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NR565 Midterm Study Guide Questions and answers latest update
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NR565 Midterm Study Guide Questions and answers latest update
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NR565 Midterm Study Guide Questions and answerslatest update
Week 1
• Which schedule drugs can APRNs prescribe? II-IV depending on which state.
• Who determines and regulates prescriptive authority?
The extent to which they can accomplish this as an autonomous practice
component is
determined by legislation that varies depending on professional licensure,
physician affiliation requirements, and state laws.
• How does limited prescriptive authority impact patients within the
healthcare system? Limited prescriptive authority creates numerous
barriers to quality, affordable, and
accessible patient care. For example, restrictions on the distance of the APRN
or PA from the physician providing supervision or collaboration may prevent
outreach to areas of greatest need. A requirement to obtain the physician's
cosignature on prescriptions can increase patient waits. Despite the use of
terms such as collaborative arrangement, these relationships create a
situation in which one partner holds the power. In the event of dissolution of
the arrangement, the ultimate loss is commonly assumed by the advanced
practice provider rather than the physician.
• What are the key responsibilities of prescribing?
• What should be used to make prescribing decisions?
Prescription writing requires prudent and deliberate decision-making processes to maintain patient
safety and reduce liability, including:
• documentation of a provider-patient relationship for the recipient of the prescribed medications
• documentation of a thorough history and physical examination for the recipient
• documentation of discussions regarding risk factors, side effects, or therapy options
• documentation of drug monitoring or titration plan, if applicable
• documentation of consultations, if any
• avoidance of prescribing medications for self, family, or friends
• Be familiar with pharmacokinetic and pharmacodynamic changes of older
adults and how that would translate to baseline information needed to
prescribe.
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
o What is it? These guidelines include a safety component aimed to protect older
adults by helping prescribers avoid medications that are or can be harmful to older
adults. The Beers Criteria is updated annually, and it is applicable in all health care
settings except hospice and palliative care.
o Why is it important?
• Impacts/outcomes of polypharmacy
Polypharmacy greatly increases the risk for interactions. Some of these
interactions are
negligible, but some can have life-threatening consequences. It is of crucial
importance to ask the patient about all current drugs, including over-the-
counter (OTC) medications and other herbal preparations. Many patients do
not consider OTC or alternative pharmaceuticals as “medications” and may
not mention them unless you ask specifically.
• CYP450 inhibitors: Inhibitors are medications that inhibit the metabolic activity of one or
more
of the CYP450 enzymes. Medications that inhibit an enzyme potentially slows that enzyme's
activity or blocks the activity required for the metabolism of other medications, thereby
increasing the levels of medications dependent on that particular enzyme for
biotransformation. This inhibition prolongs the pharmacological effect, which may result in
toxicity.
o Examples: Valproate, Isoniazid, sulfonamides, amiodarone,
chloramphenicol, ketoconazole, grapefruit juice, quinidine.
VISACKGQ
o What do they do?
o What do they cause if not used correctly? (aka: What would the
patient experience?) toxicity, increased medication effect.
• Examples of CYP450 inducers: Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis. This action leads
to
additional sites available for biotransformation. The increased number of sites enhances
medication metabolism, decreasing the concentration of the "parent drug" while increasing
metabolite production.
o Examples: Carbamazepine, rifampin, alcohol, phenytoin,
griseofulvin, phenobarbital, sulfonylureas. CRAPGPS
o What do they do?
o What do they cause if not used correctly? (aka: What would the
patient experience?) decreases drug concentration,
decreasing its effect.
• What happens when someone has a poor metabolism phenotype?
The poor metabolizer (PM) phenotype occurs when both alleles of
either
CYP2D6 or CYP2C19 carry inactivating mutations and
give rise to synthesis of enzyme with impaired activity or
no synthesis of enzyme at all.
• What dos the U.S. Food and Drug Administration regulate when it comes
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