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NR 565 - ADVANCED PHARMACOLOGY MIDTERM –
CHAMBERLAIN EXAM QUESTIONS WITH COMPLETE SOLUTIONS
GUARANTEED PASS BRAND NEW 2025
During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long term consequences?
- ANSWER - >1st trimester (fetus most at risk d/t rapid growth) What is BEERS criteria? - ANSWER - >Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately decides What is the CYP450 (cytochrome P450) - ANSWER - >liver enzyme system where medications are metabolized, can either be inducers or inhibitors and create drug-drug interactions CYP450 inducers - ANSWER - >Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease blood levels of drug), elevate CYP450 enzymes CYP450 inducers pneumonic - ANSWER - >"Bullshit Crap GPS INDUCES rage" CYP450 inducer drug names - ANSWER - >Barbituates, St John wort, Carbamazepine, rifampin, alcohol, phenytoin, griseofulvin, phenobarbital, sulfonylureas
CYP450 inhibitors - ANSWER - >inhibit metabolism, increase blood levels of medications CYP450 pneumonic - ANSWER - >"VISA credit card debt INHIBITS spending on designers like CK to look GQ" CYP450 inhibitors drug names - ANSWER - >Valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole, grapefruit juice, quinidine Physiological changes during pregnancy that impact pharmacodynamics and pharmacokinetic properties of drugs? - ANSWER - >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 - ANSWER -
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? - ANSWER - >slow and erratic due to low blood flow in muscles first few days of life
How can healthcare providers decrease likelihood of an elderly patient experiencing an adverse drug reaction? - ANSWER -
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? - ANSWER - >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 affordability of drugs support systems Why do nitrates need to be taken no later than 4 PM? - ANSWER - >Need nitrate free interval so tolerance doesn't develop
Nine factors that impact outcome of medication? - ANSWER -
Gender and race Genetics and pharmacogenomics Variability in absorption placebo effect Tolerance patho age bodyweight Do you need informed consent for genetic testing? - ANSWER - yes What is the purpose of the Genetic Information Non- Discriminatory Act? - ANSWER - >Protects patients from discrimination by employers and insurance providers based on genetic information Difference between practice authority and prescriptive authority? - 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. Who regulates prescriptive authority? - ANSWER - >the jurisdiction of a health professional board. This may be the
Patient name DOB Date Allergies Medication name Strength Quantity Indication for use Direction for use Refills Signature What are some potential problems that arise with written prescriptions? - ANSWER - >Must contain all elements May have pre-populated information Write legibly Avoid error prone abbreviations Tamper resistant scripts are often required Reasons for monitoring drug therapy - ANSWER - >determining therapeutic dosage evaluating medication adequacy identifying adverse effects serious or life-threatening risks. Which schedules of drugs can APRNs prescribe? - ANSWER -
depends on state - most II-V
How does limited prescriptive authority impact patients within the healthcare system? - ANSWER - >longer wait times to sign a prescription limits practitioners that are needed in rural areas unequal relationships between providers. Ex. one has more power high need for providers due to lack of providers and high amounts of patients. Independent practitioners= more patients being seen= lessens the patient/provider load Provider key responsibilities when prescribing? - ANSWER -
safe and competent practice understanding of the drugs, reactions, and pharmacology Be aware of the age group you are prescribing to Ex. Children vs older adults What should be used to make prescribing decisions? - ANSWER
documented provider-patient relationship, not prescribing for family or friends, documenting a thorough H&P, including discussions with the patient, drug monitoring/titrating. cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal function, need for monitoring, and special populations What happens when someone has a poor metabolism phenotype? - ANSWER - >medications metabolized slower, medication might not work or put them at risk for side-effects
"I was traveling and busy" "I lost the medication level" "I ran out" "I couldn't remember if I took it this morning and sometimes I just forget" What are black box warnings? - ANSWER - >Is the strongest safety warning a drug can carry and still remain on the market. Usually presented on the label with a heavy black border. Why are black box warnings issued? - ANSWER - >Issued by the FDA due to having serious or life-threatening risks What is neonate and infant drug dosing based on? - ANSWER -
weight or body surface area (BSA) After age one what happens to pharmacokinetic parameters, including drug sensitivity? - ANSWER - >mirror adult parameters Children under two have fast metabolism - ANSWER - >true How is absorption of transdermal medications different in neonates? - ANSWER - >more rapid and complete in infants than in older children and adults. the skin is very thin and blood flow is great in infants How is absorption of oral medications different in neonates? - ANSWER - >absorption may be enhanced or impeded
depending on the properties of the drug. gastric emptying is irregular, drugs absrobed in the intestine are absorbed slower. Common fears with genetic testing - ANSWER - >Lack of education - many health care providers do not possess the knowledge or comfort to interpret the tesgin financial cost - many insurance plans do not cover this. cost can be from $100-2000. discrimination from employers, insurance companies or providers 12 CDC guidelines for prescribing opioids - ANSWER - >Opioids are not first line therapy establish goals for pain and function Discuss risks and benefits Use immediate release opioids when starting Use the lowest effective dose Prescribe short durations for acute pain Evaluate benefits and harms frequently Use strategies to migrate risk Review PDMP data Use urine drug testing Avoid concurrent opioid and benzo prescribing Offer treatment for opioid use disorder Pure opioid agonist - ANSWER - >activate opioid receptors in brain resulting in opioid effect
When to refer a patient to a pain specialist? - ANSWER -
required for patients who take 120 mme per day of morphine milligram equivalents What is used to calculate pt's overdose risk? - ANSWER - >total morphine milligram equivalent (MME) per day to help assess the patient's overdose risk. If it is high (≥50 MME/day and especially ≥90 MME/day) Calculate total daily dose: 1. daily amount of each opioid that patient takes 2. convert to MME, multiply dose for each opioid by conversion factor 3. add them together What is MME and when to use? - ANSWER - >morphine milligram equivalent, represents the potency of an opioid in comparison to morphine, used to identify opioid prescription burden of a person What is the prescription drug monitoring program? - ANSWER - electronic databases enable providers to access information
regarding a patient's prescription history of controlled substances. Nearly all states have implemented PDMPs, and some states require providers to check the PDMP before prescribing controlled substances. When should PDMP be used? - ANSWER - >anytime a controlled substance is prescribed, refilled, or filled
Why is PDMP important? - ANSWER - >identify those at risk for overdose Assess someone for possible drug diversion? - ANSWER - >Urine test at least yearly PDMP routinely How does renal and hepatic function impact medication levels in body? - ANSWER - >Patients with renal or hepatic insufficiency can experience greater peak effect and longer duration of action for medications, thereby reducing the dose at which respiratory depression and overdose may occur. Similarly, for patients ages 65 years and older, reduced renal function and medication clearance due to age can result in a smaller therapeutic window between safe dosages and dosages associated with respiratory depression and overdose. How do elderly metabolize differently than younger people? - ANSWER - >Older adults metabolize opioids slowly and therefore require lower doses than younger adults. When should naloxone be prescribed? - ANSWER - >with every opioid prescription What is the typical dose of naloxone and how is it administered? - ANSWER - >4 mg, nasal spray- one spray to one nostril If no response, additional doses can be given every 2 to 3 minutes until emergency services arrive
Schedule II - ANSWER - >substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence Examples of schedule II - ANSWER - >Combination products with less than 15 milligrams of Hydrocodone per dosage unit (Vicodin), Cocaine, Methamphetamine, Methadone, Hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (OxyContin), Fentanyl, Dexedrine, Adderall, and Ritalin Schedule III - ANSWER - >substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Abuse potential is less than schedule I and II drugs, but more than schedule IV examples of schedule III - ANSWER - >Products containing less than 90 milligrams of Codeine per dosage unit (Tylenol with codeine), Ketamine, Anabolic steroids, Testosterone Schedule IV - ANSWER - >substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence example schedule IV - ANSWER - >Xanax, Soma, Darvon, Valium, Ativan, Talwin, Ambien, Tramadol Schedule V - ANSWER - >substances or chemicals are defined as drugs with lower potential for abuse than schedule IV and consist of preparations containing limited quantities of certain
narcotics. Are generally used for antidiarrheal, antitussive, and analgesic purposes example schedule V drugs - ANSWER - >Cough preparations with less than 200 milligrams of Codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin What type of analgesic for mild to moderate pain? - ANSWER -
tylenol, NSAID (Advil/motrin), COX2 inhibitors (like NSAIDS) What type of analgesic for moderate to severe pain? - ANSWER
opioids When to start using short acting opioids? - ANSWER - >Should be used exclusively for acute pain in opioid naïve (never had before) patients as opposed to opioid tolerant patients Adverse effects of opioids - ANSWER - >constipation urinary retention orthostatic hypotension emesis neurotoxicity (delirium, agitation) tolerance and physical dependence respiratory depression What are strong opioids analgesics usually reserved for? - ANSWER - >moderate to severe pain, postoperative pain, labor
and delivery, cancer, chronic pain, hospice/palliative care, end of life, acute traumatic events, burns
For what level of pain is codeine prescribed? - ANSWER - >mild to moderate What does 10% of codeine convert to/black box warning - ANSWER - >10% of each dose of codeine undergoes conversion to morphine, the active form of codeine (led to death in children and toxicity in infants through breast milk) Black box warning for hydrocodone - ANSWER - >products that contain Tylenol are associated with hepatotoxicity Black box warning opioids, fentanyl, oxycodone, hydromorphone, oxymorphone - ANSWER - >respiratory depression black box warning for methadone - ANSWER - >prolong QT interval, fatal dysrhythmias Do opioid agonist-antagonist have high or low potential for abuse? - ANSWER - >low - when compared with opioid agonists If you switch a patient from oxycodone to buprenorphine quickly what may we expect to see? - ANSWER - >If given to a patient who is physically dependent on a pure agonist, there drugs can precipitate withdrawal What level of pain is tramadol approved for - ANSWER -
moderate to moderately severe
What schedule is tramadol classified as? - ANSWER - >schedule IV What population should tramadol be AVOIDED in? - ANSWER -
pt's with epilepsy, neurologic disorders, elderly What drugs should be avoided for patients taking tramadol? - ANSWER - >CNS depressants (benzo, alcohol), MAOI, SSRI, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans What government branch declared the opioid crisis a public health emergency? - ANSWER - >Health and Human Services (HHS) what are the top 5 priorities of HHS? - ANSWER - >Improving access to treatment and recovery services Promoting use of overdose-reversing drugs Strengthening our understanding of the epidemic through better public health surveillance Providing support for cutting edge research on pain and addiction
Advancing better practices for pain management What were provisions made to the guidelines for prescribing opioids to non-cancer patients? - ANSWER - >Using opioids only after non-opioid analgesics or more conservative methods have failed
