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

Harvard UniversityMedicine

A series of questions and answers related to pharmacotherapeutics for advanced practice nurse prescribers. It covers topics such as drug absorption, distribution, metabolism, excretion, drug interactions, and prescribing principles. Useful for students and professionals in nursing who are preparing for prescribing roles.

Typology: Exams

2024/2025

Available from 01/01/2025

agnes-jason
agnes-jason 🇺🇸

119 documents

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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
Drugs that are receptor agonists may demonstrate what property?
Concentrations will produce an adverse effect
Factors that affect gastric drug absorption include
Lipid solubility of the drug
Drugs that are receptors antagonists, such as beta-blockers, may cause what?
An exaggerated response if abrupt discontinues
pf3
pf4
pf5

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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 Drugs that are receptor agonists may demonstrate what property? Concentrations will produce an adverse effect Factors that affect gastric drug absorption include Lipid solubility of the drug Drugs that are receptors antagonists, such as beta-blockers, may cause what? An exaggerated response if abrupt discontinues

Drug administration via IV:

  1. need to be lipid soluble in order to absorb easily
  2. Begin distribution in the body immediately
  3. Are easily absorbed if they are nonionized
  4. May use pinocytosis to be absorbed Are easily absorbed if they are nonionized What is the combination effect when a medication is added to a regimen for a synergistic effect? Greater than the sum of the effects of each drug individually Which of the following statements about bioavailability is true?
  5. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.
  6. brands of a drug have the same bioavailability.
  7. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
  8. 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?
  9. Water soluble and ionized drugs cross these barriers rapidly.
  10. The blood-brain barrier slows the entry of many drugs into and from brain cells.
  11. The fetal-placental barrier protects the fetus from drugs taken by the mother.
  12. 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.

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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

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
  3. Is expensive, but covered by health insurance
  4. 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 should patient education include when prescribing a medication? Discussion on adverse effects of the medication Passive monitoring of drug effectiveness includes:
  1. Therapeutic drug levels
  2. Adding or subtracting medications from the treatment regimen
  3. Ongoing provider visits
  4. Instructing the patient to report if the drug is not effective Instructing the patient to report if the drug is not effective Pharmacokinetic factors that affect prescribing include Bioavailability What recommendations bu the Institute of Medicine were made to address the impact of pharmaceutical promotion Conflicts of interest and financial relationships should be disclosed by those providing education Under new U.S. FDA labeling, Pregnancy Categories will be: Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label What does the US FDA Regulate? The official labeling of all prescriptions and over the counter drugs 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 Why are elderly at high risk of adverse drug reactions? Age-related decrease in renal function The type of adverse drug reaction that is idiosyncratic when a drug is given in the usual therapeutic dose is type Type B Digoxin may cause a type A adverse drug reaction due to:
  1. Idiosyncratic effects
  2. Its narrow therapeutic index
  3. Being a teratogen
  4. Being a carcinogen Its narrow therapeutic index What type of reaction occurs after a medication is used? Type IV If neutropenia occurs after the use of a topical medication, what type of reaction is neutropenia characterized as Cytotoxic hypersensitivyt reaction What type of reaction is anaphylactic shock? Type 1 Reaction; Also known as an immediate hypersensitivity reaction 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

Beta-2-Agonists as it causes hypertensive crisis What medications should be use cautiously with African American men with moderate persistent asthma? Salmeterol - It is an inhaled long-acting beta agonist; studies showed increase of respiratory and asthma related deaths in African Americans

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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