PMHNP Psychopharm Exam 2 2024
Once you graduate from an NP program, in order to prescribe you'll need: - -Advanced nurse
prescriber license
-DEA #
What is the purpose of a DEA #? - Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - -Written script needed
-1 month supply only
-No refills
What is the PDMP? - Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health facilities
(in the same state)
What are clinical practice guidelines? - Recommendations that are intended to optimize
patient care that are informed by a systematic review of the evidence and an assessment of
the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes (usually
through passive diffusion)? - Small, uncharged (unionized), lipid soluble--pass through
membrane without any energy
What does it mean when a drug is ionized? - It means that the drug is stuck in the
compartment it was ionized in and has to be moved to the next compartment (cannot be
absorbed into the bloodstream)
Where do weak acids absorb? - Stomach
,Where do weak bases absorb? - Small intestine
pH of stomach: - 2-4
pH of small intestine: - 6-7
pH of large intestine: - 6-7
pH of bloodstream: - 7.35-7.45
pH of bladder: - 5-8
pH of breastmilk: - 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? - In the
small intestine (since the stomach has a pH of 2-4, so the drug will become ionized and move
to the small intestine where it will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - Drugs that are weak acids
(aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it to be
excreted, not reabsorbed through the bloodstream.
What is distribution? - How a drug will be transported to the tissues it needs to go to in order
for it to exert its effects
Drug factors related to distribution: - -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - -Vascularity (poor perfusion, disruption of blood flow
due to trauma--difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the brain--
will need very high dosing since only a small amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? - Albumin
, Why do we monitor albumin? - Indicative of nutritional status and how well protein-bound
drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has very low
levels of albumin? - The drug does not bind to the protein (albumin) as much as expected, so
there is a lot of free drug floating in the plasma; high risk for drug toxicity
Protein bound means: - Inactive form of the drug; does not have any therapeutic effect when
bound to a protein
Free drug means: - Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein binding
site on the albumin? - Some drug interactions can occur. Drugs fight for binding position, but
both drugs do not get enough as the usually would. Leads to higher free drug levels,
decreased overall albumin binding, and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - PO drug goes through GI tract and absorbs in the stomach or
intestines into local circulation that reaches the liver. The liver inactivates portions of the
drug before it goes into systemic circulation. Some drugs with a very high 1st pass effect may
have to be given IV (goes directly into systemic circulation) or in higher PO doses (watch for
side effects)
What does a substrate for an enzyme mean? - It needs it to undergo metabolism
What is an enzyme inducer? - It increases clearance of the drug (decreased blood levels of
drug--may need dose increase)
What is an enzyme inhibitor? - It reduces clearance (increased blood levels of drug--may
need dose decrease)
Who is at risk for drug toxicity? - Elderly, those with decreased renal function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? - -Decreased
absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - Category A
What is the contraindicated drug category for pregnant women? - Category X
What is pharmacodynamics? - What the drug does to the body
Once you graduate from an NP program, in order to prescribe you'll need: - -Advanced nurse
prescriber license
-DEA #
What is the purpose of a DEA #? - Needed to prescribed scheduled drugs
Rules for prescribing Schedule II drugs: - -Written script needed
-1 month supply only
-No refills
What is the PDMP? - Prescription Drug Monitoring Program
Used to effectively track patient's controlled substance uses across different health facilities
(in the same state)
What are clinical practice guidelines? - Recommendations that are intended to optimize
patient care that are informed by a systematic review of the evidence and an assessment of
the benefits/harms of alternative care practices
Ex: sepsis, CAP
Common causes of medication errors: - -Illegible writing
-Drug names that sound alike
-Medications that look alike
-Administering a drug with the wrong route
What is pharmacokinetics? What are its 4 categories? - What the body does to the drug
1. Absorption
2. Metabolism
3. Distribution
4. Excretion
Quickest route of absorption? Slowest? - IV = quickest
IM = slowest
What is the most common way drugs pass through cell membranes? - Passive diffusion
What characteristics of a drug allow it to pass most quickly through cell membranes (usually
through passive diffusion)? - Small, uncharged (unionized), lipid soluble--pass through
membrane without any energy
What does it mean when a drug is ionized? - It means that the drug is stuck in the
compartment it was ionized in and has to be moved to the next compartment (cannot be
absorbed into the bloodstream)
Where do weak acids absorb? - Stomach
,Where do weak bases absorb? - Small intestine
pH of stomach: - 2-4
pH of small intestine: - 6-7
pH of large intestine: - 6-7
pH of bloodstream: - 7.35-7.45
pH of bladder: - 5-8
pH of breastmilk: - 7.1
Where will a drug absorb if it is a weak base that ionizes at a pH of 4 and lower? - In the
small intestine (since the stomach has a pH of 2-4, so the drug will become ionized and move
to the small intestine where it will be able to absorb into the bloodstream)
How can we manipulate the urine pH in cases of overdose? - Drugs that are weak acids
(aspirin) can be trapped and excreted through the urine.
We raise pH of the urine (with sodium bicarb) to force the drug to ionize and allow it to be
excreted, not reabsorbed through the bloodstream.
What is distribution? - How a drug will be transported to the tissues it needs to go to in order
for it to exert its effects
Drug factors related to distribution: - -Lipid solubility
-Molecular size
-Degree of ionization
-Duration of action
-Cellular binding
-Therapeutic effects
-Toxic effects
(lipid soluble, small, and non-ionized drugs will distribute more quickly)
Body factors related to distribution: - -Vascularity (poor perfusion, disruption of blood flow
due to trauma--difficulty distributing)
-Blood barriers (blood-brain-barrier can be problematic if we need to get drugs to the brain--
will need very high dosing since only a small amount of the drug will get through)
-Transport mechanisms
-Plasma binding proteins
-Disease states
-Volume of distribution
-Drug interactions
What is the key plasma protein involved with protein binding for medications? - Albumin
, Why do we monitor albumin? - Indicative of nutritional status and how well protein-bound
drugs will be transported to their target locations
What happens to the therapeutic effect of a drug when the patient is elderly and has very low
levels of albumin? - The drug does not bind to the protein (albumin) as much as expected, so
there is a lot of free drug floating in the plasma; high risk for drug toxicity
Protein bound means: - Inactive form of the drug; does not have any therapeutic effect when
bound to a protein
Free drug means: - Active form of the drug (available for therapeutic effect)
What happens when a patient is on two drugs that are competing for the same protein binding
site on the albumin? - Some drug interactions can occur. Drugs fight for binding position, but
both drugs do not get enough as the usually would. Leads to higher free drug levels,
decreased overall albumin binding, and potential toxicity for both drugs.
**Unpredictable**
What is the 1st pass effect? - PO drug goes through GI tract and absorbs in the stomach or
intestines into local circulation that reaches the liver. The liver inactivates portions of the
drug before it goes into systemic circulation. Some drugs with a very high 1st pass effect may
have to be given IV (goes directly into systemic circulation) or in higher PO doses (watch for
side effects)
What does a substrate for an enzyme mean? - It needs it to undergo metabolism
What is an enzyme inducer? - It increases clearance of the drug (decreased blood levels of
drug--may need dose increase)
What is an enzyme inhibitor? - It reduces clearance (increased blood levels of drug--may
need dose decrease)
Who is at risk for drug toxicity? - Elderly, those with decreased renal function
-Cannot properly excrete the drug
What are the key pharmacokinetic changes that occur during pregnancy? - -Decreased
absorption
-Increased hepatic metabolism
-Increased renal excretion
**Dose adjustments are common during pregnancy
What is the safest drug category for pregnant women? - Category A
What is the contraindicated drug category for pregnant women? - Category X
What is pharmacodynamics? - What the drug does to the body
