Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Questions and Answers, Exams of Nursing

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Pharmacotherapeutics for Advanced

Practice Nurse Prescribers

Nurse practitioner prescriptive authority is regulated by who? - ✔✔The State Board of Nursing for Each State What is the benefits of having an APRN prescriber? - ✔✔APRN's care for patients more holistically and include patients in making decisions regarding their care What does clinical judgement in prescribing include? - ✔✔Factoring in the cost of the particular What is included in the criteria for choosing and effective drug for a disorder? - ✔✔Consulting nationally recognized guidelines for disease management NP's thrive under the new health-care reform because of what? - ✔✔NP's have the ability to control care cost and improve patient outcome Nutritional intake and lab results reflect hypoalbuminemia; why is this important for prescribers? - ✔✔The Distribution of drugs to target tissues may be affected

Drugs that have an significant first-pass effect what? - ✔✔they are rapidly metabolized by the liver and may have little if any desired action The route of excretion of a volatile drug will likely be? - ✔✔Lungs Medroxyprogesterone (Depo Provera) is prescribed IM to create storage reservoir of the drug. What are storage reserviors> - ✔✔Increased the length of time a drug is available and active Why is Cephalexin given every 8 hours? What knowledge of the drug does the NP know? - ✔✔Half Life Azithromycin doing requires that the first day's doing be twice those of the other four day; This is considered a loading does. What is a loading dose? - ✔✔Rapidly actives drug levels in the therapeutic range The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - ✔✔Onset of action Phenytoin required that a trough level be drawn. When and why are peak and trough levels are done - ✔✔To determine if a d rug is in the therapeutic range

2. brands of a drug have the same bioavailability.
3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
4. Combining an active drug with an inert substance does not affect bioavailability. - ✔✔Bioavailability issues are especially important for drugs with narrow therapeutic Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?
5. Water soluble and ionized drugs cross these barriers rapidly.
6. The blood-brain barrier slows the entry of many drugs into and from brain cells.
7. The fetal-placental barrier protects the fetus from drugs taken by the mother.
8. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women - ✔✔The blood-brain barrier slows the entry of many drugs into and from brain cells. What is the purpose of phase I and phase II of metabolism in the liver? - ✔✔Change drug molecules to a form that an excretory organ can excrete What happens to the metabolites after they are metabolized in the liver? - ✔✔the metabolite may or may not be more active than the

parent drug and they are totally deactivated so they are excreted without and effect; it depends on the medication being given What causes the body to increased the excretion of a drug through the renal system - ✔✔Unbinding a nonvolatile drug from plasma proteins. What is "steady state"? - ✔✔When the amount of the drug in the body remains constant When two pain medications are given together to treat pain, what kind of drug-to-drug interaction occurs? - ✔✔Additive Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:

1. Reducing the dosage of one of the drugs
2. Scheduling their administration at different times
3. Prescribing a third drug to counteract the adverse reaction of the combination
4. Reducing the dosage of both drugs - ✔✔Prescribing a third drug to counteract the adverse reaction of the combination What is the period of time called that it takes for a drug too decreased by 50% in the body? - ✔✔Half Life

4. glucose - ✔✔Sodium Bicarb Which of the following variables is a factor in drug absorption?
5. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
6. A rich blood supply to the area of absorption leads to better absorption.
7. The less soluble the drug, the more easily it is absorbed.
8. Ionized drugs are easily absorbed across the cell membrane. - ✔✔A rich blood supply of the are of absorption leads to better absorption What is an advantage of prescribing a sublingual medication? - ✔✔Absorbed rapidly Drugs that use CYP 3A4 isoenzymes for metabolism may? - ✔✔Induced and inhibit the metabolism of another drug When do drugs reach steady state? - ✔✔After four or give half lives Ppregulation or hyper sensitization may lead to - ✔✔An exaggerated response if the drug is withdrawn Why do prescribers often use liquid medications such as liquid ibuprofen for children? - ✔✔Children often able to swallow pills

In deciding which of multiple drugs used to treat a condition, the NPO chooses Drug A because it:

1. Has serious side effects and it is being used for a life-threatening condition 2 ) Will be taken twice daily and will be taken at home
2. Is expensive, but covered by health insurance
3. Non of these are important in choosing a drug - ✔✔Will be taken twice daily and will be taken at home What is known about the differences between the pharmacokinetics of men and women. - ✔✔Percentage of fat differs between genders What is the first step of the prescribing process according to WHO? - ✔✔Diagnosis the problem Treatment goals in prescribing should: - ✔✔be patient-centered The therapeutic goals when prescribing include - ✔✔curative, palliative, and preventative When determining drug treatment, what should an NP always do? - ✔✔Individualize the drug choice for the specific patient

What is approval of the FDA required for? - ✔✔Medical devices, including artificial joints When is an investigational new drug filed with the FDA? - ✔✔Prior to human testing of any new drug entity Phase IV clinical trials in the US are also known as - ✔✔Postmarketing research trials Is off-label prescribing legal? - ✔✔yes if there is scientific evidence for the use What does the US Drug Enforcement Administration Regulate? - ✔✔Registers manufacturers and prescribers of controlled substances Are drugs that are disgnedated Schedule II by the DEA refillable - ✔✔No. A new prescription needs to be written What are some precautions when prescribing a controlled substance? - ✔✔Using tamper-proof paper for all prescriptions written for controlled drugs.

What are some strategies for prescribers to use to prevent the misuse of controlled prescriptions? - ✔✔Use a chemical dependency screening tool; fir limit-setting regarding controlled substances; and practicing saying no to deal with patients who are push overs What are some behaviors that predict addition to controlled substances

• ✔✔Stealing and borrowing another patients drugs When are medications agreements/pain medication contracts recommended? - ✔✔Universally for all medications prescribed for chronic pain When and what do prescriptions needs to be written - ✔✔Medical devices, controlled drugs, and legend drugs Based on the patients below, who is at high risk for experiencing an adverse drug reaction?

1. 32-year old male
2. 22- year told female
3. 3 month old female 4)48 year old male - ✔✔3 month old Why are infants and babies are a higher risk of adverse drug reactions?

• ✔✔lack of safety and efficacy studies in pediatric populations

What time of reaction is someone using a corticosteroid at risk for? - ✔✔Type C Why do immunomodulators such as azathioprine cause a delayed reaction (type D reaction) - ✔✔because they are carcinogens An example of a first-dose reaction that may occur includes:

1. Orthostatic hypotension that does not occur with repeated doses
2. Purple glove syndrome with phenytoin use
3. Hemolytic anemia from ceftriaxone use
4. Contact dermatitis from neomycin use - ✔✔Orthostatic hypotension that does not occur with repeated doses Drugs that are prone to cause adverse drug reactions include - ✔✔Insulins US FDA MedWatch system is activated when: - ✔✔An adverse even or serious problem occurs with a medication that is not already identified on the label The Vaccine Adverse Events Reporting System is - ✔✔A voluntary reporting system that healthcare providers or consumers may use to report vaccine adverse events

What is pharmacoeconomics? - ✔✔The analysis of the cost and consequences of any health-care related treatment or services The direct cost of drug therapy includes - ✔✔Pain and suffering due to inadequate drug therapy Indirect costs associated with drug therapy include? - ✔✔Loss of wages while undergoing drug therapy The intangible cost of drug therapy include? - ✔✔Inconvenience, pain, and suffering incurred with therapy What is it called when a pharmacoeconomic analysis takes place regarding two similar treatments for a disease? - ✔✔Cost-minimization analysis Cost-effectiveness analysis compares two or more treatments or programs that are: - ✔✔not necessarily therapeutically equivalent When the cost of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as - ✔✔Cost-benefit analysis

long-acting beta agonist; studies showed increase of respiratory and asthma related deaths in African Americans LTBA's received a black box warning due to? - ✔✔increased risk of asthma related deaths What is the bronchodilator of choice for those taking propranolol? - ✔✔Ipratropium Life-style management for those taking theophylline. - ✔✔self- monitoring of respiratory status w. peak flowmeter; stop smoking; voice environmental triggers for asthma What does Tiotropium bromide treat (Spiriva)? - ✔✔COPD the medication is an inhaled anticholinergic How often should Beclomethasone be used for someone with asthma?

• ✔✔Daily What are some side effects if montelukast (singular)? - ✔✔Aggression, anxiety, depression, and or suicidal thoughts Who can montelukast be prescribed for? - ✔✔a child with moderate persistent asthma

Are there known drug reactions with Beclomethasone (QVAR) - ✔✔No What prescription of the following will someone with acute rhinitis benefit from?

1. Fluticasone
2. Cetirizine (Zyrtec)
3. OTC Cromolyn Nasap Spray (Nasalcrom)
4. Any of the Above? - ✔✔Any of the above What should be monitor for those who are taking diphenhydramine? - ✔✔Urinary retention Why are second generation antihistamines such as Claritin taking for seasonal allergies instead of first generation? - ✔✔They are less sedating then first generation antihistamines Who can be prescribed Sudafed? - ✔✔Anyone over the age of 4 years old In what populations should cough and cold medicines that contain sympathomimetic decongestion be used cautiously? - ✔✔Older adults, infects, and hypertensive patients