NR508 (NR 508) Midterm Outline | LATEST 2020 - $13.99   Add to cart

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NR508 (NR 508) Midterm Outline | LATEST 2020

NR508 Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and responsibilities of APRN prescribers: Collaborate w/ physician on best drug to give patient, in depth knowledge of drugs, use pharma protocols, central role in educating nurses & patients on appropriate use of drugs Clinical judgement in Prescribing- Is a prescription the right tx? Goals of therapy, effective drugs for the disease? Monitoring goals met? Cost? Collaboration with other providers- different perspective on prescribing, critical for quality patient care Autonomy and Prescriptive authority- varies state to state. 21 states are independent prescribing, 26 are autonomous. Chapter 2: Review of Basic Principles of Pharmacology Metabolism: Biotransformation/ Chemical change of drug structure Enhance excretion, inactivate the drug, increase therapeutic action, activate pro-drug, increase/decrease toxicity Factors (Age, genetics, pregnancy, liver dz, time of day, environment, diet, alcohol, drug interactions) Drug Dose Determined: a) Dose-response relationship b) Therapeutic index: ratio of lethal dose/therapeutic dose c) Plasma level profile: Onset of action time d) Half-life e) Bioavailability: % of drug absorbed & available. Effected by incomplete absorption & first-pass metabolism Tissue Distribution: Fats=lipid-soluble drugs (low blood flow), bone (tetracycline deposits in bone & teeth), Blood-brain barrier= impenetrable only lipid-soluble drugs cross (Levadopa), Placental barrier= low molecular weight drugs pass easier (ethanol) Receptors: agonist: drug bind to/stimulates cell causing a response Antagonists: drug binds to/occupies cell without stimulating a response Potency: lower drug concentration to require response Efficacy: max effect a drug can produce Pro-drug: Given inactive form, body metabolizes into the active compound (Levadopa) Pharmacokinetics: 1. Absorption: Mvmt of drug from site of administration to blood- Variables: blood flow, solubility of drug, pH, molecular weight, drug concentration, dosage 2. Distribution: Mvmt of absorbed drug in fluids thru body to target tissue 3. Protein Binding: Circulation, some of drug is bound to protein & some not (free drug) The FREE drug is the active drug. Low albumin = Free Drug in circulation Example: Phenytoin (dilatin) Seizure drug, measure lvl of phenytoin & albumin to adjust to appropriate level 4. Metabolism (including first-pass and Phase I and II): LIVER a) Phase I: Oxidation (Increase water solubility) b) Phase II: Union of Drug molecule w/ water soluble substance Cytochrome P450 metabolism (IN LIVER) A. Inhibit CYP450 is CYP3A4. Metabolizes Azoles (Antifungals), statins, prednisone, carbamazepine. Present in GI tract affected by food (Grapefruit juice inhibits the CYP3A4 increasing drug levels) B. Induction of CYP450: Increased enzyme synthesis or decreased enzyme degradation (Phenobarbital induces enzyme activity- increases metabolism) Excretion: 1. Renal: passive glomerular filtration, active tubular secretion Factors: age, hydration, cardiac output, kidney fxn 2. Biliary: drugs excreted in bile can be reabsorbed into intestine 3. Lungs: Gases (eg for volatile drugs) First Pass Effect: Rapidly metabolized by liver & has little desired action left Chapter 3: Rational Drug Selection Process of rational drug prescribing: 6 Steps proposed by WHO: define the problem, specify the therapeutic objective, collaborate with the patient, choose the treatment, educate the patient, monitor effectiveness Patient education: Poor adherence, pt education @ 5th-6th grade lvl, purpose of med, instructions for administration, & adverse drug reactions Monitor effectiveness: Passive: patient educated on outcome & instructed to contact provider. Active: Follow up lab tests & monitoring to measure therapeutic effectiveness Drug, Patient, and Provider factors that influence drug selection: 1) Drug Factors: pharmacokinetic, pharmacodynamics, therapeutic, safety, cost, patient factor, provider factor, alt. therapies 2) Patient factors: Previous adverse rxns, health beliefs, current drug therapy, drug interactions, consult PharmD on complex drug regimens, patient age, pregnancy 3) Provider factors: ease of prescribing/monitoring, formularies, personal list

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