701 Study Guide Week 1 PDF

**Week 1 Study Guide** - Describe the differences between full, reduced, and restricted prescriptive authority. - Full- State practice and licensure **laws permit all NPs to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage trea...

**Week 1 Study Guide** - Describe the differences between full, reduced, and restricted prescriptive authority. - Full- State practice and licensure **laws permit all NPs to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments**, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. **State laws permit NPs to independently evaluate, diagnose, order tests, and prescribe medications, including controlled substances, without oversight** (as per the National Academy of Medicine\'s recommendation). - Reduced- State practice and licensure laws **reduce** the ability of NPs to engage in at least one element of NP practice. **State law requires a career-long (or minimum number of years) regulated collaborative agreement with another health provider in order for the NP to provide patient care; or it limits the setting of one or more elements of NP practice**. Requires a regulated collaborative agreement with another provider, limiting NPs\' scope in certain settings or for specific treatments. - Restricted- State practice and licensure laws **restrict** the ability of NPs to engage in at least one element of NP practice. **State law requires career-long supervision, delegation, or team management by another health provider in order for the NP to provide patient care.** Requires direct supervision or delegation by another provider for prescribing. - What things must a prescription include? - Prescribers name, contact information, license/ DEA number, patients name and DOB, drug name, strength, dosage, route, frequency, quantity to dispense refill date, and signature, indication for the medication, and the "brand medically necessary" clause inapplicable. - What are the rules for Schedule II meds that are phoned in? - **Cannot call in schedule II medications unless it is an emergency,** and then a written script needs to be presented within 72 hours. Some references say 7 days. - Requires all standard prescription details. - What are the various Schedule classes (I-V) and which medications are found in each? - Schedule I- no medical use (heroin, LSD) - Schedule II- high abuse potential (morphine, oxycodone) - Schedule III- moderate abuse potential (ketamine, anabolic steroids, test) - Schedule IV- low abuse potential (benzodiazepines, tramadol) - Schedule V- lowest potential for abuse (antidiarrheal, drugs containing codeine) - What is priority information to include in patient medication teaching? - Medication name, purpose, dosing, administration, adverse effects, storage, required labs, food, and other drug interactions, duration of therapy, when to contact a provider, and importance of adherence. - What are practical ways to help patients overcome compliance/adherence issues? - Align medication with other daily activities, give a pill organizer, and use a reminder app to help with forgetfulness. - Recommended signing up for automated pharmacy messages about refills to help with lack of planning. - Use generic versions and educate the patient on assistance programs to help with the cost of meds. - Take with or without food or offer different flavors or formulations to help with dissatisfaction. - Educate on the reason the dose has been set with a given rationale to avoid altered dosing. - What do the rate of absorption and amount of absorption determine? - **The rate** of absorption determines the **onset of drug action** - The **amount of absorption** determines the **intensity of the drug effect.** - Both are affected by the route of administration. - Describe 3 factors that influence distribution. - Blood flow to tissues abscesses and tumors. - The ability of the drug to exit the vascular system capillary permeability, BBB, and placenta transfer. - The ability of the drug to enter cells receptors, channels, lipid solubility, transport system. - Explain drug interactions related to protein binding. - Many drugs can for reversible bonds with protein in plasma - Drug protein bond has to be broken down for the drug to be active within the body. - **The affinity** of the bond **determines the unbound drug availability.** (Distribution) - High protein bond drugs may compete for binding sites, thus increasing the free drug levels and toxicity risk (warfarin has a high protein bond.) - What are the 3 main steps in renal excretion? - Glomerular filtration- moving wastes from blood to urine. - Passive tubular reabsorption- distal to the glomerulus. Drug levels in the blood are now low concentration gradient and **movement of lipid-soluble drugs back into the blood.** - Active tubular secretion- active transport to get remaining drugs into the table for urinary excretion. - Compare and contrast MEC, toxic concentration, and duration of action. - MEC- minimum effective concentration within plasma levels for therapeutic effect. - Toxic concentration- level causing harm. - Duration- time drug levels remain above MEC - When is a decline from plateau used clinically? - Used **to predict drug clearance and adjust dosing intervals.** - Helps determine how fast someone can recover from an OD as well. - With a short half-life, the drug will fall back into a therapeutic range more quickly. - Compare agonists and antagonists. - Agonists- active receptors Drugs mimic the action of the body's endogenous activity. - Antagonists- prevent receptor activation. These drugs attach to a receptor and block it. - What is an example of a partial agonist and how does it work? - Pentazocine- moderate intrinsic activity leading to lowered max effect as compared to agonist. - Given alone partial agonist. - Given that meperidine bumps, some of the Meperidine off receptors reduce therapeutic effects. - Describe ED50, therapeutic index, and LD50. - ED50- the dose that produces the desired effect in 50% of the population - TI- ratio of the LD50 to ED50 - LD50- lethal dose for 50% of the test subjects. - What are 6 famous drug-food interactions? - Grapefruit- inhibits CYP enzymes causing - Vitamin K affects warfarin - Ca reduces tetracycline absorption - High-fat meals enhance some drug absorption, such as Saquinavir for HIV - Tyramine and MAOIs increase blood pressure together - T2D meds using meals to prevent N/V and/ or intentional slow absorption. - What are the potential benefits of pharmacogenomics? - Minimize medication side effects - Optimize medication selection - Lowers cost of treatment - Decrease the length of treatment - Enhance medication safety. - What types of medications cross the placental barrier easily? Not so easily? - Lipid-soluble drugs cross the barrier easily. - Drugs that are ionized (charged/related to pH), highly polar, water-soluble, or protein-bound cross with more difficulty. - What are 5 famous ADRs that can occur during pregnancy and which drugs cause them? - Heparin leads to OP and vertebral fractures. - Prostaglandins (misoprostol) stimulate uterine contractions leading to abortion or preterm labor. - Aspirin suppresses contractions and increases bleeding - Narcotics, anti-anxiety meds, stimulants, and recreational drugs lead to dependence in the neonate. - Pain relievers used in labor can lead to a decrease in respiratory effort in neonates. - What criteria must be met for a drug to be considered teratogenic? - The drug must cause a **characteristic set of malformations** - Must act only during specific periods of vulnerability. - Incidence of the malformation increases with increased dosing and increased duration of exposure. - List 6 famous drug-related effects in pregnancy and neonates. - Anti-cancer/ immunosuppressants- CNS malformations, organ defects - Antiseizure- neural tube defects, craniofacial defects, growth delay, heart malformation, hypospadias. - ETOH- FAS - Benzodiazepines- hypotonicity, withdrawal, hypoglycemia, resp compromise. - Aminoglycosides- deafness - Tetracyclines- tooth and bone abnormalities - Sex hormones- masculinization or reproductive organ defects - Warfarin- fetal hemorrhage, skeletal and CNS defects - Misoprostol- fetal abortion - Accutane- craniofacial, cardiac, thymic, and CNS malformations. - How do we minimize risk when prescribing medication to breastfeeding women? - Dose after breastfeeding - Avoid drugs that have long half-life - Avoid SR and ExtR formulations - Choose drugs that are not lipid-soluble - Choose drugs that are least likely to affect the infant - Used lowest effective dose - Consider formula feeding if hazardous drug cannot be avoided. - What are neonatal characteristics that lead to altered drug responses? - Gastric emptying time is prolonged and erratic - IM absorption is slowed due to underdeveloped musculature - Transdermal absorption is **faster due to thin stratum corneum** - Lower levels of protein binding (due to lower levels of albumin) - BBB not fully developed - Drug metabolism in the liver is slowed - Renal excretion is reduced - Which marker should be used to check for potential excretion issues in older adults? - Creatine clearance before prescribing high-risk medications. - What are the Beers criteria and the STOPP tool used for? How do they differ? - Used to identify the high likelihood of causing ADRs in older adults. - STOPP focuses on reducing polypharmacy and unsafe prescribing. - What are examples of common drug therapy required in end-of-life care? How do the rules change? - Comfort is now the main focus. - constipation (stool softeners or laxatives) - pain (oral opioids or transdermal patches) - dyspnea (oxygen, bronchodilators, or glucocorticoids) - nausea and vomiting (metoclopramide, haloperidol, ondansetron) - respiratory secretions (anticholinergics)