Download Pharmacology Module 1: Questions and Answers for Nurse Practitioners and more Exams Pharmacology in PDF only on Docsity!
How does the role of the RN differ from that of the nurse practitioner? How does the role of the RN differ from that of the nurse practitioner? CORRECT ANSWERS✅ -RN administers medications and has to understand pharmacokinetics. can offer input because they spend the most time with provider -NP prescribes medication with new knowledge that is more in depth. -clinical judgement for specific situations -collaborate with other providers What is a non-NP APN? CORRECT ANSWERS✅ can include nurse anesthesia or nurse midwives or clinical nurse specialists. there are different laws for prescriptive authority in different states Who regulates the nurse practitioner's scope of practice? CORRECT ANSWERS✅ state board of nursing regulates practice. 5 states have joint oversight with medical board. scope of practice is determined by NP license for that state Who regulates the nurse practitioner's prescriptive authority? CORRECT ANSWERS✅ state guidelines and laws What specific advanced knowledge is required to be a safe prescriber? CORRECT ANSWERS✅ -pathophysiology and disease process -pharmacology -rational drug selection Describe a holistic approach to care. CORRECT ANSWERS✅ -education is tailored to pt, -culturally specific and sensitive
Using good clinical judgment, what questions should you ask yourself before prescribing a medication for a patient? CORRECT ANSWERS✅ -is a prescription the right treatment? -what are the effective drugs for the disease? -what are the goals of therapy? -monitoring to see if drug is meeting goals? -OTC or prescription? -cost? -sources of info (lexicomp) Why is NP collaboration with other providers so important? CORRECT ANSWERS✅ it is critical for quality patient care. -pharmacists are experts in pharmacokinetics and pharmacotherapeutics -physicians have a different perspective on prescribing (curative vs holistic) Describe the World Health Organization's Six-Step Model of Rational Prescribing. CORRECT ANSWERS✅ 1. Define the patients problems
- Specify the therapeutic objective (what is the goal? curative vs comfort vs symptom relief)
- choose the treatment
- Start the treatment ($4 retail list?)
- educate the pt
- Monitor the effectiveness
What is the gold standard for initial drug selection? CORRECT ANSWERS✅ - pharmacokinetic factors -pharmacodynamics factors -therapeutic factors -safety -cost to society -pt factors -provider factors -alternative therapies What are some pharmacodynamics factors that influence drug selection? CORRECT ANSWERS✅ -ease of medication titration is influenced by the dose- response curve of the drug -therapeutic index: narrow is more difficult to manage vs wide is safer and requires less monitoring /wide range of safe doses What are the 5 pharmacokinetic factors that influence drug selection? CORRECT ANSWERS✅ -bioavailability (%, ex. Digoxin -CYP 450 metabolism -renal elimination (if high, may not be app for CKD pt for example) -dose-concentration curve -half life How is the safety profile of a drug initially determined, and where in the drug monograph may safety concerns be found? CORRECT ANSWERS✅ clinical trials. outlined in the cautions and precautions section of the drug monograph. also pay attention to medwatch report and FDA advisories
Review the basic ways that cost influences drug selection. CORRECT ANSWERS✅ - cost to pt (could influence adherence), ask about prescription drug coverage. consider $4 list. -cost to society: thoughtful prescribing considers cost to health system What is a drug formulary? CORRECT ANSWERS✅ A drug formulary is a database of approved medications in drug therapy categories that includes information on the medications' preparation, safety, effectiveness and cost. personal formulary: small list of drugs that each provider is comfortable prescribing on a routine basis How does pharmaceutical promotion influence rational drug prescribing? CORRECT ANSWERS✅ company will pay for you and market for you to choose their drug. free vacations and dinners can influence rational drug prescribing When should prescribers specifically disclose conflicts of interests and financial relationships with pharmaceutical companies? CORRECT ANSWERS✅ when it affects safety of pt Why are legend drugs named as such, and what agency regulates these drugs? CORRECT ANSWERS✅ FDA regulates these. Legend drug is a prescription drug that must be prescribed by a provider. legend states: "Caution: Federal law prohibits dispensing without a prescription" look at module 1 study guide for FDA duties and guidelines CORRECT ANSWERS✅ ok
According to the FDA, what is the difference in a legend and over the counter (OTC) drug? CORRECT ANSWERS✅ The legal distinction between a legend drug and an over-the counter (OTC) drug is not founded on relative safety per se but rather involves a regulatory decision on whether adequate directions for the drug's proper use can be written for the layperson. If the FDA determines that adequate directions can be written, the manufacturer is not allowed to identify the drug with a prescription legend What is off-labeling prescribing? CORRECT ANSWERS✅ med isused for an indication that is not approved by the FDA Who must register and obtain a DEA registration number? CORRECT ANSWERS✅ anyone who manufactures, prescribes, transports or handles a controlled substance What are controlled substances? Who determines whether a substance is controlled? Can is vary from state to state? CORRECT ANSWERS✅ DEA determines if a substance is controlled. A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by a government based on their potential for abuse, accepted medical use, and diversion potential. does not vary from state to state but whether or not NP can prescribe it does vary by state to state Identify specific details for the Controlled Substance Schedule. Which cannot be refilled? Which can be phoned in?Schedule 1Schedule 2Schedule 3Schedule 4Schedule 5 CORRECT ANSWERS✅ 1: no medical use
2: cannot be refilled 3: telephone prescription okay 4:telephone prescription okay 5: same as all prescription drugs Identify measures that prescribers can use to ensure the security of their DEA number and prescription pads. CORRECT ANSWERS✅ always write out the DEA number, never sign in advance, never use as a notepad, store pad in a locked area, -name, NPI number, address and telephone number hand written on pad, spell out quantity instead of writing in a number Name at least 5 controlled substance prescribing precautions. CORRECT ANSWERS✅ -store prescription pad in a locked area -tamper proof paper -name, NPI number, address and telephone number on pad -DEA number if controlled substance -Date -refills -spell out quantity -can fax or electronically submit any rx except schedule 2 What strategies can prescribers use to prevent drug misuse by patients? CORRECT ANSWERS✅ -use of chemical dependence screening skills -limited-setting regarding controlled-drug prescribing -documentation of a confirmed dx and the r/o of chemical dependence before initiating a controlled prescription
adopted into state pharmacy law and include specific inks and papers. Contact the state board directly regarding statespecific prescription requirements. Define Electronic prescribing or "e-prescribing". CORRECT ANSWERS✅ sending a prescription from computer or printing from computer without writing it What are benefits of E-prescribing? CORRECT ANSWERS✅ -decreases med errors -increases med tracking -identifies allergies/interactions Ethically, to whom can an NP prescriber write a prescription, and when should it, or should a medication be prescribed or dispensed? CORRECT ANSWERS✅ they have to be a patient, not a family or friend, pt must have been assessed and there should be a record of this in chart that is linked to prescription What two groups are at the highest risk for adverse drug reactions (ADRs)? CORRECT ANSWERS✅ infants/children. the elderly What actions by the prescriber can reduce the possibility of drug-drug interactions, and subsequent ADRs? CORRECT ANSWERS✅ -consider what medications the pt is on, pay attention to who is at high risk for ADR, always document the med, strength, and FRREQUENCY of med taken by pt, Identify the recognized types of ADRs, definition, cause, and examples of each. CORRECT ANSWERS✅ type A: dose dependent. r/t effects of drug. e.g. insulin and BS too low
type B: drug allergy or hypersensitivity. not dose dependent or predictable/preventable. type 1- type C: r/t cumulative dose of med. relatively uncommon. type D: delayed rxn that is apparent some time after drug is used (teratogenic/carcinogenic) type E: r/t withdrawal of drug type F: unexpected failure of drug. can be caused by drug interactions The presence and severity of teratogenesis depends upon what 3 factors? CORRECT ANSWERS✅ 1. Genetic susceptibility -interpatient variation in susceptibility exists. This means that not every baby exposed to a teratogen will exhibit effects of the drug.
- Developmental stage during the exposure (gestational age). 2-8 weeks gestation is the most likely time for susceptibility to malformations; a time when many women don't know they are pregnant. After 8 weeks, the CNS is the system of major susceptibility.
- Dose of the drug - there is wide variability between patients so dose of drug that is teratogenic is difficult to determine. Name some examples of carcinogenic drugs. CORRECT ANSWERS✅ Oral contraceptives, androgens, immunomodulators, steroids, nitrites What is the difference in compliance and adherence? CORRECT ANSWERS✅ Compliance implies an involuntary act of submission and provider centric decision making. Adherence implies a voluntary act of negotiation and joint acceptance of a treatment regimen.
-NP prescribes medication with new knowledge that is more in depth. -clinical judgement for specific situations -collaborate with other providers What is a non-NP APN? CORRECT ANSWERS✅ can include nurse anesthesia or nurse midwives or clinical nurse specialists. there are different laws for prescriptive authority in different states Who regulates the nurse practitioner's scope of practice? CORRECT ANSWERS✅ state board of nursing regulates practice. 5 states have joint oversight with medical board. scope of practice is determined by NP license for that state Who regulates the nurse practitioner's prescriptive authority? CORRECT ANSWERS✅ state guidelines and laws What specific advanced knowledge is required to be a safe prescriber? CORRECT ANSWERS✅ -pathophysiology and disease process -pharmacology -rational drug selection Describe a holistic approach to care. CORRECT ANSWERS✅ -education is tailored to pt, -culturally specific and sensitive Using good clinical judgment, what questions should you ask yourself before prescribing a medication for a patient? CORRECT ANSWERS✅ -is a prescription the right treatment?
-what are the effective drugs for the disease? -what are the goals of therapy? -monitoring to see if drug is meeting goals? -OTC or prescription? -cost? -sources of info (lexicomp) Why is NP collaboration with other providers so important? CORRECT ANSWERS✅ it is critical for quality patient care. -pharmacists are experts in pharmacokinetics and pharmacotherapeutics -physicians have a different perspective on prescribing (curative vs holistic) Describe the World Health Organization's Six-Step Model of Rational Prescribing. CORRECT ANSWERS✅ 1. Define the patients problems
- Specify the therapeutic objective (what is the goal? curative vs comfort vs symptom relief)
- choose the treatment
- Start the treatment ($4 retail list?)
- educate the pt
- Monitor the effectiveness What does it mean for the nurse practitioner to collaborate with the patient in regards to drug therapy? CORRECT ANSWERS✅ individualize for each pt -previous rxns -health beliefs
-safety -cost to society -pt factors -provider factors -alternative therapies What are some pharmacodynamics factors that influence drug selection? CORRECT ANSWERS✅ -ease of medication titration is influenced by the dose- response curve of the drug -therapeutic index: narrow is more difficult to manage vs wide is safer and requires less monitoring /wide range of safe doses What are the 5 pharmacokinetic factors that influence drug selection? CORRECT ANSWERS✅ -bioavailability (%, ex. Digoxin -CYP 450 metabolism -renal elimination (if high, may not be app for CKD pt for example) -dose-concentration curve -half life How is the safety profile of a drug initially determined, and where in the drug monograph may safety concerns be found? CORRECT ANSWERS✅ clinical trials. outlined in the cautions and precautions section of the drug monograph. also pay attention to medwatch report and FDA advisories Review the basic ways that cost influences drug selection. CORRECT ANSWERS✅ - cost to pt (could influence adherence), ask about prescription drug coverage. consider $4 list.
-cost to society: thoughtful prescribing considers cost to health system What is a drug formulary? CORRECT ANSWERS✅ A drug formulary is a database of approved medications in drug therapy categories that includes information on the medications' preparation, safety, effectiveness and cost. personal formulary: small list of drugs that each provider is comfortable prescribing on a routine basis How does pharmaceutical promotion influence rational drug prescribing? CORRECT ANSWERS✅ company will pay for you and market for you to choose their drug. free vacations and dinners can influence rational drug prescribing When should prescribers specifically disclose conflicts of interests and financial relationships with pharmaceutical companies? CORRECT ANSWERS✅ when it affects safety of pt Why are legend drugs named as such, and what agency regulates these drugs? CORRECT ANSWERS✅ FDA regulates these. Legend drug is a prescription drug that must be prescribed by a provider. legend states: "Caution: Federal law prohibits dispensing without a prescription" look at module 1 study guide for FDA duties and guidelines CORRECT ANSWERS✅ ok What does the FDA regulatory jurisdiction over drugs encompass? CORRECT ANSWERS✅ -approval process for new drugs or new indications -official labeling -surveillance of adverse drug events
directions for the drug's proper use can be written for the layperson. If the FDA determines that adequate directions can be written, the manufacturer is not allowed to identify the drug with a prescription legend What is off-labeling prescribing? CORRECT ANSWERS✅ med isused for an indication that is not approved by the FDA Who must register and obtain a DEA registration number? CORRECT ANSWERS✅ anyone who manufactures, prescribes, transports or handles a controlled substance What are controlled substances? Who determines whether a substance is controlled? Can is vary from state to state? CORRECT ANSWERS✅ DEA determines if a substance is controlled. A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by a government based on their potential for abuse, accepted medical use, and diversion potential. does not vary from state to state but whether or not NP can prescribe it does vary by state to state Identify specific details for the Controlled Substance Schedule. Which cannot be refilled? Which can be phoned in?Schedule 1Schedule 2Schedule 3Schedule 4Schedule 5 CORRECT ANSWERS✅ 1: no medical use 2: cannot be refilled 3: telephone prescription okay 4:telephone prescription okay 5: same as all prescription drugs
Identify measures that prescribers can use to ensure the security of their DEA number and prescription pads. CORRECT ANSWERS✅ always write out the DEA number, never sign in advance, never use as a notepad, store pad in a locked area, -name, NPI number, address and telephone number hand written on pad, spell out quantity instead of writing in a number Name at least 5 controlled substance prescribing precautions. CORRECT ANSWERS✅ -store prescription pad in a locked area -tamper proof paper -name, NPI number, address and telephone number on pad -DEA number if controlled substance -Date -refills -spell out quantity -can fax or electronically submit any rx except schedule 2 What strategies can prescribers use to prevent drug misuse by patients? CORRECT ANSWERS✅ -use of chemical dependence screening skills -limited-setting regarding controlled-drug prescribing -documentation of a confirmed dx and the r/o of chemical dependence before initiating a controlled prescription -practice just saying no What strategies can prescribers use to deal with drug scams? CORRECT ANSWERS✅ learn to recognize the common ones, refuse to give in, practice the skill of turning the tables on the scammer, beware of forging and altering of
