Pharm Exam 1 Worksheet PDF

Pharm Exam 1 ( WEVE GOT THIS) ​ PP Notes ★​ Mentioned in class Overall exams Mechanism of act...

Pharm Exam 1 ( WEVE GOT THIS) ​ PP Notes ★​ Mentioned in class Overall exams Mechanism of action Contraindications Black box Rarely dosing- exceptions Scenario type questions:symptoms and diseases for treatments Monitoring or effectiveness based on levels thyroid Max doses Know vaccine schedules EXAM 1: Yearly Vaccs, special circumstances per vaccine 1.​ Bioavailability- Bioavailability from oral medications can be affected by food, gastric motility, ​ The extent to which an administered dose of a drug reaches its site of action ○​ A drug administered orally will be first absorbed by the GI tract (which may lose some drug) ○​ Then to the liver – which may again lose some drug (sometimes a substantial amount – first pass effect) ○​ Then to the systemic circulation ○​ If a drug is administered intravenously, it goes first to systemic circulation ​ Bioavailability – the fractional amount of a drug that reaches the site of action. ○​ Orally must absorb from the GI tract, then pass through the liver before entering systemic circulation – not all the ingested drug reaches the circulation ○​ “First pass effect” – liver can substantially reduce the bioavailability ​ IV – complete bioavailability, rapid distribution ​ Bioavailability, the fraction of drug absorbed into the systemic circulation ​ Bioavailability (esp. important with drugs with narrow therapeutic index) 2.​ Prescribing basic within the role of the APRN (??) ​ Before writing a script ​ Assess your patient ○​ Medication, food, and environmental allergies ○​ Dietary intake (how often do they eat) ○​ Pregnancy/lactation ○​ Identify all medications and supplements the pt is taking ​ Consider nationally recognized guidelines ​ Consider the most appropriate prescription for THIS pt ​ What do you do if it’s not your patient? Friend, relative. 3.​ Regulations/Regulators related to prescribing ​ Controlled Substances ​ In Oklahoma NPs can prescribe Schedule III-V. OK NPs CANNOT prescribe any schedule II. ​ In Oklahoma NPs may write for one month of a controlled substance. Refills CANNOT be provided on the prescription. ○​ Physicians may write for up to 6 months of refills for sch III, IV, and V ​ Schedule III, IV, and V may be called in to a pharmacy the same way as other prescriptions ​ “Must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his or her professional practice” ​ Must be written in ink ​ Include DEA number ​ Do not prescribe for yourself or family members ​ (Oklahoma specific) NP prescribing governed by the Oklahoma Board of Nursing ○​ NPs are required to have a supervising physician ​ Must have DEA and OBNDD to prescribe controlled meds in the state of Oklahoma. Do not currently have to list the OBNDD number 4.​ Factors that affect absorption ​ Distribution ○​ Volume of distribution – the amount of drug in the body divided by plasma concentration ​ Amount of drug in body/V = C ○​ Rates of distribution – faster to areas of the body with high perfusion, slower in those with slower perfusion ○​ Steady state – drug availability equals drug elimination ○​ Half life – the time it takes for plasma concentration to be reduced by 50% ○​ Terminal half life – drug released from secondary sites (muscle, fat) into plasma once dosing stops and prolongs half life ​ steady-state concentration eventually will be achieved when a drug is administered at a constant rate. At this point, drug elimination (the product of clearance and concentration; Equation 2–5) will equal the rate of drug availability. ​ Factors Modifying Drug Action ○​ Coadministration with other drugs, supplements, and nutraceuticals, or food – can cause toxicity or inhibit therapeutic effect ○​ Receptor desensitization – continued stimulation with agonist results in decreased effect of the drug ​ Age and Drugs ○​ Most drugs evaluated in young and middle-aged adults ○​ Pharmacokinetics and pharmacodynamics may vary with extremes of age ○​ With elderly ​ Consider changes in body function and composition ​ Beers Criteria ​ Beers criteria- list of drugs that should be avoided in older adults, drugs that should be avoided or be used at lower doses in older patients with reduced kidney function, and specific drug-disease and drug-drug interactions that are known to be harmful in this population. ​ Gut Microbiome 1  ○​ Microbiome is the ecosystem of each human – exist in many areas… skin, vagina, oral cavity, etc. ○​ Gut microbiota can impact drug metabolism, indirectly or directly ○​ Use of microbiota in therapy – fecal transplants in C-diff, use of probiotics ○​ Drug effects on microbiome – antibiotics especially, PPIs, metformin 5.​ Patient elements that affect prescribing ​ Drug Excretion ​ May be excreted unchanged or as metabolites ​ Biliary and fecal – if present in bile – may cause reabsorption ​ Sweat, saliva, tears – not in amounts worth worrying about ​ Breast milk – use caution when prescribing to breastfeeding mothers ​ Excretory organs, the lung excluded, eliminate polar compounds more efficiently than substances with high lipid solubility. Thus, lipid-soluble drugs are not readily eliminated until they are metabolized to more polar compounds. Substances excreted in the feces are principally unabsorbed orally ingested drugs or drug metabolites either excreted in the bile or secreted directly into the intestinal tract and not reabsorbed. Excretion from the lung is important mainly for the elimination of anesthetic gases ​ Renal Drug Excretion ○​ Renal – 25-30% of all drugs ​ In neonates – renal function low compared to body mass ​ In adults – slow decline in renal function ○​ Excretion of drugs and metabolites in the urine involves three distinct processes: glomerular filtration, active tubular secretion, and passive tubular reabsorption. ​ Commodity ​ Patients visit provider to “get” prescription ​ Patient education regarding necessity of medication ​ Direct to consumer advertising ​ Pregnancy categories ​ Compliance ​ Compliance – “the extent to which the patient follows a regimen prescribed by a healthcare professional.” ​ Promote collaborative interaction between provider and pt ○​ Does the plan work for the patient? ○​ Frequency of dosing ​ Pt belief that the therapy is beneficial to their health ​ Consider non-compliance when pt is not responsive to therapy 6.​ Elements of a prescription ​ Use English words. Avoid abbreviations. Write out medication. Be legible. ​ Elements of prescription ○​ Superscription – date of prescription, name, address, wt, and ag of pt ○​ Inscription – name and amount or strength of the drug ○​ Subscription – instruction to the pharmacist (dispense #X) ○​ Signa (or Sig) – instructions for the patient regarding how to take the prescription ○​ Signature of the provider ○​ Provider name should be printed on the prescription ○​ Should be written in ink (required for controlled meds) ​ If the prescription sheet doesn’t have the provider’s name printed on it, the provider must print their name on the prescription. ​ Prescriptions will be filled with a generic equivalent unless specified otherwise. ​ Number of refills should be specified – even if zero 7.​ Ethics in prescribing ​ Keep prescription pads secured ​ Do not pre-sign prescription forms ​ Spell out number to dispense (#30, thirty) ​ Consider who has access to your NPI and other info. ★​ When would you when would you not prewscribe 8.​ Agonists vs antagonists ​ Receptors – protein molecules embedded in the cell wall. Receive chemical information from other molecules (drugs, hormones, etc) ​ Agonist drugs – bind to specific receptors to cause a response in the cell ​ Antagonist drug – directly opposes the actions of an agonist ​ By binding to agonist receptor sites ​ By combining with the agonist ​ By indirectly inhibiting the effects of the agonist ​ A receptor is a protein that recognizes a signaling molecule endogenous to the organism, i.e., an endocrine, paracrine, autocrine, or juxtacrine factor, and that translates that recognition into a meaningful cellular event. ​ An agonist is like the key that fits in the lock (the receptor) and turns it to open the door (or send a biochemical or electrical signal to exert an effect). The natural agonist is the master key but it is possible to design other keys (agonist drugs) that do the same job. ​ An antagonist is like a key that fits nicely into the lock but doesn’t have the right shape to turn the lock. When this key (antagonist) is inserted in the lock, the proper key (agonist) can’t go into the same lock. 9.​ First pass effect ​ “First pass effect” – liver can substantially reduce the bioavailability ​ Oral-undergoes first pass effect. 2  ​ Controlled release – Controlled, extended, sustained release, and prolonged-action. Uniform absorption for 8 hr or longer. Most appropriate for drugs with short half-lives (t1/2