diazepam, zolpidem (Ambien), alprazolam, and clonazepam Schedule V drugs - CORRECT ANSWERS-These drugs have less potential for abuse than schedule II, III, and IV drugs Robitussin, Lomotil, Lyrica Treatment of chronic pain (ex. how would osteoarthritis be treated?) - CORRECT ANSWERS-Start with nonopijoid medications (NSAIDS) and nonpharmacologic treatments (like yoga). Risk factors for opioid use disorder - CORRECT ANSWERS-chronic pain, family history, other substance abuse, prescribed for long term use Methadone (black box warning & benefits of use in opioid use disorder) - CORRECT ANSWERS-Can treat pain (similar properties to morphine) and treat opioid addiction. By taking methadone, the addict avoids withdrawal and the need to procure illegal drugs. *Only available through certified opioid treatment programs BBW: Prolongs the QT interval and so it can cause a potentially fatal dysrhythmia. Torsades has developed in taking 65-400 mg/day. Use with caution in patients who already have a prolonged QT. ALSO methadone can cause severe respiratory depression. Buprenorphone/Naloxone (benefits of using this combination) - CORRECT ANSWERS-Buprenorphine (Suboxone) can be prescribed in general medical settings. It alleviates cravings and reduces the use of illicit drugs. With the combination of buprenorphine and naloxone (ex. Bunavail), the naloxone discourages IV abuse. Why would you consider prescribing pregabalin rather than an opioid for chronic pain? - CORRECT ANSWERS-Pregabalin (Lyrica) can treat neuropathic pain and fibromyalgia. It does not pose the risk for abuse that opioids do.
What order are hypertension medications typically prescribed in? - CORRECT ANSWERS-Non Black: Thiazide->ACEI->ARB
with asthma because they can cause bronchoconstriction Action of diuretics - CORRECT ANSWERS-Increases the amount of fluid excretion via the renal system
Contraindications to thiazide diuretics - CORRECT ANSWERS-Sulfa allergy D/t electrolyte changes (HYPO Na and K), caution w/: -Renal impairment -Cardiovascular issues D/t affect on uric acid, caution with history of gout Diabetes Monitoring needs with diuretics - CORRECT ANSWERS-Monitor electrolytes, weight loss, blood pressure (hypotension), dehydration What should you prescribe for someone with heart failure in response to fibrotic changes? p. 329 - CORRECT ANSWERS-Spironolactone (aldosterone antagonist) Aldosterone contributes to myocardial remodeling (which impairs pumping) and myocardial fibrosis (which increases risk for dysrhythmias) - aldosterone antagonists in combination with an ACE or ARB can counteract these changes. What are the effects of cardiac glycosides? - CORRECT ANSWERS-Cardiac glycosides are used to treat heart failure. Ex. Digoxin *increases strength of contraction, helps with HF symptoms, DOES NOT prolong life, is a 2nd line therapy INCREASE the strength of cardiac contractions (POSITIVE inotrope) DECREASE heart rate (NEGATIVE chronotrope) What happens when quinidine and digoxin are combined? - CORRECT ANSWERS-Quinidine increases digoxin levels by decreasing excretion or altering distribution RISK FOR DIGOXIN TOXICITY (s/s: altered heart rhythm, GI upset) What is the Atherosclerotic Cardiovascular Disease Risk Score and when is it used? - CORRECT ANSWERS-The ASCVD Risk Score is a calculator that providers can use to determine a treatment plan. Low risk - lifestyle changes
