Exam (elaborations) NURP 422 (NURP422) NURP 422 - Exam 1 Study Guide.

Office Hours- Review of Concepts with Dr. Aboagye
50 QUESTIONS TOTAL
UNDERSTAND KEY TOPICS

REGULATION & PRESCRIBING

 NO questions on history of nurse practitioner
 Drug Development Process
o Pre-Clinical
 Animal testing, no human testing, many years

o Once determined they want to start testing on humans, an investigational new drug application is
filed --- once approved different phases will occur

o Phase I
 Short phase (only few months), small group of HEALTHY individuals, usually less than
100 individuals
 Looking at identifying side effects, tolerance, determining safe dose range

o Phase II
 SAFETY PHASE --- Months to years
 Studies are on humans with TARGET disease, small population of100-200 individuals
 Identifying side effects, common short-term side effects, best treatment regiment
 Highest rate of drug failure in this phase

o Phase III
 REGULATORY PHASE --- years to decades
 Monitoring safety and efficacy, large population - thousands of individuals in multiple
locations
 Specialists in the field

o NEW DRUG APPLICATION- done investigating and want this drug available to the general
population

o Phase IV
 AFTERMARKET
 Drug is on the market but continues to be monitored, specifically looking at special
populations, safety and adverse events, observational studies

 Know your nurse practice act- know what it is and how it influences NPs
o Regulatory bodies
 Board of nursing
 Determines scope of practice for RN and NP
 DEA
o know what it is/role/function/ect
o DEA does NOT determine the scope of practice for NP- only provide number so NP can
prescribe according to scope of practice in home state

 Important to know what each category includes
 Schedule I
 High abuse potential, no current medical use per FDA

,  Marijuana: states are passing law, but FDA is not in agreement
 Heroin, ecstasy
 Schedule II
 High abuse potential
 Narcotics, amphetamines such as stimulants (ADHD),
 There are some regulations on refills, how rx gets to pharmacy
 Schedule III
 Moderate abuse potential
 Schedule IV
 Low abuse
 Schedule V
 Lowest abuse potential

 What does it mean to be a conscientious prescriber?
o What we need to ASK before prescribing medications
 Allergies?
 What happens when they take a medication?
 What medications is this individual on?
 What is the past medical Hx?
 If child bearing age, when was last period?

o What do I need to CONSIDER?
 How much is the Rx, can pt afford? Can they fill the rx?
 Health literacy: Do they understand what I am saying? Can they read the information
presented?
 Has my pt been involved in decision making process? Is pt agreeable to this Rx/plan of
care? If not involved- they may not want to take the medication  failure
 Have I done everything I can to make sure the pt is adherent?
 What can I do to help my pt follow this Tx plan?
 Have I selected the most appropriate drug and dose?
 Have I considered co-morbidities?
 Have I taken into consideration current meds/allergies?

 Master at writing correct, appropriate, and complete Rxs-
o full SIG is very important. He says #10 on the practice sheet is a very common test question that
you might see again

o 10. Prescribe 60 year old F Lisinopril for new diagnosis of hypertension.

 Lisinopril 10mg-Take 1 tablet by mouth daily for high blood pressure. #30 tabs 0 refills.
 Big key is to understand the simple concepts

 Side effects vs. Adverse Effects
o What does that mean for us as a provider?

o Side Effect:
 If pt has side effect, we may avoid in future to improve adherence
 But if ONLY drug that will work for pt, we can still prescribe
 Common SE: GI issues (make sure to ask what “allergy” is)
o Adverse effect
 You can’t, won’t, don’t want to prescribe

,  Something that is not expected
o Example: Lisinopril
 Commonly causes a cough in patients --- SIDE EFFECT
 If lisinopril causes angioedema --- ADVERSE EFFECT

PHARMACODYNAMICS: Action of the drug

 What is pharmacodynamics?
o The study of the biochemical and physiologic effects of drugs and places emphasis on dose-
response relationship (drug concentration and effect). Mechanism of action- How a drug affects
an organism, whereas pharmacokinetics is how the organism affects the drug, both of these
together influence dosing, benefit and adverse effects. What can affect pharmacodynamics?
Route of administration, rate of metabolism, rate of distribution and excretion. 1. Individual
characteristics (age and ethnicity) 2. Disorder. 3. Concentration of the drug at the receptor site. 4.
Drug to drug interaction.

 Characteristics of ligand-receptor binding: Lock and Key. Depends on size and shape of the drug and
the receptor. Drug binds to receptor site, transduces the signal across the cell membrane to produce a
biologic/cellular response. Dependent on affinity. Binding with either mimic the body’s effects (agonist)
or block the body’s effect (antagonist)

 Receptors (LOCK)
o Proteins that interact with ligand
o Primarily present on plasma membrane
o Have life cycle and can be recycled

 Agonist (KEY)

 Ligand binds to receptors
o Ligands can be neurotransmitters, hormones, medications

 Medication binds to receptor and activates response
o (Key fits into lock, key turns, door opens  RESPONSE)

 Receptor Types
o Ligand Gated Ion Channel
 Ligand binds open channel- Na goes in, K comes out
o Cytokine receptors
 Respond to peptides
o G- Protein
 Most common
 Require 2nd messengers & energy

o What is going on in body to make these drugs work?

 Signal Transduction Pathway Triggered by ligand binding, cell recognition, creating a conformation
change in the receptor and then the signal is transmitted across the cell membrane to initiate a response.
o Occurs by 2nd messenger
o Phase I
 Signal recognition- Ligand binds
o Phase II