NR565 / NR 565 Midterm Exam Study Guide
Advanced Pharmacology Fundamentals -
Chamberlain
1. Prescriptive authority for nurse practitioners also regulates
prescribing rights beyond medications and controlled substances.
These rights include therapeu- tic devices and services and are
outlined in state practice laws and regulations and include Durable
Medical Equipment (DME) such as wheelchairs, power scooters,
hospital beds, portable oxygen equipment, handicap placards, etc.
and medical services such as Physical Therapy (PT), Occupational
Therapy (OT), home health services, etc. Prescriptive authority
encompasses more than writing a prescription correctly. It requires
adherence to ethical guidelines to ensure that patients are
safeguarded from harm. Ethical prescribing starts with being well-
informed about medications. Mechanism of action, efficacy, and
safety are important considerations, as are a patient's distinct needs
and circumstances, including the number of medications prescribed
(Mitchell & Oliphant, 2: APRN prescribing role
2. Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments
and prescribe medications, including controlled substances without
,physician oversight: benefits of full practice authority
3. Administering medications and prescribing medications are
two distinct processes. Prescription writing requires prudent and
deliberate decision-mak- ing processes to maintain patient safety
and reduce liability, including:
*documentation of a provider-patient relationship for the recipient
of the pre- scribed medications
*documentation of a thorough history and physical examination for
the recip- ient
*documentation of discussions regarding risk factors, side effects, or
therapy options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the
formula- tion of a diagnosis based on clinical reasoning and the
selection and monitor- ing of the most appropriate
pharmacological treatment
Considerations include: Cost, guidelines, availability,: promoting positive
,outcomes through prudent prescribing practices
4. identifies drugs with a high likelihood of causing adverse effects in
older adults. Accordingly, drugs on this list should generally be
avoided in adults older than 65 years except when the benefits are
significantly greater than the risks.: Beer's Criteria
5. the study of the biochemical and physiologic effects of drugs on
the body and the molecular mechanisms by which those effects are
produced: Pharmacodynamics
6. the study of drug movement throughout the body: Pharmacokinetics
7. the study of how genes affect a person's response to drugs. The
purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug
therapies to patients: Pharmacogenomics
8. Inducers are xenobiotics (medications and environmental
agents) that ele- vate CYP450 enzyme activity by increasing enzyme
synthesis. This action leads to additional sites available for
biotransformation. The increased number of sites enhances
medication metabolism, decreasing the concentration of the
"parent drug" while increasing metabolite production.
, Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas): CYP450 inducers
9. Inhibitors are medications that inhibit the metabolic activity of
one or more of the CYP450 enzymes. Medications that inhibit an
enzyme potentially slows that
enzyme's activity or blocks the activity required for the metabolism of
other medications, thereby increasing the levels of medications
dependent on that particular enzyme for biotransformation. Inhibitors
= decrease medication me- tabolism (Valproate, Isoniazid,
Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit
Juice, Quinidine): CYP450 inhibitors
10. The greatest concern surrounding race-based therapy has to
do with genetic variability. We know there is great diversity within
and among racial groups; therefore, a "one fits all" approach based
on race is unwise. Still, we can use known associations to guide
choices. For example, differences in metabolism between people
with East Asian and European heritage are common. The provider
can use this knowledge to guide initial dosing (with adjustment, as
indicated based on response) if genetic testing is not feasible or
warranted: cul- tural influences in prescribing
Advanced Pharmacology Fundamentals -
Chamberlain
1. Prescriptive authority for nurse practitioners also regulates
prescribing rights beyond medications and controlled substances.
These rights include therapeu- tic devices and services and are
outlined in state practice laws and regulations and include Durable
Medical Equipment (DME) such as wheelchairs, power scooters,
hospital beds, portable oxygen equipment, handicap placards, etc.
and medical services such as Physical Therapy (PT), Occupational
Therapy (OT), home health services, etc. Prescriptive authority
encompasses more than writing a prescription correctly. It requires
adherence to ethical guidelines to ensure that patients are
safeguarded from harm. Ethical prescribing starts with being well-
informed about medications. Mechanism of action, efficacy, and
safety are important considerations, as are a patient's distinct needs
and circumstances, including the number of medications prescribed
(Mitchell & Oliphant, 2: APRN prescribing role
2. Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments
and prescribe medications, including controlled substances without
,physician oversight: benefits of full practice authority
3. Administering medications and prescribing medications are
two distinct processes. Prescription writing requires prudent and
deliberate decision-mak- ing processes to maintain patient safety
and reduce liability, including:
*documentation of a provider-patient relationship for the recipient
of the pre- scribed medications
*documentation of a thorough history and physical examination for
the recip- ient
*documentation of discussions regarding risk factors, side effects, or
therapy options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the
formula- tion of a diagnosis based on clinical reasoning and the
selection and monitor- ing of the most appropriate
pharmacological treatment
Considerations include: Cost, guidelines, availability,: promoting positive
,outcomes through prudent prescribing practices
4. identifies drugs with a high likelihood of causing adverse effects in
older adults. Accordingly, drugs on this list should generally be
avoided in adults older than 65 years except when the benefits are
significantly greater than the risks.: Beer's Criteria
5. the study of the biochemical and physiologic effects of drugs on
the body and the molecular mechanisms by which those effects are
produced: Pharmacodynamics
6. the study of drug movement throughout the body: Pharmacokinetics
7. the study of how genes affect a person's response to drugs. The
purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug
therapies to patients: Pharmacogenomics
8. Inducers are xenobiotics (medications and environmental
agents) that ele- vate CYP450 enzyme activity by increasing enzyme
synthesis. This action leads to additional sites available for
biotransformation. The increased number of sites enhances
medication metabolism, decreasing the concentration of the
"parent drug" while increasing metabolite production.
, Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas): CYP450 inducers
9. Inhibitors are medications that inhibit the metabolic activity of
one or more of the CYP450 enzymes. Medications that inhibit an
enzyme potentially slows that
enzyme's activity or blocks the activity required for the metabolism of
other medications, thereby increasing the levels of medications
dependent on that particular enzyme for biotransformation. Inhibitors
= decrease medication me- tabolism (Valproate, Isoniazid,
Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit
Juice, Quinidine): CYP450 inhibitors
10. The greatest concern surrounding race-based therapy has to
do with genetic variability. We know there is great diversity within
and among racial groups; therefore, a "one fits all" approach based
on race is unwise. Still, we can use known associations to guide
choices. For example, differences in metabolism between people
with East Asian and European heritage are common. The provider
can use this knowledge to guide initial dosing (with adjustment, as
indicated based on response) if genetic testing is not feasible or
warranted: cul- tural influences in prescribing
