In the elderly decrease albumin and decreased lean mass affects medications how?

medication binds to protein so decreased protein affects how medication is absorbed and 

distributed

In elderly decreased body fat affects medications how?

need fat to transport medications and some drug metabolism is dependent on body weight

When prescribing medication, we must understand that liver function declines with age due to?

decreased blood flow to the liver, decreased hepatic enzymes

What are medication examples of Schedule II drugs?

-Ativan & Valium

-Fentanyl

-Oxycodone

-Methadone

What medications are Schedule III drugs?

-Xanax

-Tramadol

-anabolic steroids

-<90mg>

What medications are Schedule IV drugs?

-Ativan

-Tramadol

-Methadone

-Adderall

Which schedule drugs can APRNs prescribe?

Schedule II through Schedule IV

examples of reasons for medication non-adherence

-too busy

-too expensive

-ran out

-forgetting

-traveling & busy

Distribution in medication in elderly can be affected in what ways?

-decreased lean mass

-decreased albumin

-decreased body fat

-slower gastric acidity

-slower absorption results in delayed response

What is the most important cause of adverse drug reactions?

***overprescribing/polypharmacy

***decreased renal excretion

-high drug dosages (start low & go slow)

-lack of monitoring medications

What can a poor metabolism phenotype do to a metabolism of a drug?

-slow or increase absorption

-slow the metabolism

-keep drug in body longer

-increase toxicity

How does poor metabolism affect a high or low therapeutic index?

-increase drug toxicity

(example plavix - clots & increased platelets)

Black box warning for Opioids

respiratory depression

Black box warning for Fentanyl

FATAL respiratory depression

Black box warning for Methadone (NP cannot prescribe)

QT interval prolongation

Black box warning for Codeine

-breastfeeding and infant death can occur

-10% of dose converts to morphine

Black box warning for hydromorphone & oxymorphone (NP cannot prescribe long-acting

hydromorphone and oxymorphone)

-risk for high abuse & overdose

-respiratory depression

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Which of the following medications are preferred for stroke prevention in patients with atrial fibrillation?

Group of answer choices

Aspirin

Fondaparinux

Blockers of factors Xa or IIa

Argatroban

Warfarin

What best describes the different formulations of 5-aminosalicylates (5-ASA)?

Group of answer choices

The different formulations are administered in distinct ways and target unique parts of the bowel.

The different formulations are recognized to be less effective compared to the original product.

The different formulations are still being developed and are not available for use.

The different formulations must be taken as suppositories only.

The different formulations change the length of time 5-ASA stays in the bowel.

A patient with type 2 diabetes mellitus requires a rapid-acting insulin to control postprandial blood glucose spikes. Which of the following insulins would be most appropriate for this purpose?

Group of answer choices

Insulin detemir (Levemir)

Insulin glulisine (Apidra)

Insulin NPH

Insulin glargine (Lantus)

Insulin deglutec (Triseba)

Which of the following is an antidote for cyanide poisoning?

Group of answer choices

Atropine

Ammonia

Sodium nitrite

Methoxyhemoglobin

Sildenafil

What is the physiological cause of myasthenia gravis (MG)?

Group of answer choices

Nerve impulses generate a muscular response that is too overwhelming to generate proper muscular functioning.

Nerve cells are unable to release signals to the muscle cells.

Muscle contractions are inhibited by blocked or damaged acetylcholine receptors.

Muscle cells respond too sensitively to nerve impulses resulting in an exaggerated response.

A patient is being treated for depression with a specific medication. The pharmacokinetic profile of this medication reveals a dissociation constant (Kd) of 344 pg/ml and an effective dose for 50% of the population (ED50) of 200 pg/ml. What can be inferred from these pharmacokinetic parameters?

Group of answer choices

An ED50 lower than Kd suggests the drug is ineffective.

The presence of spare receptors can be inferred from these values.

The medication is likely to cause severe side effects due to high potency.

The drug requires full receptor saturation to be effective, as indicated by the Kd and ED50 values.

The drug's high Kd value indicates it has a very high binding affinity.

Explain the problem and explain how you would\naddress the problem. If prescribing a new drug, write out a complete medication order\njust as you would if you were completing a prescription.

4. Daute is a 56-year-old man seeking evaluation for increasing shortness of\nbreath. He noticed difficulty catching his breath about 3 years ago. Physical\nactivity increases his symptoms. He avoids activity as much as possible to\nprevent any SOB. His previous physician had placed him on\nsalmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He\nthinks his physician initiated the medication for the shortness of breath, but he is\nnot entirely sure. He did not refill the prescription and has not been taking it.\nPertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12\nmonths of treatment with oral antibiotics. He has a 40-pack-year smoking history.\nWhat treatment plan would you implement for this patient? What medication(s)\nwould you prescribe? How would you monitor the effectiveness of this plan?

Explain the problem and explain how you would\naddress the problem. If prescribing a new drug, write out a complete medication order\njust as you would if you were completing a prescription.

3. Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age\n7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days\nper week over the past 2 months. Over the past week she has been using\nalbuterol at least once per day. She reports being awakened by a cough three\nnights during the last month. She is becoming more short of breath with exercise.\nShe also has a fluticasone MDI, which she uses “most days of the week.” Her\ncurrent medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA\ntwo puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80\nmg PO BID. What treatment plan would you implement for this patient? What\nmedication changes would you make? How would you monitor the effectiveness\nof this plan?

Explain the problem and explain how you would\naddress the problem. If prescribing a new drug, write out a complete medication order\njust as you would if you were completing a prescription.

1. Sara is a 45-year-old female presenting for her annual exam. Her blood pressure\ntoday is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her\nlast visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking\nibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal\nfor her blood pressure? What medication would you prescribe to treat her blood\npressure? What education would you prescribe?

2. Monty is a 52-year-old male following up on his labs that were drawn last week.\nHe smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is\nallergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL\ncholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan\nwould you implement for Monty’s lipid profile? What is the goal Total Cholesterol\n(TC), HDL-C, and LDL-C level for Monty? How would you monitor the\neffectiveness of your treatment plan? How many risk factors for coronary artery\ndisease does this patient have? Identify them specifically.

What is the recommend dose of Amoxicillin for a 6-year-old child with acute otitis media?

Click on Condition, Click on Gastroenterology, Click on Colon, Click on Acute Pancreatitis.  What is the current guideline cited?

What are the adverse effects of Metformin?

Should Lisinopril be given to a pregnant women? What complications have been identified?

What are the empiric treatment recommendations for H. Pylori?

Identify the law, rule, code, or statute that describes the advanced practice nurse's authority to prescribe medical devices or DME in Missouri

Identify the Missouri law, rule, code, or statute that describes the advanced practice nurse's authority to prescribe controlled substances in your state

who is in charge of opiate regulations in missouri

Provide the name Texas'  organization, group or task force that created guidelines or recommendations for pain management therapies and education.

What are the first assessments in the GINA guidelines for asthma treatment

A 63-year-old woman was prescribed Levothyroxine 1.6mcg/kg/dose. if her weight is 110kg what will be her daily dose

Provide the name of Virginia state's organization, group or task force that created guidelines or recommendations for pain management therapies and education.

Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response.

Resources, groups or organizations in Virginia where prescribers can reference best practices for pain management treatment

What is Virginia state guideline development overview for prescription monitoring program and their web address

Organizations in Virginia that developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain

What lab should be drawn before alendronate is ordered and monitored at regular intervals during treatment?

Liver function test?

Creatinine level?

Platelet count?

Red blood count

What labs should be drawn before giving alendronate

Identify the law, rule, code, or statute that describes the advanced practice nurse's authority to prescribe medical devices or DME in Texas state.

Discuss when the use of opioids is appropriate and for what duration should they be prescribed. Provide a reference for your response.

Some states have multiple organizations or initiatives (ex: Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether Texas state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group's recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention.

NR565 week 2 assignment- Provide the name of the practicing  Texas state's organization, group, or task force that created guidelines or recommendations for pain management therapies and education.

NR565 Week 2: State-Specific Guidelines for Prescribing Controlled Substances & Medical Devices for Texas state