NR565 Pharmacology Midterm Study Guide

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NR565 Pharmacology Midterm Study Guide

Week281

- Drug28Schedules

I- Substances28or28Chemicals28are28defined28as28drugs28with28no28currently28accepted28Medica
l28use28and28a28high28potiental28for28abuse-28Heroin28,28LSD,28Weed,

II- Substances28or28chemicals28are28defined28as28drugs28with28a28high28potiental28for28abuse28
with28use28potientially28leading28to28severe28psuchological28or28physical28dependices28–
28Vicodine,28cocaine,28meth,28methadone,28diluadid


III- Substances28or28chemicals28are28definded28as28drugs28with28moderate28to28low28potiental28
for28physical28and28psychological28dependence.28(28Less28than289028mg28of28codeine28Katami
ne,28anabolic28steroids28testosterone

IV- Substances28or28chemicals28are28defined28with28low28potiental28for28abuse28and28
low28risk28of28dependence.28(28Xanax,28Valium28Ativan28Talwin28Darvocet

V- Substances28or28chemicals28are28defined28as28lower28potiental28for28abuse.2 8 Lomotil,28lurica



o Which28ones28can28and28can28not28be28prescribed28by28nurse28pr

actitioners28Schedule28I

- Prescriptive28Authority
o Understand28what28prescriptive28authority28is28and28who28mandates28it.

Prescriptive28authority28is28the28legal28right28to28prescribe28drugs.28Full28prescriptive28authority2
8affords28the28legal28right28to28prescribe28independently28and28without28limitation.28Physicians28
have28full28prescriptive28authority.28For28nonphysician28providers,28the28degree28of28prescriptive2
8authority28varies.28Some28have28full28prescriptive28authority;28however,28for28many,28prescripti
ve28authority28is28restricted.28Limitations28are28generally28tied28to28oversight28by28a28doctor28of2
8medicine28(MD)28or28doctor28of28osteopathy28(DO)28as28part28of28the28provider's28scope28of28pr
actice

Mandiated28by28Board28of28Nursing,28State28Board28of28Medicine28and28State28Board28of28pharm
acy28determinded28by28the28state

Recall28that28there28are28two28components28of28prescriptive28authority:28(1)28the28right28to28prescr
ibe28independently28and28(2)28the28right28to28prescribe28without28limitation

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o What28problems28arise28when28it28is28limited?

Limited28prescriptive28authority28creates28numerous28barriers28to28quality,28affordable,28and28acce
ssible28patient28care.28restrictions28on28the28distance28of28the28APRN28or28PA28from28the28physi
cian28providing28supervision28or28collaboration28may28prevent28outreach28to28areas28of28greatest
28need.




• Know28the28responsibilities28of28prescribing
o The28best28way28to28keep28your28patients28(and28yourself)28safe28is28to28be28prud
ent28and28deliberate28in28your28decision-
making28process.28Have28a28documented28provider–
patient28relationship28with28the28person28for28whom28you28are28prescribing.28Do
28not28prescribe28medications28for28family28or28friends28or28for28yourself.28Docu
ment28a28thorough28history28and28physical28examination28in28your28records.28Incl
ude28any28discussions28you28have28with28the28patient28regarding28risk28factors,28s
ide28effects,28or28therapy28options.28Have28a28documented28plan28regarding28dru
g28monitoring28or28titration,28if28applicable.28If28you28consult28additional28provi
ders,28note28that28you28did28so.28Finally,28use28the28references28provided28in28the
28following28box28to28assist28in28safely28and28rationally28choosing28one28medicat
ion28over28another.
• -2 8 Know28patient28reasons28for28medication28non-adherence
o Forgertfullness
o Lack28of28Planning
o Cost
o Dissatisfaction
o Altered28Dosing




• -
2 8 Know28how28what28type28of28evidence28prescribers28should28use28to28make
28treatment28recommendations
o
• -
2 8 Be28familiar28with28physiological28changes28of28aging28that28impact28pharma
cological28treatments



• -2 8 Be28familiar28with28Beer’s28Criteria
o potentially28Inappropriate28Medication28(PIM)28use28in28older28adults
o potentially28Inappropriate28Medication28(PIM)28use28in28older28adults28due28to28m
edication-28disease28or28medication-
syndrome28interactions28that28may28exacerbate28the28disease28or28syndrome
o medications28to28be28used28cautiously28in28older28adults
o clinically28significant28drug28interactions28that28should28be28avoided28in28older28adults

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o medications28to28be28avoided28or28dosage28decreased28in28the28presence28of28impai
red28kidney28function28in28older28adults28(American28Geriatric28Society28Beers28C
riteria28Update28Expert28Panel,282019)
• -2 8 Know28CYP45028inducers28and28inhibitors-
Cytochrome28P45028(CYP450)28are28xenobiotic-
28metabolizing28enzymes28necessary28for28the28production28of28cholesterol28and28stero
ids28and28the28detoxification28of28chemicals28and28drug28metabolism
o Inhibitors
o Valproate
o Isoniazid
o Sulfdnamidies
o Amidarone
o Chloramephenicol
o KetoConazole
o Grapefruit28Juice
o Quinidine
o VISA-28credit28card28debt28inhibits28spending28on28designers28like28CK28and28GQ
o Inducers
o Carbhamazepine
o Rifampin
o Alcohol
o Phenytoin
o Griseofulvin
o Phenobarbital
o Sulfanyureas




• -2 8 Be28familiar28with28opioid28agonists
o A28drug28that28binds28to28and28activates28a28receptor.28Can28be28full,28partial28or28i
nverse.28A28full28agonist28has28high28efficacy,28producing28a28full28response28whi
le28occupying28a28relatively28low28proportion28of28receptors.28A28partial28agonist
28has28lower28efficacy28than28a28full28agonist.28It28produces28sub-
maximal28activation28even28when28occupying28the28total28receptor28population,28
therefore28cannot28produce28the28maximal28response,28irrespective28of28the28conc
entration28applied.28An28inverse28agonist28produces28an28effect28opposite28to28th
at28of28an28agonist,28yet28it28binds28to28the28same28receptor28binding-
site28as28an28agonist.



• -2 8 Know28the28outcome28of28having28a28poor28metabolism28phenotype
o The28term28bioavailability28refers28to28the28amount28of28an28active28drug28that2
8reaches28the28systemic28circulation28from28its28site28of28administration




• -2 8 Know28the28role28of28the28government28agencies28when28it28comes28to28prescription28drugs