Pharmacology Midterm Exam: Navigating Drug Schedules and Prescriptive Authority, Exams of Nursing

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NR 565 Midterm exam with complete solutions 2024/2025 drug schedules - schedule I - ANSWER-Drug Schedules no currently accepted medical use and for research use only high potential for abuse examples: heroin LSD MDMA (3,4-Methylenedioxymethamphetamine: AKA ecstasy) drug schedules - schedule 2 - ANSWER-combination drugs w/ < 15mg hydrocodone per dosage unit High potential for abuse and severe physical/psychological dependence examples: Vicodin, cocaine, methamphetamine, methadone, Dilaudid, oxycodone, Meperidine, Fentanyl, Adderall, Ritalin drug schedules - schedule 3 - ANSWER-drugs w/ <90 mg of codeine per dosage unit abuse would lead to mod-low physical dependence and high psychological dependence examples: ketamine, tylenol w/ codeine, anabolic steroids, testosterone drug schedules - schedule 4 - ANSWER-low potential for abuse; low level of dependence examples: xanax, Soma, Darvon, Valium, Ambien, Tramadol What problems arise when prescriptive authority is limited? - ANSWER- Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care drug schedules - schedule 5 - ANSWER-very low potential for abuse/dependence Examples: Robitussin, Lomotil, Motofen, Lyrica, Parepectolin Full Prescriptive Authority - ANSWER-Full prescriptive authority affords the legal right to prescribe independently and without limitation who mandates prescriptive authority? - ANSWER-Physicians can limit the types of drugs that the APRN can prescribe health professional boards State laws place additional restrictions with regard to controlled drugs (full, restricted, etc.) responsibilities of prescribing - ANSWER-*safe and competent prescribing must have a documented patient-provider relationship no personal prescribing! documented thorough H+P Used for moderate-severe pain, promote sedation by binding to opioid receptors in the CNS Side effects: Sedation, respiratory depression, constipation, GI upset, hypotension, urinary retention Naloxone (Narcan) is the antidote for opioid analgesics outcome of having a poor metabolism phenotype? - ANSWER-1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 2. Accumulation of inactive metabolites of drugs 3. A need for increased dosages of medications 4. Increased elimination of an active drug DEA (Federal Drug Enforcement Administration) - ANSWER-regulate drugs and other substances based on their potential for abuse and dependence classes of controlled substances: - ANSWER-Anabolic steroids, narcotics, stimulants, depressants, and hallucinogens Statin Lifespan considerations - ANSWER-OK in children >10 years old do not use in pregnancy/breastfeeding >65 yrs old greatly reduces risk of MI Which patients would require a lower starting dose of Warfarin? - ANSWER-using bile acid sequestrates/other binding medications BP meds approved for pregnancy - ANSWER-Labetalol and Methyldopa warfarin drug interactions & dosing considerations - ANSWER-Bile acide sequestrates and fibric acid derivatives monitor PT/INR and reverse with Vit K if needed Carbamazepine drug interactions & dosing considerations - ANSWER- narrow therapeutic dose (toxicity is a risk) drug of choice for lowering LDL - ANSWER-Statins clinical tools for treating hyperlipidemia - ANSWER-ASCVD risk category, AHA/ACC, clinical guidelines labs related to blood pressure medications? - ANSWER-EKG, UA, CBC, CMP, cholesterol panel, uric acid appropriate intervals for medication adjustments - ANSWER-4-6 weeks is ideal before adding another drug to the therapy regimen Alternative treatment strategies for statin intolerant patients - ANSWER- ezetimibe, fibrates, nicotinic acid, bile acid sequestrates combo therapy with infrequent statin dosing dietary changes switching to a different statin patient with HF taking an ACE inhibitor develops fibrotic changes, what should the provider do next? - ANSWER-Add an aldosterone antagonist (Spironolactone) Who is at risk for severe rebound hypertension? - ANSWER-Those abruptly stopping beta blockers and clonidine Role of aldosterone and how to manage those effects? - ANSWER-can cause cardiac inflammation, hypertophy, fibrosis, arrythmias, and ischemia. Spironolactone is an aldosterone blocker that prevents these effects digoxin dosaging adjustments and cautions - ANSWER-start low, risk of toxicity, requires frequent monitoring of serum levels; do not use w/ quinidine MOA of cardiac glycosides - ANSWER-AKA Digoxin increases myocardial contraction force--->increases cardiac output Goals of treatment for angina? - ANSWER-prevention of MI and death reduction of ischemic-related pain drugs to accomplish goals of angina? - ANSWER-CCBs, beta blockers, ranazoline, nitrates: reducing ischemia ACE-I's, cholesterol-lowering meds, aspirin: prevention of MI and death Therapeutic action of calcium channel blockers for stable angina? - ANSWER-increase the amount of exercise they can perform before they experience angina CCB Mech of action - ANSWER-Promotes relaxation of peripheral arterioles resulting in a decreased afterload which reduces cardiac oxygen demand Nitroglycerin mechanism of action - ANSWER-1. Relaxes smooth muscles causing venous dilation 2. Reduces preload and afterload to the heart 3. Dilates the coronary arteries resulting in increased perfusion of the myocardium Ranolazine contraindications - ANSWER-patients who have preexisting QT prolongation & patients w/ hepatic impairment ACE inhibitors contraindications - ANSWER-African American, 2nd/3rd timester pregnancy, renal disease Beta Blockers Contraindications - ANSWER-severe HF, Bradycardia, Advanced Heart block, Hypotension (persistent), cardiogenic shock