Pharmacology Midterm Study Guide, Exams of Nursing

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NURS 565 Midterm Study Guide Exam1 Questions

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drug schedules - schedule I - Correct 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 - Correct 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 - Correct 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 - Correct Answer low potential for abuse; low level of dependence examples: xanax, Soma, Darvon, Valium, Ambien, Tramadol What problems arise when prescriptive authority is limited? - Correct Answer Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care drug schedules - schedule 5 - Correct Answer very low potential for abuse/dependence

Examples: Robitussin, Lomotil, Motofen, Lyrica, Parepectolin Full Prescriptive Authority - Correct Answer Full prescriptive authority affords the legal right to prescribe independently and without limitation who mandates prescriptive authority? - Correct 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 - Correct Answer *safe and competent prescribing must have a documented patient-provider relationship no personal prescribing! documented thorough H+P discussion of side effects, risks/benefits, alternative options documented plan for monitoring/titration etc. if applicable consider cost, availability, CPGs, compatibility, indication patient reasons for medication non-adherence - Correct Answer cost, availability, adverse effects, complicated regimen, lack of education, disbelief in med importance, supply/missed pick-up what type of evidence prescribers should use to make treatment recommendations - Correct Answer Current Clinical Practice Guidelines Prescriptive considerations for older adults - Correct Answer decreased renal function--> serum drug accumulation polypharmacy increased illness other comorbidities (CHF, cirrhosis, CKD, DM etc.) lower therapeutic index altered pharmacokinetics (drug movement thru body) inadequate long term therapy supervision poor compliance

physiological changes in older adults that impact pharmacological treatment? - Correct Answer Absorption of Drugs: Increased gastric pH Decreased absorptive surface area Decreased splanchnic blood flow Decreased gastrointestinal motility Delayed gastric emptying Distribution of Drugs: Increased body fat Decreased lean body mass Decreased total body water Decreased serum albumin Decreased cardiac output Metabolism of Drugs: Decreased hepatic blood flow Decreased hepatic mass Decreased activity of hepatic enzymes Excretion of Drugs: Decreased renal blood flow Decreased glomerular filtration rate Decreased tubular secretion Decreased number of nephrons Beer's Criteria - Correct Answer Criteria for "Potentially Inappropriate Medication Use in Older Adults"; identifies drugs with a high likelihood of causing adverse effects in older adults pg. 62 in textbook for table CYP450 inducers and inhibitors - Correct Answer inducers: carbamazepine phenobarbital phenytoin rifampin griseofulvin inhibitors: cimetidine ciprofloxacin erythromycin all azole antifungals grapefruit juice isoniazid

ritonavir protease inhibitors Opioid Agonists - Correct Answer examples: Morphine, Fentanyl, oxycodone 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? - Correct 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) - Correct Answer regulate drugs and other substances based on their potential for abuse and dependence classes of controlled substances: - Correct Answer Anabolic steroids, narcotics, stimulants, depressants, and hallucinogens Statin Lifespan considerations - Correct 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? - Correct Answer using bile acid sequestrates/other binding medications BP meds approved for pregnancy - Correct Answer Labetalol and Methyldopa warfarin drug interactions & dosing considerations - Correct Answer Bile acide sequestrates and fibric acid derivatives monitor PT/INR and reverse with Vit K if needed Carbamazepine drug interactions & dosing considerations - Correct Answer narrow therapeutic dose (toxicity is a risk) drug of choice for lowering LDL - Correct Answer Statins clinical tools for treating hyperlipidemia - Correct Answer ASCVD risk category, AHA/ACC, clinical guidelines

labs related to blood pressure medications? - Correct Answer EKG, UA, CBC, CMP, cholesterol panel, uric acid appropriate intervals for medication adjustments - Correct Answer 4-6 weeks is ideal before adding another drug to the therapy regimen Alternative treatment strategies for statin intolerant patients - Correct 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? - Correct Answer Add an aldosterone antagonist (Spironolactone) Who is at risk for severe rebound hypertension? - Correct Answer Those abruptly stopping beta blockers and clonidine Role of aldosterone and how to manage those effects? - Correct Answer can cause cardiac inflammation, hypertophy, fibrosis, arrythmias, and ischemia. Spironolactone is an aldosterone blocker that prevents these effects digoxin dosaging adjustments and cautions - Correct Answer start low, risk of toxicity, requires frequent monitoring of serum levels; do not use w/ quinidine MOA of cardiac glycosides - Correct Answer AKA Digoxin increases myocardial contraction force--->increases cardiac output Goals of treatment for angina? - Correct Answer prevention of MI and death reduction of ischemic-related pain drugs to accomplish goals of angina? - Correct 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? - Correct Answer increase the amount of exercise they can perform before they experience angina

CCB Mech of action - Correct Answer Promotes relaxation of peripheral arterioles resulting in a decreased afterload which reduces cardiac oxygen demand Nitroglycerin mechanism of action - Correct 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 - Correct Answer patients who have preexisting QT prolongation & patients w/ hepatic impairment ACE inhibitors contraindications - Correct Answer African American, 2nd/3rd timester pregnancy, renal disease Beta Blockers Contraindications - Correct Answer severe HF, Bradycardia, Advanced Heart block, Hypotension (persistent), cardiogenic shock what to do about tachycardia associated with nitroglycerin patch - Correct Answer pretreat with a beta blocker or calcium channel blocker Use caution when combining ACEIs with potassium-sparing diuretics due to? - Correct Answer Hyperkalemia risk ACEI and ARBs can lead to renal failure in who? - Correct Answer Patients w/ bilateral renal artery stenosis Women who have both HTN and osteopenia/osteoporosis should take thiazides to - Correct Answer to slow Ca+ loss and prevent bone loss statin side effects - Correct Answer Myalgia (muscle pain) r/o Rhabdo if accompanied by dark urine Lovastatin/simvastatin should not be combined w/? - Correct Answer grapefruit juice and macrolides