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NR 565 MIDTERM EXAM 2024 | ADVANCED
PHARMACOLOGY | ALL QUESTIONS AND
CORRECT ANSWERS | LATEST EDITION |
ALREADY GRADED A+
·· Which schedule drugs can APRNs prescribe? ------CORRECT ANSWER----------------- Schedule II-V · Who determines and regulates prescriptive authority? ------CORRECT ANSWER-------- ---------Nurse practitioner scope of practice is determined by state practice and licensure laws. · 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
- Have a documented provider-patient relationship with the person for whom you are prescribing
- Do not prescribe medications for family or friends or for yourself
- 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
- Have a documented plan regarding drug monitoring or titration, if applicable Pharmakinetiscs and Pharmodynamics of older adults ------CORRECT ANSWER--------- --------drug accumulation secondary to 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 · 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,
CYP450 ------CORRECT ANSWER-----------------Many medications are metabolized through the liver enzyme system called cytochrome P450 (CYP450). Metabolization can be inhibited or induced by drugs and once this happens drug-drug interactions can occur. VISA credit card dept Inhibits Spending on CK and GQ ------CORRECT ANSWER-------- ---------Valproate I-soniazid S-ulfamids A-miodarone C-hloramphenical Ketoconazole G-rapefruit Juice Q-uinidine CYP450 Inhibitors ------CORRECT ANSWER------------------ Decreases the CYP which keeps the medication in your body longer which can cause toxicity CYP450 INDUCERS ------CORRECT ANSWER-----------------Increase CYP450 to work faster causes Drugs to leave your body faster.
•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. •During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long-term consequences? ------CORRECT ANSWER-----------------1 trimester •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). •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 Why do Nitrates need to be taken no later than 4 pm? ------CORRECT ANSWER---------- -------Need nitrate free interval so tolerance doesn't develop •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 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. •Who regulates prescription authority? ------CORRECT ANSWER-----------------The regulation of prescriptive authority is under the jurisdiction of a health professional board. This may be the State Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state. Although the federal government controls drug regulation, it has no control over prescriptive authority. •What is scope of practice determined by? ------CORRECT ANSWER-----------------Nurse practitioner scope of practice is determined by state practice and licensure laws. •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 restricted practice authority? ------CORRECT ANSWER-----------------Nurse practitioners are limited in at least one element of practice by requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to provide patient care.
What is Colchicine used for ------CORRECT ANSWER-----------------Class= Antigout Antiinflammatory Drug What is the dosage for Colchicine ------CORRECT ANSWER-----------------Acute attack (Colcrys only): 1.2 mg at first sign of the flare, followed by 0.6 mg 1 h later (maximum, 1.8 mg/24 h). Prophylaxis (Colcrys, Mitigare): 0.6 mg once or twice daily (maximum, 1.2 mg/24 h) What type of patients is Colchicine used for ------CORRECT ANSWER-----------------In the past, colchicine was considered a drug of choice for acute gout—even though it has a poor risk/benefit ratio. Today, colchicine is generally reserved for patients who are unresponsive to or intolerant of safer agents. What are some of the adverse effects of Colchicine ------CORRECT ANSWER------------- ----Bone marrow suppression Abdominal pain Nausea Vomiting Diarrhea What concurrent use of opioids and what type of medications or substances should be avoided and WHY ------CORRECT ANSWER-----------------1. Alcohol
- Benzos
- CNS Depresents.
- Antihistamines What are the classic triad signs of Opioid overdose ------CORRECT ANSWER------------- ----1. Resp. Depression leads to coma
- Pinpoint pupils
- Miosis
how antagonists work ------CORRECT ANSWER-----------------Prevention of release from the presynaptic neuron Occupation and blocking of the receptor site How does Fentanyl compare to Morphine ------CORRECT ANSWER-----------------It is 100 times more stronger than Morphine Fentanyl is metabylized in the ________ by_______ which cause fentanyl levels to increase by ____________ inhibitors. ------CORRECT ANSWER-----------------1. Liver
- CYP3A
- CYP3A what IS METADONE USE FOR ------CORRECT ANSWER-----------------1. Opiods use disorder. What level of pain is Codeine prescribed for ------CORRECT ANSWER-----------------Mild to Moderate pain. What does the 10 % of Codiene convert to ------CORRECT ANSWER----------------- Morphine. What is the Black Box Warning for Hydrocodone ------CORRECT ANSWER----------------- Think about what it contains(Tylenol) so it can cause HEPATOTOXICITY Do agonist/Antagonist have a high or low level for abouse and what population is this used for? ------CORRECT ANSWER-----------------1. Lower potential
- Used for Opoiod Use Disorder What are some examples of Agonist-Antagonist medication ------CORRECT ANSWER-- ---------------Bupreinorphine
- Discussing the Benefits and Risks of Long term opioids
- Using only one prescriber and one pharmacy PRMP to look up when medications were filled.
- Comprehensive follow up assessment of the side effects of treatment
- Stopping opioids after and attempt at opioids rotation has provided inadiquate benefits
- Fully documenting the entire process. What are some of the effects of opioids use the don't change with long term use and tolerance ------CORRECT ANSWER-----------------1. EUPHORIA
- Respiratory Depression
- Miosis(PUPIL CONSTRICTION)
- Constipation Methdone is used for ___________thearapy and __________therapy ------CORRECT ANSWER-----------------1. Maintenance
- Suppressive What is the Black Box warning for Methodone ------CORRECT ANSWER----------------- Prolong QT Long half Life Resp Depression Should only be prescribed by specially trained health care provider What is the reversal for Benzodiazepines ------CORRECT ANSWER----------------- FLUMAZENIL IV Only Does Methadone or Bupreorphine have a ceiling to respitory depression? ------ CORRECT ANSWER-----------------Methodone does have a ceiling Buprenorphine? What are adverse effects to lasix ------CORRECT ANSWER-----------------Hypokalemia and increased urination Hyponatrium
Dehydration Auto toxicity Drug interaction with Lasix ------CORRECT ANSWER-----------------Digoxin Lithium What medicaton will we prescribe with Loop Diurect to prevent an electrolyte imbalance ------CORRECT ANSWER-----------------Potassium Sparing diuretics'. What is a name of Thiazide Diurectic ------CORRECT ANSWER-----------------HTZ or also called Microzide WHAT IS THE MOA for Microzide ------CORRECT ANSWER-----------------Reabsorbing of Na in the Distal Conduluant Tubule What are Thiazide diaretic use to treat ------CORRECT ANSWER-----------------1st choice for Hypertension without any other morbidities. What is the MOA of Aldactone or Spiroaldactone ------CORRECT ANSWER----------------
- Blocks action of Aldosterone in the distal Nephrone Removes Na in Urine What is Spirolactone use to treat ------CORRECT ANSWER----------------- What are some Adverse effects to Spiroalctone ------CORRECT ANSWER----------------- HYPER K Dysrhythmia Gynomastatiod Mensural irregulates Deepening of the voice in women
When is the only time you would not give ACE inhibitors ------CORRECT ANSWER------- ----------Bilateral renal Stenosis ACE inhibitors can be benificial in which population? ------CORRECT ANSWER----------- ------At risk for end stage renal disease Diabetic What baseline data and monitoring for ACE Inhibitors ------CORRECT ANSWER---------- -------GFR, Creatinine etc 2-4 weeks after starting Angiortension Receptor Blockers are used for treatment of what ARBS ------CORRECT ANSWER-----------------Heart Failure Diabetic MI and Stroke prevention If someone develops a cough with ACE Inhibitors they can switch to ------CORRECT ANSWER-----------------ARBS What is the MOA of ARBS ------CORRECT ANSWER-----------------Blocks effects of AG II (not the production of AG II, so there is no increase in bradykinin thus no Cough) Adverse effects of ARBS ------CORRECT ANSWER-----------------hypertension, dizziness, Angioedema What is the name of the only Direct Renin Inhibitor(DRI) ------CORRECT ANSWER------- ----------Oliscerin
What is the only thing Direct Renin Inhibitor use for ------CORRECT ANSWER------------- ----HYPERTENTION What should be with administration of Direct Renin Inhibitor ------CORRECT ANSWER-- ---------------Dont eat with fatty foods What are Adverse effects of DRI ------CORRECT ANSWER-----------------Angioedema Hyper K. High doses Diarrhea What is the MOA of Eplerenone? ------CORRECT ANSWER-----------------Blocks aldosterone antagonist Inhibitors of what can lead to toxic levels of Eplerone ------CORRECT ANSWER----------- ------CYP What is the adverse effects of Eplerone ------CORRECT ANSWER-----------------Hypo K. What is the names of the Calcium Channel Blockers(PRILS) ------CORRECT ANSWER- ----------------VERAPRILS, VASOPRILS What effects does Calcium Channel Blockers ------CORRECT ANSWER-----------------1. Decrease HR. by blocking the SA node
- Decrease force of contraction
- Dilate ventricles What is CCB used to treat ------CORRECT ANSWER-----------------Angina supraventricular Tachycardia A-Fib,flutter
Headache, dizziness, weakness, and fatigue What is minoxidil used for? ------CORRECT ANSWER-----------------severe hypertension What is the unique Adverse effects of Minoxidil ------CORRECT ANSWER----------------- Hair Growth What is the difference between primary and secondary Hypertension ------CORRECT ANSWER-----------------Primary- No cause to there hypertension Secondary- There is a cause to their hypertension What test can be done on pt. with Hypertension ------CORRECT ANSWER----------------- CNP, Kidney function, What are the three system that regulate Blood Pressure ------CORRECT ANSWER------- ----------The Kidney systematic nervous system RASS For general population what medication is used to treat Hypertension ------CORRECT ANSWER-----------------1. Thiazides- Improve morbitiy and mortality Must have a good GFR to work that is why we don't use the ACE and ARBS What is initial treatment for CKD ------CORRECT ANSWER-----------------1. ACE inhibitor first-protect the kidney
- ARBS- Hypertention medicaton avoided in Heart Failure ------CORRECT ANSWER----------------
- Calcium Channel Blockers- because it reduces cardiac output
Hypertention medication avoided in DIABETES ------CORRECT ANSWER----------------- Thiazides- because they increase blood sugar Beta blockers- mask hypoglycemia First Choise antihyperten. for African American ------CORRECT ANSWER----------------- 1 - Thiazide
- Calcium Channel Blockers First line of medicaiton for Pregnancy ------CORRECT ANSWER-----------------Labetelol Methodopa Nearly all antihypertension can interfere with what ------CORRECT ANSWER--------------- --SEXUAL FUNCTION WHAT PT. EDUCATON FOR HYPERTENSION ------CORRECT ANSWER----------------- Sexual function Overall health blood pressure 3 drugs to treat Heart Failure ------CORRECT ANSWER-----------------Diuretics Beta Blockers ACE/ARBS RAAS What kind of Diurectic produce the most diuresis ------CORRECT ANSWER----------------
- Loop Diuretics' Are ACE inhibitors safe in pregnancy? ------CORRECT ANSWER-----------------No, they are teratogenic 2nd and 3rd most dangerous
- Digoxine
- Quinadine
- Amiodarone Black box for QuINADINE ------CORRECT ANSWER-----------------Atrial Flutter and Atrial Fib Black box for Mexiletine ------CORRECT ANSWER-----------------Life threatening arrhythmia black box amiodarone ------CORRECT ANSWER-----------------Pulmonary Toxicity Amiodarone can increase level of what drug ------CORRECT ANSWER----------------- Coumadin Digoxin Statins- Which potassium Channel Blockers should not be taken with Grapefruit juice of any of the cyp3A4 and why ------CORRECT ANSWER-----------------AMIODARONE increase What are lab values for Total Cholesterol and LDL ------CORRECT ANSWER-------------- ---Total Cholesterol less than 200 LDL less than 110 Are Statins safe to use in pregnancy ------CORRECT ANSWER-----------------If you have to you can use Fibraze or Athesthamide Names of HMG-CoA reductase inhibitors ------CORRECT ANSWER-----------------Statins
How is Metabolic Syndrome Diagnosed ------CORRECT ANSWER-----------------3 of the following 5:
- Elevated waist circumference
- High TG
- Low HDL
- High fasting blood glucose
- High blood pressure > 130/ What time of day should Statins be given and why ------CORRECT ANSWER-------------- ---Night Adverse effects of Statin ------CORRECT ANSWER-----------------rhamdomyolysis, myoglobinuria Don't drink Grapefruit What medication should be used with Statins because they raise statin levels ------ CORRECT ANSWER-----------------Antifungal Drugs Pedcolizone Grapefruit Juice Basline before starting a Statin ------CORRECT ANSWER-----------------Blood Pressure Lipid Pannel CK levels Fibrates are contra in patient with ------CORRECT ANSWER-----------------Liver injury can cause cancer Gal Stones What can Triger stable Angina ------CORRECT ANSWER-----------------Physical Exercise Strenous activity Large Meals
