Podcast
Questions and Answers
What is the maximum duration for which Nurse Practitioners (NPs) in Oklahoma can prescribe controlled substances?
What is the maximum duration for which Nurse Practitioners (NPs) in Oklahoma can prescribe controlled substances?
Which of the following statements about the prescribing of Schedule II medications by NPs in Oklahoma is true?
Which of the following statements about the prescribing of Schedule II medications by NPs in Oklahoma is true?
What is the formula to determine the volume of distribution (V) of a drug in the body?
What is the formula to determine the volume of distribution (V) of a drug in the body?
What must be included on a prescription for controlled substances issued by an NP in Oklahoma?
What must be included on a prescription for controlled substances issued by an NP in Oklahoma?
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What happens to drug elimination at steady state when a drug is administered at a constant rate?
What happens to drug elimination at steady state when a drug is administered at a constant rate?
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What is primarily eliminated from the lungs during excretion?
What is primarily eliminated from the lungs during excretion?
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Which of the following processes is NOT part of renal drug excretion?
Which of the following processes is NOT part of renal drug excretion?
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Why might renal function be lower in neonates compared to their body mass?
Why might renal function be lower in neonates compared to their body mass?
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Which element of a prescription specifies the instructions for a patient on how to take the medication?
Which element of a prescription specifies the instructions for a patient on how to take the medication?
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What is the significance of including the provider's name printed on the prescription?
What is the significance of including the provider's name printed on the prescription?
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What factor is most likely to affect a patient's compliance with prescribed therapy?
What factor is most likely to affect a patient's compliance with prescribed therapy?
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What should NOT be done with prescription pads to ensure ethical prescribing?
What should NOT be done with prescription pads to ensure ethical prescribing?
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What is required for controlled medications on a prescription?
What is required for controlled medications on a prescription?
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What does non-compliance in a patient typically indicate regarding their therapy?
What does non-compliance in a patient typically indicate regarding their therapy?
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Which of the following statements about generics in prescriptions is accurate?
Which of the following statements about generics in prescriptions is accurate?
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What effect can coadministration of drugs with food or supplements have on drug therapy?
What effect can coadministration of drugs with food or supplements have on drug therapy?
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What is a significant consideration when prescribing medications to elderly patients?
What is a significant consideration when prescribing medications to elderly patients?
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What is Beers Criteria primarily used for?
What is Beers Criteria primarily used for?
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How does the gut microbiome influence drug metabolism?
How does the gut microbiome influence drug metabolism?
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What is a primary route of excretion for lipid-soluble drugs?
What is a primary route of excretion for lipid-soluble drugs?
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Which of the following substances would most likely be eliminated in feces?
Which of the following substances would most likely be eliminated in feces?
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What potential impact do antibiotics have on the gut microbiome?
What potential impact do antibiotics have on the gut microbiome?
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What is an important factor to consider when prescribing to breastfeeding mothers?
What is an important factor to consider when prescribing to breastfeeding mothers?
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What happens to drug action as a result of receptor desensitization?
What happens to drug action as a result of receptor desensitization?
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How can fecal transplants be beneficial in pharmacotherapy?
How can fecal transplants be beneficial in pharmacotherapy?
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Which factor does NOT significantly affect the bioavailability of oral medications?
Which factor does NOT significantly affect the bioavailability of oral medications?
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What does the 'first pass effect' refer to?
What does the 'first pass effect' refer to?
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In which scenario is it critical to assess dietary intake before prescribing medications?
In which scenario is it critical to assess dietary intake before prescribing medications?
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Which of the following statements about intravenous (IV) drug administration is TRUE?
Which of the following statements about intravenous (IV) drug administration is TRUE?
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Which of the following is NOT a consideration when prescribing medication as an APRN?
Which of the following is NOT a consideration when prescribing medication as an APRN?
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Why is bioavailability especially important for drugs with a narrow therapeutic index?
Why is bioavailability especially important for drugs with a narrow therapeutic index?
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What key factors should be assessed before writing a medication script?
What key factors should be assessed before writing a medication script?
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What is the primary concern when prescribing medication to a pregnant or lactating patient?
What is the primary concern when prescribing medication to a pregnant or lactating patient?
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What is the primary function of agonist drugs?
What is the primary function of agonist drugs?
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How do antagonists prevent agonists from functioning?
How do antagonists prevent agonists from functioning?
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Which process is primarily responsible for reducing the bioavailability of orally administered drugs?
Which process is primarily responsible for reducing the bioavailability of orally administered drugs?
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What type of drug formulation is best suited for medications with short half-lives?
What type of drug formulation is best suited for medications with short half-lives?
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What is the significance of a receptor in drug action?
What is the significance of a receptor in drug action?
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What characteristic distinguishes an antagonist from an agonist?
What characteristic distinguishes an antagonist from an agonist?
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Which of the following best describes the analogy of an agonist in drug interactions?
Which of the following best describes the analogy of an agonist in drug interactions?
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In what way can an antagonist indirectly inhibit an agonist's effects?
In what way can an antagonist indirectly inhibit an agonist's effects?
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What is an effect of the first pass metabolism on drug efficacy?
What is an effect of the first pass metabolism on drug efficacy?
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Controlled release formulations are designed to achieve which of the following?
Controlled release formulations are designed to achieve which of the following?
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Study Notes
Medication and Vaccination Considerations
- Various factors affect drug absorption, distribution, metabolism, and excretion (ADME)
- Food, gastric motility, and liver metabolism impact oral bioavailability
- IV administration bypasses first-pass liver metabolism, resulting in complete bioavailability and rapid distribution
- Controlled substances, like schedules III-V, have different prescription restrictions than schedule II in Oklahoma
- Patient factors, like allergies, dietary intake, and pregnancy/lactation, influence prescribing decisions
- Consider nationally recognized guidelines and patient-specific information when prescribing
Patient Factors
- Gut microbiome impacts drug metabolism, influencing drug efficacy and toxicity
- Age affects pharmacokinetics and pharmacodynamics, necessitating adjustments in elderly populations, using Beers Criteria
- Renal function affects drug excretion, notably in neonates and adults with declining function
- Excretion routes include unchanged or as metabolites in bile/feces, sweat, saliva, tears, and breast milk
Drug Interactions
- Co-administration with other drugs, supplements, food, and nutraceuticals can affect drug action
- Receptor desensitization occurs with continuous agonist stimulation, decreasing drug effect
- Drugs may compete for plasma protein binding sites, altering circulating levels and increasing adverse drug reactions
- Knowledge of CYP450 enzymes and their interactions (e.g. inhibition/enhancement) and effects on drug metabolism is crucial
- Drug-drug interactions affect absorption, protein binding, metabolism, and receptor binding. These affect the therapeutic effect or induce toxicity
Classifications and Considerations
- Agonists bind to receptors to elicit a response, while antagonists block agonist action
- Storage reservoirs (bone, fat) can influence drug distribution and duration of action
- Blood-brain barrier protects the central nervous system and only allows small molecules across; certain drugs mimic endogenous components to get across
- Factors affecting drug action (age, co-administration, and receptor desensitization)
Clinical Pharmacokinetics
- Bioavailability, volume of distribution, clearance, and elimination half-life determine drug disposition
- Therapeutic window defines the concentration range for desired effects with minimal adverse reactions
- Maintenance doses maintain steady-state concentration, while loading doses achieve steady state faster
- Dosing frequency depends on dose, half-life, and therapeutic range.
Vaccine Classifications
- Live attenuated vaccines use a weakened form of a virus, inducing strong immune responses but not suitable for immunocompromised patients or those with febrile illness and sometimes pregnancy
- Inactivated vaccines use killed pathogens, inducing a weaker immune response and requiring multiple doses or boosters
- Live attenuated vaccines are less stable and might require refrigeration
- Inactivated vaccines are more stable.
- Vaccine types include live attenuated, inactivated, subunit, polysaccharide, surface protein, toxoids, and mRNA.
- Vaccination considerations include age, comorbidities, risks for diseases, allergies to vaccine components and pregnancy
- Vaccination schedules for different vaccines have special considerations.
- Live vs attenuated vaccines: Live (weakened) and attenuated (killed) elicit strong, durable immune responses, but not for immunocompromised patients or during pregnancy; attenuated vaccines may be refrigerated. Inactivated vaccines elicit weaker responses, require multiple doses, and are stable, often suitable for certain healthcare settings or conditions.
- Pregnancy and lactation labeling rules are available (but not necessarily detailed in the notes).
- The Centers for Disease Control (CDC) Advisory Committee on Immunization Practice (ACIP) sets recommendations for vaccination schedules.
Drug Toxicity and Reactions
- Drug-induced toxicity results from ADME processes, leading to adverse drug reactions
- Allergic reactions are immune-mediated responses to drugs, ranging from mild rash to severe anaphylaxis
- Idiosyncratic reactions are unpredictable abnormal responses to drugs, often due to genetic predisposition
- Toxicology studies adverse effects of substances on living organisms
Drug Withdrawal and Abuse.
- Withdrawal symptoms, diagnosis, treatment, cross-tolerance to sedatives, and associations with mental/physical health conditions
- Pharmacotherapy of alcohol use disorder (AUD) after clinical evaluations and behavioral therapy (e.g. detoxification, anti-craving medication)
- FDA approved medications for AUD include Disulfiram, Naltrexone, Acamprosate
- Opioid use disorder (OUD) treatment involves detoxification, stabilization, and long-term management (especially with methadone, buprenorphine, or extended-release naltrexone).
- Treatment initially addresses physical dependence through detoxification and gradually reducing the dosage of opioids
- Long term treatment focuses on preventing relapse through relapse prevention, anti-craving medication, and cognitive-behavioral therapy
- Benzodiazepine use/abuse are commonly used as sedatives, hypnotics, and acutely for alcohol detoxification; Flumazenil (Romazicon) is an antidote.
Opioid Use Disorder.
- Opioid agonists activate mu opioid receptors (MOR) and are strong analgesics; tolerance, dependence, and withdrawal can develop
Cannabis
- Medicinal and psychoactive properties, A9-THC, legal implications, tolerance, dependence, and withdrawal, and adverse effects (also includes potential therapeutic uses)
- Synthetic forms of THC (e.g. dronabinol, Marinol) are used medically
Cannabidiol (CBD)
- Prominent cannabinoid in cannabis, not psychoactive, and available in hemp extracts (though less regulated)
- Potential therapeutic uses (pain, epilepsy, anxiety, mood disorders, neurodegenerative diseases, and opioid use disorder) and adverse effects.
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Description
This quiz covers key concepts in pharmacology, specifically focusing on drug absorption, distribution, metabolism, and excretion (ADME). It also addresses the impact of patient-specific factors like age, allergies, and renal function on medication effectiveness and safety. Test your knowledge on these important considerations in prescribing practices.
