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NUR 521 AVD PHARM BLUEPRINT
EXAM 1 QUESTION AND ANSWER
LATEST UPDATE 2025-
Why should APRNs have full prescriptive authority? Who would benefit from this? - Answer -To inc pt care, accessibility, quality, and affordability. Pts benefit, especially underprivileged, rural communities. Could also improve wait times and lower hc costs for pts and hc systems by reducing reliance on more expensive providers. APRNs could benefit because they could practice to the full extent of their abilities Schedule I Drugs - Answer -No medical use in the US Heroin Marijuana LSD MDMA Schedule II Drugs - Answer -High abuse potential w/ psych/physical dependence Stimulants and depressants Opium Morphine Codeine Dilaudid Methadone Demerol Hydrocodone
Schedule III Drugs - Answer -High abuse potential but less than I and II Contains compounds w/ limited amounts of certain drugs Products containing no more than 90mg of Codeine per dosage unit Tylenol w/ codeine Buprenorphine (Suboxone) Schedule IV Drugs - Answer -Abuse potential less than I, II, and III Barbital Phenobarbital Chloral Hydrate Dorazepate (Tranxene) Alprazolam (Xanax) Quazepam (Dormalin) Schedule V Drugs - Answer -Abuse potential less than I-IV Preparations w/ limitis amounts of certain narcs/stims used for diarrhea, cough, and pain Buprenorphine Propylhexedrine What components are necessary when writing a prescription? - Answer -Prescriber name, license #, contact info Prescriber DEA # (if applicable) NPI # Pt name/ DOB Name of med Indication for med
Written- never presign, write in ink, avoid abbrev, use tamper resistant scripts E-prescribing- CMS incentivizes using EMR to prescribe. "Meaningful Use" with intent to inc pt safety/ improve outcomes. Requires 2 factor authentication software to prescribe scheduled meds What is the benefit of collaboration during drug selection and prescription writing? - Answer -Develop a relationship with pharmacist and infectious disease Pharmacist can help with additional information regarding drug interactions. They have firsthand knowledge of formulary. They can assist with dosing. What information should be included in patient education material? - Answer -Name of med Purpose of med Dose Admin AEs Storage Lab testing (what, why,when, where, how) Interactions Duration of therapy Limit content of edu to main points Important info first Use active voice Use white space to make it less overwhelming Use illustrations Use layman's terms
Check for readability Why is patient education so important? - Answer - Education is the best way to promote positive outcomes with drug therapy. For compliance and promoting safe outcomes What is the best way to promote positive outcomes with drug therapy? - Answer -Patient education, monitoring therapy, and promoting adherence to therapy Why do we monitor drug therapy? - Answer -Determining therapeutic dosage Evaluating med adequacy Identifying AEs What are reasons that patient's will not take their medications? How can you address these as a provider? - Answer -Forgetfulness Lack of planning Cost Dissatisfaction Altered dosing Do annual med reviews to determine if the meds are necessary, what problems if any that the pt is having, polypharmacy, change in condition, if SEs outweigh condition, if there is a combo med available Absorption - Answer -The movement of a drug from the site of admin to the bloodstream/circulation.
- Pro drug (broken down into active ingredients)
- Inc toxicity
- Dec toxicity Considerations in Drug Metabolism - Answer -Age Induction and Inhibition of P First-pass effect of the liver Nutrition Competition between drugs Enterohepatic recirculation Drugs that are metabolized by P450 are called - Answer - Substrates Drugs that inc the rate of drug metabolism are called - Answer -Inducers Drugs that dec the rate of drug metabolism are called - Answer -Inhibitors Excretion - Answer -The movement of drugs and their metabolites out of the body. Elimination - Answer -Combination of metabolism and excretion. Drugs can exit the body via: - Answer -Urine (majority) Bile Sweat Saliva Breast milk
Expired air Steps of urinary excretion - Answer -1. Glomerular filtration: moves drugs from the blood into the tubular urine
- Passive tubular reabsorption: distal to the glomerulus, a concentration gradient moves drugs from the lumen of the tubule back into the blood, lipid-soluble drugs undergo passive reabsorption, and nonlipid-soluble drugs are excreted in the urine.
- Active tubular secretion: transport systems in the tubules that pump drugs from blood to the tubular urine Factors that affect drug secretion - Answer -pH Competition for active tubular transport Age The ability of a drug to cross a cell membrane is determined by: - Answer -Its ability to pass through single cells 3 ways drugs cross cell membranes - Answer -1. Channels/ pores (not as common, must be a small compound like K and Na)
- Transport System: PGP transports a wide variety of drugs out of cells
- Direct penetration: most common because most drugs are too large to pass through channels and/or they lack a transport system. Must be lipid-soluble to penetrate membranes because membranes are made of lipids ("like dissolves like")
Where do acids accumulate in pH partitioning? - Answer - Acids accumulate on the alkaline side. Where do bases accumulate in pH partitioning? - Answer - Bases accumulate on the acidic side. What is bioavailability? - Answer -The amount of an active drug that reaches the systemic circulation from its administration site. Different formulations of the same drug can vary in bioavailability. Factors that can affect bioavailability - Answer -Factors such as tablet disintegration time, enteric coatings, and sustained-release formulations can alter bioavailability and can thereby make drug responses variable. Explain how the same drug manufactured by different drug companies can have different absorption rates. - Answer -Medications can be chemically equivalent but absorbed at different rates because of things like different filler ingredients used What happens when a patient takes a drug that is metabolized by P450 enzymes if an inducing OR an inhibiting drug is added to the current drug regimen? - Answer -Significant changes in the drug's metabolism and effectiveness can occur, potentially leading to adverse effects or treatment failure. When an inducing drug is added:
- inc drug metabolism
- reduced drug levels
- reduced drug efficacy
- toxicity from prodrugs When an inhibiting drug is added:
- Dec drug metabolism
- Inc drug levels
- Toxicity
- Exaggerated therapeutic effects, potentially causing adverse reactions
- Reduced clearance of the drug, further contributing to its accumulation and potential toxicity Agonists - Answer -Molecules that ACTIVATE RECEPTORS. (Ex. neurotransmitters and hormones)
- They bind to receptors and mimic the action of the body. They have both affinity and high intrinsic activity. Antagonists - Answer -Prevent receptor activation by endogenous regulatory molecules and drugs.
- Has an affinity for receptor, but no intrinsic activity-it can attach, but it cannot activate the receptor. These work by PREVENTING the body's response. (EX. Antihistamines are histamine receptor antagonists that suppress allergy symptoms by binding to receptors for histamine.) Partial Agonists - Answer -Moderate intrinsic activity Can act as both antagonist and agonists.
-Document complaint/ action taken -Follow-up appt with pt -Report severe/unexpected AEs to the FDA What factors contribute to medication errors? - Answer -- Prescribing practices (inappropriate drug selection, error in dosage, lack of clear instructions, illegible writing)
- Oversight (failure to keep UTD med list, failure to continue or DC meds, absence of med rec)
- Communication (inadequate/ unclear instructions, failure to verify sound-alike drugs, inadequate pt edu) How can a provider minimize the risk for med errors? - Answer -- Verify that the drug selected is the drug intended
- Make sure drug references are UTD
- Verify pt allergies
- Check for DIs (Authoritative DI software recommended)
- Consider pt factors when selecting drug
- Consider if the drug is necessary
- Verify unit of drug dosages, ht/weight/decimal placement
- Write precise/ detailed instructions/ large font when needed
- Print instead of cursive, proper spelling, decimals, and numbers
- UTD med list at every visit and how the patient actually takes their meds (include dates when drugs are started/stopped/ altered and the reasons why)
- Pt education with pts and caregivers, verify understanding of teaching, provide handouts (written in 5th-8th grade level)
What would you do if a patient called and complained about a mild complaint that wasn't a known side effect? - Answer -Ask questions: Did symptoms appear shortly after the drug was first used?
- Did symptoms abate when the drug was discontinued?
- Did symptoms reappear when the drug was reinstituted?
- Is the illness itself sufficient to explain the event?
- Are other drugs in the regimen sufficient to explain the event?
- Because newly released drugs may have unreported adverse effects, be alert for unusual responses when prescribing new drugs.
- If the patient develops new symptoms, it is wise to suspect that the drug may be responsible—even if the symptoms are not described in the literature.
- Check post-market drug evaluations at www.fda.gov anf determine whether serious problems have been reported.
- If the drug is especially new, however, you may be the first provider to have observed the effect. If you suspect a drug of causing a previously unknown adverse effect, you should report the effect to MedWatch. You can file your report online Investigate before reporting the drug and if you have significant suspicion that the drug caused the AE, report it. Explain adaptive and physiological processes - Answer -- Body wt/ composition (esp in peds)
Pharmacogenomics - Answer -The study of the influence of genetic factors on drug response that result in the absence, overabundance, or insufficiency of drug- metabolizing enzymes When are pregnant women most susceptible to teratogenic drugs? - Answer -In any stage of pregnancy but especially in the 1st trimester. Preimplantation Period (conception-week2): teratogens are all or nothing. Could prevent conception or could still allow normal implantation and formation Embryonic Period (3-8wks) : teratogens produce gross malformations. Avoid exposure Fetal Period (9wks-term) In the 1st trimester, teratogens can cause gross malformations, brain abnormalities, learning deficits/ behavioral abnormalities Pregnancy considerations - Answer -- Benefits of tx must balance risks
- Most drugs have not been tested during pregnancy
- Conditions that threaten mother's health must be addressed
- By the 3rd trimester, renal blood flow is doubled, inc GFR= drugs clear fast
- Hepatic metabolism is inc with some drugs
- Lipid-soluble drugs cross the placenta easily
- Ionized, highly polar, and protein-bound drugs cross placenta with difficulty
- AEs can affect mom and baby
5 FDA pregnancy categories - Answer -A- Safe/ no known effects B- Relatively safe/ animal studies have shown no or low fetal risk C- Animal studies have shown there is fetal risk but no controlled studies in women D- Proven risk for harm in animals/ babies X- Definite proven risk for fetal harm What should you consider when prescribing medications to infants/ children? - Answer -- Doses are according to body weight (kg)
- Determine the concentration of the drug
- Drug levels in infants remain above the MEC longer than in adults
- Infants have immature pharmacokinetic processes
- By 1 year, pharmacokinetic processes are similar to adults
- Renal excretion is lower in infants (drugs eliminated mostly by the kidneys should be given in reduced doses or at longer intervals)
- Drugs that have a narrow TI should be monitored closely for toxicity
- For drugs that do not have ped dosing established: Child's BSAx adult dosage divided by 1.73 m2= ped dose (Measure the child's weight (in kilograms - kg). Check the child's height or length (in centimeters - cm). Multiply the weight and height. Divide the result by 3600. Find the square root of that number= BSA
- Dec CO Metabolism of Drugs
- Dec hepatic blood flow
- Dec hepatic mass
- Dec activity of hepatic enzymes Excretion of Drugs
- Dec renal blood flow
- Dec GFR
- Dec tubular secretion
- Dec # of nephrons How do you calculate the GFR? - Answer -National Kidney Foundation offers online calculators to determine creat clearance and GFR (Cockcroft-Gault Formula/ eGRF calculator) GFR is the best calculator for determining kidney function in older adults What is the Beers Criteria and why is it used? - Answer - Identifies drugs with a high likelihood of causing severe AEs in older adults. It is used to guide safe medication prescribing and administration in older adults (65+) Neuropharmacology - Answer -The study of the effects of drugs on the nervous system PNS CNS Divisions of the Parasympathetic Nervous System - Answer -Sympathetic nervous system
Parasympathetic nervous system Functions of the Sympathetic Nervous System (SNS) - Answer -"fight or flight"
- Adrenergic receptors (alpha and Beta)
- Pupil dilation (mydriasis)
- Dec salivation
- Inc HR/ contractility
- Bronchial dilation
- Dec digestion
- Inc release of glucose
- Epi/ Norepi release from adrenal medulla
- Vasoconstriction
- Regulates body temperature by (Heart/ Blood Vessels/Lungs) Parasympathetic Nervous System (PNS) - Answer -"Rest and Digest" Cholinergic/ muscarinic receptors
- Dec HR, contractility
- Pupil constriction (miosis)
- Inc salivation
- Bronchiole constriction
- Inc digestion/ gallbladder function -Bladder contraction (GI/Bladder/Eye) Functions of the autonomic nervous system (ANS) - Answer -Innervated by SNS and PNS nerves to control internal body processes such as:
