NR 565 Advanced Pharmacology
Midterm Study Guide – Key Concepts,
Clinical Applications, and Practice
Review
State Laws Impact on Prescriptive The regulation of prescriptive authority is under the
Authority jurisdiction of a health professional board. This may be the
State Board of Nursing, the State Board of Medicine, or the
State Board of Pharmacy, as determined by each state.
Although the federal government controls drug regulation, it
has no control over prescriptive authority.
Full Practice Authority In a full practice environment, NPs can conduct client
evaluations, diagnose, order, and interpret diagnostic tests,
and initiate and manage treatments, including prescribing
medications and controlled substances. This level of practice
occurs under the state board of nursing's exclusive licensure
and is the preferred model by leading national nursing
and medical organizations.
,Nurse Practitioner Role: Prescriptive - Prescriptive authority for nurse practitioners regulates
Authority 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. Appropriate selection, dosing, and duration of
pharmaceutical agents are key to maximizing outcomes
and minimizing adverse effects.
Metabolic influences on drug - Age
administration - Induction and inhibition of drug-metabolizing enzymes
(P450)
- First-pass effect:
- Nutritional status
- Competition between drugs
Renal Disease Impact on Kidney disease can reduce drug excretion, causing drugs to
Pharmacodynamics accumulate in the body. If the dosage is not lowered,
drugs may accumulate to toxic levels. Accordingly, if a
patient is taking a drug that is eliminated by the kidneys,
and if renal function declines, the dosage must be
decreased.
Generic vs Brand Name Generic drugs are chemically identical to their brand-name
counterparts but are typically less expensive. Brand-name
drugs are marketed under a proprietary name and often have
higher costs due to research, development, and marketing
expenses. Generic drugs must meet the same standards for
quality, safety, and efficacy as the brand-name drugs.
Duration of Therapy This refers to the length of time a medication should be
taken to effectively treat a condition. It's important to
follow
prescribed durations to ensure that the medication works as
intended and to prevent issues such as drug resistance or
relapse of the condition.
Role of Formularies Formularies are lists of medications that are preferred
and covered by a particular health insurance plan or
healthcare system. They are designed to guide prescribing
practices by promoting cost-effective treatments while
ensuring that effective and safe medications are
available.
, Blood Flow Impact on Absorption Drugs are absorbed most rapidly from sites where blood flow
is high because blood containing a newly absorbed drug
will be replaced rapidly by drug-free blood, thereby
maintaining a large gradient between the concentration of
drug outside the blood and the concentration of drug in the
blood. The greater the concentration gradient, the more rapid
absorption will be.
Bioavailability and Variable Drug - Bioavailability = the amount of an active drug that reaches
Responses the systemic circulation from its site of administration.
- Different formulations of the same drug can vary
in bioavailability. Factors such as tablet disintegration
time,
enteric coatings, and sustained-release formulations can alter
bioavailability and thereby make drug responses variable.
- Differences in bioavailability occur primarily with
oral preparations.
- Differences in bioavailability are of greatest concern for
drugs with a narrow therapeutic range.
Drug Metabolism & Therapeutic Index For drugs that have a high therapeutic index (TI), altered rates
of metabolism may have little effect on the clinical outcome.
However, if the TI is low or narrow, then relatively small
increases in drug levels can lead to toxicity and relatively
small decreases in drug levels can lead to therapeutic failure.
Genetic Variants & Drug Metabolism - The most common mechanism by which genetic variants
modify drug responses is by altering drug metabolism.
- These gene-based changes can either accelerate or slow the
metabolism of many drugs. The usual consequence is either a
reduction in benefits or an increase in toxicity.
Genetic Variants That Alter Drug - CYP2D6 variants: Tamoxifen: reduced effect
Metabolism - CYP2C19 variants: Clopidogrel: reduced effect
- CYP2C9 variants: Warfarin: increased toxicity
- TMPT variants: Thiopurines: increased toxicity
Absorption The process by which a drug moves from its
administration site into the bloodstream.
Distribution Once in the bloodstream, a drug must be distributed to
sites of action throughout the body via the vascular
system.
Metabolism The process where the body chemically alters drugs for
therapeutic use and forms them into components that can be
more easily excreted.
Excretion Involves the removal of drugs and their metabolites from
the body.
Midterm Study Guide – Key Concepts,
Clinical Applications, and Practice
Review
State Laws Impact on Prescriptive The regulation of prescriptive authority is under the
Authority jurisdiction of a health professional board. This may be the
State Board of Nursing, the State Board of Medicine, or the
State Board of Pharmacy, as determined by each state.
Although the federal government controls drug regulation, it
has no control over prescriptive authority.
Full Practice Authority In a full practice environment, NPs can conduct client
evaluations, diagnose, order, and interpret diagnostic tests,
and initiate and manage treatments, including prescribing
medications and controlled substances. This level of practice
occurs under the state board of nursing's exclusive licensure
and is the preferred model by leading national nursing
and medical organizations.
,Nurse Practitioner Role: Prescriptive - Prescriptive authority for nurse practitioners regulates
Authority 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. Appropriate selection, dosing, and duration of
pharmaceutical agents are key to maximizing outcomes
and minimizing adverse effects.
Metabolic influences on drug - Age
administration - Induction and inhibition of drug-metabolizing enzymes
(P450)
- First-pass effect:
- Nutritional status
- Competition between drugs
Renal Disease Impact on Kidney disease can reduce drug excretion, causing drugs to
Pharmacodynamics accumulate in the body. If the dosage is not lowered,
drugs may accumulate to toxic levels. Accordingly, if a
patient is taking a drug that is eliminated by the kidneys,
and if renal function declines, the dosage must be
decreased.
Generic vs Brand Name Generic drugs are chemically identical to their brand-name
counterparts but are typically less expensive. Brand-name
drugs are marketed under a proprietary name and often have
higher costs due to research, development, and marketing
expenses. Generic drugs must meet the same standards for
quality, safety, and efficacy as the brand-name drugs.
Duration of Therapy This refers to the length of time a medication should be
taken to effectively treat a condition. It's important to
follow
prescribed durations to ensure that the medication works as
intended and to prevent issues such as drug resistance or
relapse of the condition.
Role of Formularies Formularies are lists of medications that are preferred
and covered by a particular health insurance plan or
healthcare system. They are designed to guide prescribing
practices by promoting cost-effective treatments while
ensuring that effective and safe medications are
available.
, Blood Flow Impact on Absorption Drugs are absorbed most rapidly from sites where blood flow
is high because blood containing a newly absorbed drug
will be replaced rapidly by drug-free blood, thereby
maintaining a large gradient between the concentration of
drug outside the blood and the concentration of drug in the
blood. The greater the concentration gradient, the more rapid
absorption will be.
Bioavailability and Variable Drug - Bioavailability = the amount of an active drug that reaches
Responses the systemic circulation from its site of administration.
- Different formulations of the same drug can vary
in bioavailability. Factors such as tablet disintegration
time,
enteric coatings, and sustained-release formulations can alter
bioavailability and thereby make drug responses variable.
- Differences in bioavailability occur primarily with
oral preparations.
- Differences in bioavailability are of greatest concern for
drugs with a narrow therapeutic range.
Drug Metabolism & Therapeutic Index For drugs that have a high therapeutic index (TI), altered rates
of metabolism may have little effect on the clinical outcome.
However, if the TI is low or narrow, then relatively small
increases in drug levels can lead to toxicity and relatively
small decreases in drug levels can lead to therapeutic failure.
Genetic Variants & Drug Metabolism - The most common mechanism by which genetic variants
modify drug responses is by altering drug metabolism.
- These gene-based changes can either accelerate or slow the
metabolism of many drugs. The usual consequence is either a
reduction in benefits or an increase in toxicity.
Genetic Variants That Alter Drug - CYP2D6 variants: Tamoxifen: reduced effect
Metabolism - CYP2C19 variants: Clopidogrel: reduced effect
- CYP2C9 variants: Warfarin: increased toxicity
- TMPT variants: Thiopurines: increased toxicity
Absorption The process by which a drug moves from its
administration site into the bloodstream.
Distribution Once in the bloodstream, a drug must be distributed to
sites of action throughout the body via the vascular
system.
Metabolism The process where the body chemically alters drugs for
therapeutic use and forms them into components that can be
more easily excreted.
Excretion Involves the removal of drugs and their metabolites from
the body.
