NR 565 Advanced Pharmacology Fundamentals Week 1-4 &
Midterm Exam Study Guide
APRN prescribing role
Prescriptive authority for nurse practitioners also regulates prescribing rights beyond medications and
controlled substances. These rights include therapeutic 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, 2016). Most patients receiving a prescription are taking other medications, whether
prescription or over-the-counter. Appropriate selection, dosing, and duration of pharmaceutical agents
are key to maximizing outcomes and minimizing adverse effects
benefits of full practice authority
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
promoting positive outcomes through prudent prescribing practices
Administering medications and prescribing medications are two distinct processes. Prescription writing
requires prudent and deliberate decision-making processes to maintain patient safety and reduce
liability, including:
*documentation of a provider-patient relationship for the recipient of the prescribed medications
*documentation of a thorough history and physical examination for the recipient
*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 formulation of a diagnosis based on
clinical reasoning and the selection and monitoring of the most appropriate pharmacological treatment
, Considerations include: Cost, guidelines, availability, interactions, side effects, allergies, hepatic/renal
functions, need for monitoring, & special populations
Beer's Criteria
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.
Pharmacodynamics
the study of the biochemical and physiologic effects of drugs on the body and the molecular
mechanisms by which those effects are produced
Pharmacokinetics
the study of drug movement throughout the body
Pharmacogenomics
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
CYP450 inducers
Inducers are xenobiotics (medications and environmental agents) that elevate 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 inhibitors
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
metabolism (Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole,
Grapefruit Juice, Quinidine)
cultural influences in prescribing
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
Midterm Exam Study Guide
APRN prescribing role
Prescriptive authority for nurse practitioners also regulates prescribing rights beyond medications and
controlled substances. These rights include therapeutic 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, 2016). Most patients receiving a prescription are taking other medications, whether
prescription or over-the-counter. Appropriate selection, dosing, and duration of pharmaceutical agents
are key to maximizing outcomes and minimizing adverse effects
benefits of full practice authority
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
promoting positive outcomes through prudent prescribing practices
Administering medications and prescribing medications are two distinct processes. Prescription writing
requires prudent and deliberate decision-making processes to maintain patient safety and reduce
liability, including:
*documentation of a provider-patient relationship for the recipient of the prescribed medications
*documentation of a thorough history and physical examination for the recipient
*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 formulation of a diagnosis based on
clinical reasoning and the selection and monitoring of the most appropriate pharmacological treatment
, Considerations include: Cost, guidelines, availability, interactions, side effects, allergies, hepatic/renal
functions, need for monitoring, & special populations
Beer's Criteria
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.
Pharmacodynamics
the study of the biochemical and physiologic effects of drugs on the body and the molecular
mechanisms by which those effects are produced
Pharmacokinetics
the study of drug movement throughout the body
Pharmacogenomics
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
CYP450 inducers
Inducers are xenobiotics (medications and environmental agents) that elevate 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 inhibitors
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
metabolism (Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole,
Grapefruit Juice, Quinidine)
cultural influences in prescribing
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
