NR 565 Midterm Exam Study Guide Advanced Pharmacology Fundamentals - Chamberlain
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 Administering medications and prescribing medications are two distinct
prescribing practices 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
,NR 565 Midterm Exam Study Guide Advanced Pharmacology Fundamentals - Chamberlain
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 knowledge to guide initial dosing (with adjustment, as
indicated based on response) if genetic testing is not feasible or warranted
Polypharmacy: Definition, challenges, and outcomes treatment with multiple drugs
greatly increases the risk for interactions. Some of these interactions are
negligible, but some can have life-threatening consequences. It is of crucial
importance to ask the patient about all current drugs, including over-the-
counter (OTC) medications and other herbal preparations. Many patients do
not consider OTC or alternative pharmaceuticals as "medications" and may not
mention them unless you ask specifically.
Acute Pain Management
Chronic Pain Management
Opioid Management
, NR 565 Midterm Exam Study Guide Advanced Pharmacology Fundamentals - Chamberlain
Regulations of Controlled Substances The U.S. Department of Justice Drug Enforcement Agency (DEA) coordinates
with local, state, and federal agents to reduce illicit drug use. The DEA enacted
the Controlled Substances Act (CSA) in 1970 to regulate drugs and other
substances based on their potential for abuse and dependency. Five schedules
of controlled substances were created that are updated annually. Classes of
scheduled substances include narcotics, depressants, stimulants,
hallucinogens, and anabolic steroids. The DEA issues eligible providers with a
registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of
MG2705208
M=nurse practitioner and G=Greene
Opioid Epidemic & Responsible Prescribing
Opioid Use Disorder a pattern of use that leads to significant impairment or distress. Typically, this
disorder is marked by unsuccessful efforts to reduce or control use resulting in
the inability to fulfill work, school, or home responsibilities. Opioid use disorder
is different from drug tolerance and physical dependence, which may also
exist. Opioid use creates high levels of positive reinforcement, increasing the
likelihood of continued use. It is often a chronic lifelong disorder, leading to
serious consequences such as disability and death. Although it is similar to
other substance use disorders, it has distinct features that have fueled the
current opioid epidemic. Opioids can lead to physical dependence in only 4-8
weeks. Abruptly stopping use in chronic users leads to severe symptoms, which
motivates continued use to prevent withdrawal. The 2016 CDC guidelines for
prescribing opioids recommends calculating the total daily dose of opioids to
help identify patients who might benefit from the reduction or tapering of
opioids, given the risk of overdose
State Prescription Drug Clinicians should review the patient's history of controlled substance
prescriptions using state prescription drug monitoring program (PDMP) data to
determine whether the patient is receiving opioid dosages or dangerous
combinations that put him or her at high risk for overdose. Clinicians should
review PDMP data when starting opioid therapy for chronic pain and
periodically during opioid therapy for chronic pain, ranging from every
prescription to every 3 months.
Monitoring Programs safeguards to address the opioid public health crisis include prescription drug
monitoring programs (PDMPs). These electronic databases enable providers to
access information regarding a patient's prescription history of controlled
substances. Nearly all states have implemented PDMPs, and some states
require providers to check the PDMP before prescribing controlled
substances. According to the CDC (2020), PDMPs have shown promising
results in changing prescribing behaviors, decreasing the use of multiple
providers by patients, and decreasing substance abuse treatment admissions.
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 Administering medications and prescribing medications are two distinct
prescribing practices 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
,NR 565 Midterm Exam Study Guide Advanced Pharmacology Fundamentals - Chamberlain
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 knowledge to guide initial dosing (with adjustment, as
indicated based on response) if genetic testing is not feasible or warranted
Polypharmacy: Definition, challenges, and outcomes treatment with multiple drugs
greatly increases the risk for interactions. Some of these interactions are
negligible, but some can have life-threatening consequences. It is of crucial
importance to ask the patient about all current drugs, including over-the-
counter (OTC) medications and other herbal preparations. Many patients do
not consider OTC or alternative pharmaceuticals as "medications" and may not
mention them unless you ask specifically.
Acute Pain Management
Chronic Pain Management
Opioid Management
, NR 565 Midterm Exam Study Guide Advanced Pharmacology Fundamentals - Chamberlain
Regulations of Controlled Substances The U.S. Department of Justice Drug Enforcement Agency (DEA) coordinates
with local, state, and federal agents to reduce illicit drug use. The DEA enacted
the Controlled Substances Act (CSA) in 1970 to regulate drugs and other
substances based on their potential for abuse and dependency. Five schedules
of controlled substances were created that are updated annually. Classes of
scheduled substances include narcotics, depressants, stimulants,
hallucinogens, and anabolic steroids. The DEA issues eligible providers with a
registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of
MG2705208
M=nurse practitioner and G=Greene
Opioid Epidemic & Responsible Prescribing
Opioid Use Disorder a pattern of use that leads to significant impairment or distress. Typically, this
disorder is marked by unsuccessful efforts to reduce or control use resulting in
the inability to fulfill work, school, or home responsibilities. Opioid use disorder
is different from drug tolerance and physical dependence, which may also
exist. Opioid use creates high levels of positive reinforcement, increasing the
likelihood of continued use. It is often a chronic lifelong disorder, leading to
serious consequences such as disability and death. Although it is similar to
other substance use disorders, it has distinct features that have fueled the
current opioid epidemic. Opioids can lead to physical dependence in only 4-8
weeks. Abruptly stopping use in chronic users leads to severe symptoms, which
motivates continued use to prevent withdrawal. The 2016 CDC guidelines for
prescribing opioids recommends calculating the total daily dose of opioids to
help identify patients who might benefit from the reduction or tapering of
opioids, given the risk of overdose
State Prescription Drug Clinicians should review the patient's history of controlled substance
prescriptions using state prescription drug monitoring program (PDMP) data to
determine whether the patient is receiving opioid dosages or dangerous
combinations that put him or her at high risk for overdose. Clinicians should
review PDMP data when starting opioid therapy for chronic pain and
periodically during opioid therapy for chronic pain, ranging from every
prescription to every 3 months.
Monitoring Programs safeguards to address the opioid public health crisis include prescription drug
monitoring programs (PDMPs). These electronic databases enable providers to
access information regarding a patient's prescription history of controlled
substances. Nearly all states have implemented PDMPs, and some states
require providers to check the PDMP before prescribing controlled
substances. According to the CDC (2020), PDMPs have shown promising
results in changing prescribing behaviors, decreasing the use of multiple
providers by patients, and decreasing substance abuse treatment admissions.
