NR508_Midterm_chapter Best Study Guide to Improve your Grades 100%

Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and responsibilities of APRN prescribers  Advanced practice  Final decision for meds  Degree of authority and autonomy decided by state by sta ...

Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and responsibilities of APRN prescribers  Advanced practice  Final decision for meds  Degree of authority and autonomy decided by state by state  Every year updated titling, roles, and prescriptive authority  Scope of practice determined by NP license and licensing jurisdiction  Understand that employment sites may restrict this legal scope but cannot extend it Clinical judgement in Prescribing  Clinical judgement  Best therapy least invasive, least expensive, least likely cause abuse  Usually best for lifestyle, no pharm, and pharm therapies  Is clear indication for drug therapy? o B4 beginning ask if necessary  Drugs are effective in treating disorder o Which one best  Goal of therapy with this drug o Cure disease or lifestyle, adverse effects  Not meeting goals? o When consult therapist  Unnecessary duplication with other drugs already taken  Over the counter drug ok?  What about cost? o Pay for out of pocket  Where is info to answer questions o Journals, FDA, eval reliable drug info Collaboration with other providers  Physicians, pharm, ARNP, PA, nurses Autonomy and Prescriptive authority  All states different authority and scope of practice Chapter 2: Review of Basic Principles of Pharmacology Metabolism: Metabolism & Half Life  Metabolism can increase, decrease onset duration of action, and toxicity of medications  Change one chemical into another  First pass metabolism: major organ for drug metabolism because it contains high amounts of drug metabolism enzymes and because it is the first organ encountered by the drug once they are absorbed by the GI tract. Determines if can be given orally.  Rate of drug metabolism depends on drug blood levels. Related to drug per hour. First order metabolism is time drug decreases by half  50% at one half-life 75 at two half-lives and 87.5 at three half lives Drug Responses  Receptors: agonists, antagonists  Agonists: drugs that produce receptor stimulation and change what they bind  Antagonist: occupy receptor without stimulating them prevent agonist from occupying them Pharmacokinetics: Absorption, Distribution, Protein Binding, Metabolism (including firstpass and Phase I and II)  Abortion o By weight solubility, and other factors o GI like foods change absorption  Distribution o Membrane permeability like BBB o Plasma protein binding  If not bound higher in blood and tissues o Storage  Lipoic accumulate in fats calcium in teeth  metabolism o Phase I – non-synesthetic- drugs are oxidized or educe to more polar form o Phase II – synthetic- polar group like glutathione is conjugated to the drug  Cytochrome P450 metabolism  Mixed function, catalyzes the metabolism of large number of drugs and hem that are high lipid soluble, it can delay metabolism or extend life of one of the competing drugs Excretion: Renal, Biliary, Other (eg for volatile drugs)  Renal o Organic anion transport : HCTZ, furosemide, PCN G, salicyicates o Organic CATIONS transport: atropine, cimetidine, morphine, quinie  Biliary o Digoxin : Cardiac cycodes excreted this way  ETOH excreted in pulm also Chapter 3: Rational Drug Selection Process of rational drug prescribing: 6 Steps proposed by WHO  Step one define problem  Two specify therapeutic objective  Three choose tx  Four start tx  Five educate pt  Six monitor effectiveness Patient education  Why they are taking it  Instruction for admin  Side effects  At 5th or 6th grade reading level and easy to understand Monitor effectiveness  When to call doc  active schedules follow up  make adjustments Drug, Patient, and Provider factors that influence drug selection  Unnecessary duplications can occur  Simple regimen  Previous adverse reactions listen to pt and offer different meds  Fewest side effects will promote adherence  If they believe it will help them the will use meds  Assess beliefs and attitudes  Access to drug interaction software a must  Infants have immature liver and renal  Elder have liver and renal dysfunction adjust  Preg is huge factor  Ease of monitoring best for pts  Need to be familiar with formularies Influences on Rational Prescribing: Pharmaceutical Promotion  Conflict of interest needs disclosed Chapter 4: Legal and Professional Issues in Prescribing New Drug Approval process including Clinical Phases  Preclinical o Screening and toxicology  1 o eval first testing compound on subjects  2 o small # pt tested o 3  controlled and uncontrolled drug safety U.S. FDA Regulatory Jurisdiction: official labelling vs off-label use of drugs  pt needs  based on studies and theories  knowing indication and approval may have liability if use off label Chapter 5: Adverse Drug Reactions Mechanistic Classification of ADRs including Types of Immune-Mediated ADRs and Types A-F  I IgE mediated angioedema and anaphylaxis (allergies rhinitis)  II antibody dependent cytotoxicity herprin induced thrombocytopenia untie with heptens and destroy tissues caused by foods and herbs too hemolytic anemia  III immune hypersensitivity athrus reaction to tetanus vaccine IGG, IGM deposited in joints and knees kidneys pain swelling edema hemorrhage  IV cell mediated and delayed hypersensivity drug rash, esopnhillia and system syndrome cell mediated non-antibody T cells dermatitis, Steven Johnson, DRESS, toxic endermic necrolysis. Common Causes of ADRs: Risk Factors, including common drugs involved and which cause skin reactions  Risk factors genetics, age, sex, poloypharm, medical conditions and drug reactions, o Hlab 5071 t mediated worse with HIV meds Abacavir o hlab1502 in Chinese with carbampezine, and allopurinol  Common warfarin, insulin, digoxin, antibiotics, sedative, antipsychotics, chemo drugs, and  Skin Steven Johnson with amoxicillin, trimethoprim, sufa, ampicillin, iopodate, blood products, cephalosporin, erythromycin, diphdralazine hydrochloride, pcn G, cyanocobalamin (vit b12). Time-Related Classification of ADRs including drugs associated with withdrawal symptoms  Immediate or delayed like vanco and red man syndrome  Phenytoin can cause purple glove syndrome when admin peripherally  First dose orthostatic hypotension with doxazosin and orthoclone okt3  Early reactions GI upset with metformin and SSRI (start small and go slow to counteract)  Intermediate reactions hyperuricemia with furosemide, hemolytic anemia with cefrotexone, intest nephritis with PCN g, Contact derm with neomycin  Late reactions osteoporosis and thinning with corticosteroids and hypogonadism with opioids use  Withdrawal – oxy anxiety and insomnia rhinorrhea, anorexia, vomiting, tahcy, tremors  Clonidine and propranolol cause rebound HTN with withdrawal  Delayed reactions – Tard dyskinesia with antiphyocics and Reglan for months even after stopping meds