NR565 Pharmacology Midterm Exam With Answers (150 Solved Questions)

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1/15Advance Pharmacy NR565 MIDTERM1.·· Which schedule drugs can APRNs prescribe?:Schedule II-V2.· Who determines and regulates prescriptive authority?:Nurse practitionerscope of practice is determined by state practiceand licensure laws.3.· How does limited prescriptive authority impact patients within thehealthcare system?:limited authority creates problems for the patient. Thepatient is not able to get the care they need4.· What are the key responsibilities of prescribing?:1. Be prudent anddeliberate in your decision-making process2.Have a documented provider-patient relationship with the person for whom youare prescribing3.Do not prescribe medications for family or friends or for yourself4.Document a thorough historyand physical examination in your records5.Include any discussions you have with the patient regarding risk factors, sideeffects, or therapy options6. Have a documented plan regarding drug monitoring or titration, if applicable5.· What should be used tomake prescribing decisions?:6.Pharmakinetiscs and Pharmodynamics of older adults:drug accumulationsecondary to reduced renal functionpolypharmacy (the use of five or more medications daily)greater severity of illness presence of comorbiditiesuse ofdrugs that have a low therapeutic index (e.g., digoxin)increased individual variation secondary to altered pharmacokineticsinadequate supervision of long-term therapy poor patient adherence7.:8.· Beer's Criteria:•potentially Inappropriate Medication (PIM) use in olderadults•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 kidneyfunction in older adults (American Geriatric Society Beers Criteria Update ExpertPanel, 2019)

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2/159.CYP450:Many medications are metabolized through the liver enzyme systemcalled cytochrome P450 (CYP450). Metabolization can be inhibited or inducedby drugs and once this happens drug-drug interactions can occur.10.VISA credit card dept Inhibits Spending on CK and GQ:Valproate I-soniazidS-ulfamidsA-miodaroneC-hloramphenicalKetoconazoleG-rapefruit JuiceQ-uinidine11.CYP450 Inhibitors:-Decreases the CYP450 which keeps the medication inyour body longer which can cause toxicity12.CYP450 INDUCERS:Increase CYP450 to work fastercauses Drugs to leave yourbody faster.13.Inducers for PY450 Chronic Alcholics Steal Phen Phen and Never RefuseGreasy Carbs:Chronic AlcoholicsSt. Johns WortPhenytoinPhenobarbitalNevirapineRefiampinGriseofalvinCarbamazepine14.· What happens when someone has a poor metabolism phenotype?:Metabolizes to slow or to fast.15.How is absorption of intramuscular medication different in neonates?:-

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3/15•Slow and erratic due to low blood flow in muscles first few days of life16.•Why is absorption of medication in the stomach increased in infancy?:-Delayed gastric emptying (adult values reached by 6-8 months)17.What are some medications that should be avoided in the pediatricpatient?:glucocorticoids, discoloration of developing teeth withtetracyclines,and kernicterus with sulfonamides18.•What should be included in medication administration patienteducation?:1. dosage size and timing2.route and technique of administration3.duration of treatment4.drug storage5.nature and time course ofdesired responses6. nature and time course of adverse responses19.•What are some of the Physiologic changes that occur in the body whena woman is pregnant that can change the pharmacodynamic andpharmacokinetic properties of many drugs?:-Increased GFR=Increaseddrug excretion-Increased hepatic metabolism for some drugs.-Decreasedtone and mobility of bowel-Increased drug absorption.20.•During what trimester is a pregnant woman most at risk for adversedrug reactions with potential long-term consequences?:1 trimester21.•What are some medications that we know to be teratogenic?:•Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones,vitamin A in large doses, some anticoagulants, and hormonal medicationssuch as diethylstilbestrol (DES).22.•How can we as healthcare providers decrease the likelihood of a elderlypatient experiencing an adverse drug reaction?:•-obtaining a thoroughdrug 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

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4/1523.Why do Nitrates need to be taken no later than 4 pm?:Need nitrate freeinterval so tolerance doesn't develop24.•What are the ninefactors that impact the outcome of medicationaccording to Rosenthal & Burcham?:•Gender and race•Genetics and pharmacogenomics•Variability in absorption•placebo effect•Tolerance•patho•age•bodyweight25.•What is the difference between NP practice authority and prescriptiveauthority?:Practice authority refers to the nurse practitioner's ability topractice without physician oversight, whereas prescriptive authority refers tothe nurse practitioner's authority to prescribe medications independently andwithout limitations.26.•Who regulates prescription authority?:The regulation of prescriptiveauthority is under the jurisdiction of a health professional board. This may bethe State Board of Nursing, the State Board of Medicine, or the State Board ofPharmacy, as determined by each state. Although the federal governmentcontrols drug regulation, it has no control over prescriptive authority.27.•What is scope of practice determined by?:Nurse practitioner scope ofpractice is determined by state practice and licensure laws.28.•What is full-practice authority?:Nurse practitioners have the autonomy toevaluate patients, diagnose, order and interpret tests, initiate and managetreatments and prescribe medications, including controlled substances withoutphysician oversight.29.•What is reduced practice authority?:Nurse practitioners are limited in atleast one element of practice. The state requires a formal collaborativeagreement with an outside health discipline for the nurse practitioner toprovide patient care.30.What is restricted practice authority?:Nurse practitioners are limited in atleast one element of practice by requiring supervision, delegation, or teammanagement by an outside health discipline for the nurse practitioner toprovide patient care.

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