NR565/NR 565 Midterm Exam Study Guide (Latest 2024/2025) Advanced Pharmacology Fundamentals - Chamb

NR565 / NR 565 Midterm Exam Study Guide (Latest 2024 / 2025): Advanced Pharmacology Fundamentals – Chamberlain ACE inhibitors contraindications ANSWER: African American, 2nd/3rd timester pregnancy, renal disease ACEI and ARBs can lead to renal failure in who? ANSWER: Patients w/ bilateral renal artery stenosis 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 appropriate intervals for medication adjustments ANSWER: 4-6 weeks is ideal before adding another drug to the therapy regimen Beer's Criteria 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 Beta Blockers Contraindications ANSWER: severe HF, Bradycardia, Advanced Heart block, Hypotension (persistent), cardiogenic shock BP meds approved for pregnancy ANSWER: Labetalol and Methyldopa Carbamazepine drug interactions & dosing considerations ANSWER: narrow therapeutic dose (toxicity is a risk) CCB Mech of action ANSWER: Promotes relaxation of peripheral arterioles resulting in a decreased afterload which reduces cardiac oxygen demand classes of controlled substances: ANSWER: Anabolic steroids, narcotics, stimulants, depressants, and hallucinogens clinical tools for treating hyperlipidemia ANSWER: ASCVD risk category, AHA/ACC, clinical guidelines

CYP450 inducers and inhibitors ANSWER: inducers: carbamazepine phenobarbital phenytoin rifampin griseofulvin inhibitors: cimetidine ciprofloxacin erythromycin all azole antifungals grapefruit juice isoniazid ritonavir protease inhibitors DEA (Federal Drug Enforcement Administration) ANSWER: regulate drugs and other substances based on their potential for abuse and dependence digoxin dosaging adjustments and cautions ANSWER: start low, risk of toxicity, requires frequent monitoring of serum levels; do not use w/ quinidine drug of choice for lowering LDL ANSWER: Statins 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 drug schedules - schedule 5 ANSWER: very low potential for abuse/dependence Examples: Robitussin, Lomotil, Motofen, Lyrica, Parepectolin 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) 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 Full Prescriptive Authority ANSWER: Full prescriptive authority affords the legal right to prescribe independently and without limitation Goals of treatment for angina? ANSWER: prevention of MI and death reduction of ischemic-related pain labs related to blood pressure medications? ANSWER: EKG, UA, CBC, CMP, cholesterol panel, uric acid Lovastatin/simvastatin should not be combined w/? ANSWER: grapefruit juice and macrolides MOA of cardiac glycosides ANSWER: AKA Digoxin increases myocardial contraction force--->increases cardiac output 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 Opioid Agonists 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? 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 patient reasons for medication non-adherence ANSWER: cost, availability, adverse effects, complicated regimen, lack of education, disbelief in med importance, supply/missed pick-up patient with HF taking an ACE inhibitor develops fibrotic changes, what should the provider do next? ANSWER: Add an aldosterone antagonist (Spironolactone) physiological changes in older adults that impact pharmacological treatment? 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 Prescriptive considerations for older adults 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 Ranolazine contraindications ANSWER: patients who have preexisting QT prolongation & patients w/ hepatic impairment responsibilities of prescribing 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 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 Statin Lifespan considerations ANSWER: OK in children >10 years old do not use in pregnancy/breastfeeding >65 yrs old greatly reduces risk of MI statin side effects ANSWER: Myalgia (muscle pain)

r/o Rhabdo if accompanied by dark urine Therapeutic action of calcium channel blockers for stable angina? ANSWER: increase the amount of exercise they can perform before they experience angina Use caution when combining ACEIs with potassium-sparing diuretics due to? ANSWER: Hyperkalemia risk warfarin drug interactions & dosing considerations ANSWER: Bile acide sequestrates and fibric acid derivatives monitor PT/INR and reverse with Vit K if needed What problems arise when prescriptive authority is limited? ANSWER: Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care what to do about tachycardia associated with nitroglycerin patch ANSWER: pretreat with a beta blocker or calcium channel blocker what type of evidence prescribers should use to make treatment recommendations ANSWER: Current Clinical Practice Guidelines Which patients would require a lower starting dose of Warfarin? ANSWER: using bile acid sequestrates/other binding medications Who is at risk for severe rebound hypertension? ANSWER: Those abruptly stopping beta blockers and clonidine 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.)

Women who have both HTN and osteopenia/osteoporosis should take thiazides to ANSWER: to slow Ca+ loss and prevent bone loss