NMP exam sample questions Flashcards
(120 cards)
1
Q
Factors that affect absorption
A
- physico-chemical properties of drug
- drug formulation
- route of administration
2
Q
what does ADME mean?
A
Absorption
Distribution
Metabolism
Excretion
3
Q
Route of administration that will produce an enteral effect
A
Rectal
4
Q
What is Bioavailability
A
The fraction of the dose which proceeds unaltered from the site of administration to the systemic circulation
5
Q
Factors affecting bioavailability
A
- Poorly water soluble/slowly absorbed drug
- Malabsorption syndrome / GI surgery
- Increased gastric emptying time
- Complex formed e.g. tetracyclines and milk
- First pass effect
6
Q
what is volume distribution?
A
pharmacokinetic parameter that represents the degree how a drug is distributed either remains in the plasma or redistribute to other tissues
7
Q
It is the process of the body breaking down and converting medication into active chemical substances
A
Drug Metabolism
8
Q
how many phase of metabolism is involved?
A
2 phases
9
Q
What is phase 1 metabolism
A
- oxidation
- hydrolysis
- uses cytochome p450
- drug metabolite can still be chemically active
10
Q
What is phase 2 metabolism
A
- conjugation
- attachment of an ionised group to the drug
- reduces drug effect
makes metabolite more water soluble for excretion
11
Q
Factors affecting drug metabolism
A
- Enzyme induction
- Enzyme inhibition
- genetic deficiency
- age
- liver disease
12
Q
What the drug does to the body
A
Pharmacodynamics
13
Q
Examples of neurotransmitters
A
- Acetylcholine (ACh)
- Histamine (H)
- Dopamine (DA)
- Noradrenaline (NA)
- Adrenaline (Adr)
- 5-Hydroxytriptamine (5-HT) [serotonin]
14
Q
Factors affecting drug excretion
A
- blood flow to kidney (normal 1500ml/min)
- glomerular filtration rate (normal 100mls/min)
- active secretion of drugs into the kidney tubule (e.g. penicillin)
- passive reabsorption back into the tubule
15
Q
is an important consideration influencing distribution
A
Protein binding
16
Q
Will plasma protein binding increase or decrease the volume of distribution?
A
decrease
17
Q
what is half life
A
Half-life is the time taken for the concentration of drug in blood to fall by half
18
Q
A patient showing toxic side effects of a drug has her plasma drug concentration measured. It is 100mg/L. The normal range is 20-30mg/L. If the half life is 24 hours how long before the level drops back to within the normal range?
A
Computation: 100mg half in 24hours
(First half life) 50mg = 24hours
(Second half life) 25mg = 48hours (normal range 20 to 30mg)
Answer:
2 days:
o After 24 hours the level will be 50mg/L
o After 48 hours the level will be 25mg/L
Recommend omit drug for 2 days, then re-start using lower dose.
19
Q
is the amount of a medication between the quantity that gives the effective dose and the amount that gives more adverse than desired effects
A
Therapeutic window
20
Q
The ability of a drug to produce an effect
A
Drug efficacy
21
Q
Loss of response to a drug usually due to a decrease in number of receptors
A
Desensitisation
22
Q
give 3 examples of narrow therapeutic index drugs
A
lithium
gentamycin
theophylline
digoxin
phenytoin
warfarin
23
Q
The term for a drug that blocks the effects of a neurotransmitter at (or near) the receptor sites
A
Antagonist
24
Q
Condition that may follow after repeated exposure to a drug in so that the effect produced by the original dose no longer occurs i.e. increasing doses required to achieve the same effect
A
Drug tolerance
25
what is does Peak level mean
the level of the drug in the patients body is at the highest
26
What is trough level
the lowest level of the drug in the patients body
27
Why do we need to assess drug plasma concentration levels
to determine dosing intervals, or how much time should pass between each new administration of the drug.
28
**True/False**
an agonist can bind reversibly to a competitive antagonist to block its action?
**False**
Antagonist blocks the action of the agonist
29
**True/False**
Ibuprofen inhibits enzymes
**True**
Ibuprofen inhibits the cyclooxygenase family of enzymes
30
**True/False**
plasma protein binding can delay excretion of drugs
**True**
Drugs binding in the protein will be held in the plasma and is not available for metabolism or excretion
31
Antagonist blocks the response to?
Agonist
32
An agonist bind to receptors to cause?
a biological response
33
is an active metabolite that when given to a person, does not have biological activity
Pro drug
34
They are naturally occurring chemicals in the body
agonist
35
chemicals that blocks responses to neurotransmitters
antagonist
36
chemical alteration of the drugs in the body
metabolism
37
What is potentiation
A drug interaction in which the addition of a second drug intensifies certain properties of the first drug administered.
38
controlled drug prescriptions are valid for how many days?
28 days
38
The primary legislation on the UK that came fully effect in 1973
Misuse of Drugs Act of 1971
38
How many months should clinical management plans be updated
6 months
39
a drug with the ability to bind to the receptor but do not initiate a change in cellular function
Antagonist
39
a drug with an affinity for a receptor resulting in stimulation of the receptor’s functional properties
Agonist
40
What are the 3 types of adrenaline receptors and their actions
"ß1 receptors - mainly on heart (Drugs that bind to beta receptors in the heart and increase the force of myocardial contraction)
ß2 receptors - mainly on bronchioles
Alpha receptors - mainly on blood vessels (to increase blood pressure)"
40
When a drug no longer has an effect as the dose increases
Ceiling effect
40
What is the difference between sympathetic and parasympathetic nervous system
"Sympathetic (adrenergic) releases Norepinephrine binds to adrenergic receptors: Stimulated by noradrenaline, “Fight or flight”, Have alpha and beta agonists
o Alpha contracts smooth muscle, dilates pupils
o Beta increases heart rate, opens airways
Parasympathetic (cholinergic) releases Acetylcholine (Ach): Stimulated by acetylcholine and binds to muscarinic receptors.
“Rest and digest”
o Contracts iris, Decreases heart rate, Increases gut activity"
41
This binds irreversibly to the receptor (or may be a different site) - high concentrations of agonist cannot completely overcome antagonism and maximal response cannot be obtained
Non-competitive antagonist
42
A patient has started taking herbal medications what will you consider?
* potential for allergic reactions
* some are toxic if used improperly or at high doses
* They may be dangerous in combination with other substances or drugs that have been prescribed adverse reactions related to the herbal medicines
* They may mask symptoms
* They may aggravate the patients current problem
42
What is First Pass effect?
the Metabolism of a drug before it enters the systemic circulation. The process of first pass metabolism occurs in the gut or in the liver and can only affect the oral route. The drug is absorbed from the GI tract and passes via the portal vein (portal circulation) into the liver where some of the drug undergo extensive biotransformation. This would mean that only a proportion of the drug reaches the circulation (decrease drug concentration).
43
What is concordance and why is it important in practice?
The decision about whether to take a medicine or not ultimately lies with the patient. It is crucial that health professionals and patients engage in ‘shared decision-making’ about medicines usage. Shared decision-making, requires health professionals to engage with patients as partners taking into account their beliefs and concerns. The shared decision making process with medicines is known as concordance and moves away from the medical/more autocratic idea of compliance.
43
Competency Framework for all UK prescribers
Royal Pharmaceutical Society - RPS 2021
44
**True/False**
Unlicensed medication prescribing is acceptable
**True**
All independent prescribers can prescribe off-licence/ off-label and unlicensed medicines within their sphere of competence.
unlicensed and off-label medicines are legally permitted only if satisfied that an alternative licensed medicine would not meet the patient's clinical needs.
45
**True/False**
as an independent prescriber, you can issue a repeat prescription for a patients that somebody else has assessed and diagnosed the condition
**True**
The prescriber is accountable for any prescriptions made including repeat prescriptions for medicines initiated by colleagues.
46
You are asked to provide a repeat prescription, what should you do?
Prescriber needs to ensure that any repeat prescription you sign is safe and appropriate (right patient, correct prescription/dose), monitoring (usage and effects). Prescriber should properly assess patients’ needs for the repeat prescription. You should consider the benefits of prescribing with repeats, and where possible, reduce repeat prescribing. You have to agree on a review date with the patient and make clear records of these discussions and your reasons for repeat prescribing.
46
**True/False**
A prescriber is always allowed to prescribe for a friend or relative
**False**
You may be able to do so under exceptional circumstances where there are no other prescribers available. You must be able to justify what is considered an ‘exceptional circumstance’ and why, at the time, a prescription could not be issued by another independent prescriber.
Standards of
proficiency for
nurse and midwife
prescribers - Practice standard 11
47
What are the 4 ethical principles that underpins decisions on treatment
* Beneficence
* Non maleficence
* Autonomy
* Justice
47
Autonomy underpins the concept of?
Informed consent
48
Refers to the time it takes for a drug to achieve optimal plasma concentrations
Steady state
48
It equates to fairness and is to do with equal distribution of benefits and burdens
Justice
49
Give examples of sources of legislation that influences prescribing
- Convention on Human Rights
- United Kingdom parliament, e.g. Medicines Act 1968, Prescription by Nurses Act 1992
- Delegated legislation, e.g. NMC Code of Conduct
- Common or Case law as interpreted by the courts/judges,
- Bye laws/ supplementary legislation
50
This is when the amount of drug in the plasma has built up to a concentration level that is therapeutically effective and as long as regular doses are administered to balance the amount of drug being cleared the drug will continue to be active
Steady state
50
5 reliable sources for medication information
* BNF
* Trust Formulary
* Trust Medication Information Service
* NICE guidance
* Pharmacy service
* Electronic Medicines compendium
* National Library of Medicine
* Peer reviewed journals
51
the patient is experiencing an adverse reaction, what will you do?
* Remedy harm caused by the reaction
* Notify the prescriber
* Record in the patient’s notes
* Notify the MHRA via the Yellow Card Scheme
52
The gap between the desired effect of a drug and the point at which it exerts toxic
Therapeutic index
52
4 Common causes of risk when prescribing and how would you minimise the risk for each
ineligible handwriting - computerised - write legibly
incorrect doses - avoid trailing zeros (5.0, 6.0), avoid abbreviations (mcg, ng, u), use zero on doses less than 1 (0.5, 0.6)
failure to check interactions/contraindications - assess and always refer to BNF/EMC/Trust formulary if unsure
lack of knowledge of doses/strength - always refer to BNF/EMC/Trust formulary if unsure - ask other prescribers (medical, pharmacist)
52
Reduces the metabolic capacity of enzymes
Inhibitor
52
which of the following constitutes a pharmacokinetic interaction?
* Amiodarone & digoxin
* Atenolol & salbutamol
* Amitriptyline and
* Warfarin and vitamin
Amiodarone & digoxin
* Atenolol & salbutamol – reduces the action of each other (Pharmacodynamic)
* Amitriptyline and oxybutynin – increases parasympatholytic effects (Pharmacodynamic)
* Warfarin and vitamin K – Vitamin K antagonises warfarin (Pharmacodynamic)
53
which of the following is a pharmacodynamic interaction?
a. Warfarin & carbamazepine
b. Warfarin & cimetidine
c. Warfarin & danazol
d. Warfarin & clopidogrel
Warfarin & clopidogrel
a. Warfarin & carbamazepine – carbamazepine metabolism in CYP450 decreases plasma concentration of warfarin (Pharmacokinetics)
b. Warfarin & cimetidine – cimetidine inhibits metabolism of warfarin – increases bleeding tendencies (Pharmacokinetics)
c. Warfarin & danazol – danazol potentiates the hypoprothrombinemic response to warfarin – increases bleeding tendencies (Pharmacokinetics)
54
What are the 4 processes studied in pharmacokinetics?
Absorption
Distribution
Metabolism
Elimination
54
Which of the following neurotransmitters is most affected by citalopram?
* Noradrenaline
* Dopamine
* Serotonin
* GABA
Serotonin
54
Why are liquids absorbed quicker than tablets?
They don’t have to disintegrate & dissolve first
55
If an enzyme inducing drug is started will other drugs metabolised by the liver be metabolised faster or slower?
Faster – hence lower blood levels than expected
56
**True/False**
the bioavailability of an IV drug is higher an oral drug
**TRUE**
57
What is medication management
It is the clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit, from the medicines they need, while at the same time minimising potential harm.
57
What process needs to be followed when a drug error occurs
* Notify the patient
* Take action to remedy harm if necessary
* Report to pharmacy/prescriber
* Report to line manager
* Thorough and careful investigation at local level
57
What information is required to be on the drug chart before a registered nurse can administer a drug?
* Name
* DOB
* right Drug
* Dose
* Frequency (time given)
* Route
* Prescriber Signature
* MRN
* Formulation
58
A black triangle in the BNF means?
New drug / the drug preparation is being monitored intensively by the MHRA
59
Medicines that are being used outside the terms of the licence
off-labeled drug
60
**True/False**
The prescriber is not accountable for any issues that may occur if the prescriber will advise a patient for over the counter drug
**False**
prescriber is accountable for any advise given to patient regardless if it is an OTC drug. Prescriber should should fully assess patients for any possible interaction/reaction and provide adequate advice about the medication.
61
**True/False**
The use of amitriptylline for migraine is an off-license prescribing
**True**
61
What are the legal requirement of a prescription under Medicines Act 1968
Wet signature
Full name of patient
Full address of patient
Full address of prescriber
date of prescription
62
**True/False**
Unlicensed prescribing is acceptable as long as it is considered best practice and where no equivalent alternative is available
**True**
62
Controlled drugs that can be prescribed by nurse independent prescribers
All CD schedules 2-5
63
**True/False**
Unlicensed medications cannot be prescribed in a PGD (patient Group direction)
**True**
Unlicensed medication can be prescribed through a CMP
64
The use of controlled drugs as medications is regulated by?
Misuse of drugs regulations 2001
65
**True/False**
There is an increased risk of ventricular arrhythmias when tricyclic antidepressants are given with amiodarone
**True**
As per BNF drug interaction
66
**POM** symbol in BNF indicates what?
**Prescription Only Medicine (POM).**
Only available on a prescription issued by an appropriately trained practitioner
67
**True/False**
Non medical prescribers should only prescribe unlicensed medication under a CMP
**False**
Medicines for Human Use Act amendments 2009 - independent non medical prescribers are allowed to prescribe unlicensed medicines
68
Liability for one's own action
accountability
69
Responsibility to tell the truth
Veracity
70
**True/False**
Drug absorption is not affected by the acidity of the GI tract
**False**
71
A written instructions for the supply or administration of named medicines to specific groups of patients
Patient Group Directions
(PGD)
72
Therapeutic drug monitoring is usually done when a drug?
has a narrow therapeutic window
73
The collection, monitoring, and evaluation of unexpected and unintended effects of medicines
Pharmacovigilance
74
**True/False**
Most non concordance is intentional
**True**
It results from conscious decisions by the patient about illness, medication experience, culture, lifestyle, religion, and education
75
What percentage of patients with asthma take their medications as prescribed
20%
76
The extent to which a persons behaviour corresponds with agreed recommendations from healthcare provider
Adherence
77
**T/F**
Patients on long term medications for chronic illness are most likely to have the best concordance
**False**
only 50%
78
It is the term for multiple medications used to treat many different disease and can cause drug interactions and ADRs
Polypharmacy
79
**True/False**
All prescriptions are valid for 6 moths
**False**
CD prescriptions are valid for 28 days
all other prescriptions are valid for 6 months
80
It is the principal site of drug metabolism
Liver
81
**True/False**
A nurse prescriber can write a prescription for a patient assessed by a nursing colleague who is not a prescriber
**True**
This should however be ***avoided*** as per NMC standards of proficiency for nurse and midwife prescribers 2006
82
**True/False**
Dieticians can prescribe through a CMP
**False**
at present, dieticians are not part of the list of professionals who can become prescribers
83
**True/False**
Pharmacist were always allowed to prescribe since before
**False**
it was only on 2003 where pharmacists became eligible to train as supplementary prescribers
84
**True/False**
Private prescriptions can be issued by supplementary prescribers
**True**
Independent and Supplementary prescribers are able to provide private prescriptions
85
**True/False**
Prescribers should be able to provide medicine administration directions to non prescribers
**True**
86
Supplementary prescribing is most useful for?
long-term conditions
87
Who is responsible and liable for the actions of supplementary prescribers
The supplementary prescriber and their employer
88
The UK parliament act which governs the manufacture and supply of medicines
Medicines Act of 1968
89
What is pharmacovigilance?
it is the process of monitoring of all medicine safety throuout their marketed life
90
It is also known as the recommended international non-proprietary name (rINN) of a drug
Generic name
91
the data sheet submitted to the MHRA which contains the drug information by the manufacturer
summary of product characteristics **(SPC)**
92
**True/False**
Mixing 2 licensed medicines together in a syringe results in an unlicensed used of medication
**True**
93
BNF section 5 relates to what type of medicines?
Antimicrobials
94
Appendix 4 in the BNF relates to?
Wound management
95
**True/False**
A prescription is considered a legal document
**True**
as per Medicined Act of 1968
96
It is the right of the individual to make choices for themselves
Autonomy
97
**True/False**
Lipid solubility is an important factor affecting drug absorption
**True**
Lipophilic drugs can easily pass into the cell membrane because they are not charged or ionised. This makes them easily absorbed.
98
A group of antibiotics that inhibits protein synthesis
Macrolides
99
A type of antibiotics that inhibits bacterial cell wall synthesis
Penicillins
100
The organisation responsible for identifying the drugs that may be prescribed on the NHS budget
**NICE**
National Institute for health and Clinical Excellence
