Pharm Midterm Study Guide
Chapter 1 Prescriptive Authority (The legal right to prescribe drugs)
State Law Impact: State laws determine the scope of NP practice. Some
states NPs may have full practice authority and other states they may have
restricted authority and have to be supervised by an MD or DO. Physicians
have full practice authority. APRN’s are educated to practice independently.
Full Practice Authority: The legal right to prescribe independently
without limitation. The ability to prescribe meds is both a privilege and a
burden. Be PRUDENT and DELIBERATE in decision making. Physicians
have full practice authority. If limitations/restrictions, prescribing would be
monitored by MD or DO. Limited authority *creates barriers to healthcare
by limiting quality, affordable, accessible patient care. Nurse prac’s can
prescribe schedule II-V (2 through 5).
Role of Prescriptive Authority: Prescriptive authority is a critical
component of autonomous practice. *Safe and competent practice of
prescribing and managing meds requires sound understanding of drugs and
the conditions they are used to manage. A nurse prac could have full
practice authority in one state but be limited in another so that could be
confusing for contract workers who go state to state (locum tenens).
Prescriptive authority is not regulated by the government, it is regulated by
the state board.
Chapter 2 Drug Interactions and Formularies
When in doubt follow the current guidelines for treatment of a
particular disease or symptom.
Assessing Drug Interactions: Evaluate patient med lists for potential
interactions that may alter therapeutic effects or increase the risk of
adverse effects. Polypharmacy greatly increases the risk of
reaction/interactions so ask about all drugs taken even OTC and herbal
supplements. Hepatic and renal dysfunction usually requires a change of
dosage due to decrease in function. Be sure to have a documented provider-
patient relationship.
Prescriptions: A complete prescription includes the following:
Prescribers names, license number and contact information
prescribers DEA number if prescribing a controlled substance
Patient name, DOB and full address
,Patient allergies
Name of medication
Indication of medication (example is atenolol for hypertension)
Medication strength (25mg)
Dose of medication and frequency (25mg once a day)
Quantity dispensed
Any refills available
EMR USE: E- prescribing makes it less likely to cause error due to direct
transmission.
Role of Formularies: A formulary is a list of medications that are approved
for use by a healthcare system or insurance plan. They help guide cost
effective and evidence based prescribing decisions. Each facility/pharmacy
provides a list of drugs according to a formulary. They are selected by
pharmacists and providers and will need to follow guidelines created by
regulatory agencies like the centers for medicare and Medicaid services.
May depend on drug costs, available rebates and the presence of generic
meds on the market. *The drug you want may not be available in your
facility or at a specific pharmacy.
Impact of Drug Selectivity on Side Effects: Drugs with high selectivity
bind only to specific receptors, reducing off target effects and minimizing
adverse reactions. Low selectivity increases risk of side effects. All drugs
have side effects, some adverse and some beneficial, monitor and ask
questions after starting any drug.
Chapter 3 Generic Vs. Brand Name Drugs
Value of Knowing: Providers need to be aware of drug names and what
they are for bc some patients may say “blood pressure pill”. Generic drugs
must meet bioequivalence standards by having the same active ingredient,
strength, dosage form and route as brand name. Understanding this helps
reduce cost without sacrificing effectiveness. The most important provider
action is medication education and to explain importance and expel rumors.
Keep a list of meds on you at all times. The patients need to know generic
and brand name. *Patients are more likely to take meds if they know the
outcome is positive. Knowing will help them follow through with the med
plan.
Duration of Therapy: Providers must determine appropriate length of time
a med should be taken based on condition treated. *Failure to recognize the
need for prolonged therapy is a common reason patients stop meds
, prematurely when a prescription runs out.. Example is antibiotics for
infection or thyroid hormone therapy for hypothyroidism.
Chapter 4 Pharmacokinetics and Receptor Action
Pharmacokinetics: The study of biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects
produce. Study of drug movement through the body.
Excretion Process:Removal of drugs from the body, primarily through the
kidneys. Can also exit through urine, bile, sweat, saliva, breast milk, expired
air. Mostly the kidneys! If the kidneys are damaged the duration and
intensity of drug responses may increase. Kidneys account for most of drug
excretion. Factors like patients age, drug competition and renal disease
affect excretion. Drugs that are excreted through bile leave in feces.
Breastmilk can affect infants.
Metabolism Process: Metabolism is biotransformation. Most drugs are
metabolized in the liver via enzyme systems, especially cytochrome P450
systems (CYP450). Which is a hepatic enzyme system that helps metabolize
drugs. There are lots of enzyme systems/families but only CYP1, CYP2,
CYP3 metabolize drugs. *The most important consequence of drug
metabolism is the promotion of renal drug excretion. The most common
result of drug metabolism is drug inactivation where drug metabolism can
convert pharmacologically active compounds to inactive forms. Infant
metabolism is limited bc the liver is not fully developed. Infants and older
adults are sensitive and may need reduced doses. Metabolism can increase
the effectiveness of some drugs like converting codeine into morphine.
Tylenol can cause liver toxicity due to metabolism. If someone has liver
damage, they may have poor metabolism. Lipid soluble drugs are
reabsorbed easily while polar/ionized drugs are excreted.
First-pass effect- Also known as first pass metabolism. Is the process by
which a drugs concentration is significantly reduced before it reaches the
systemic circulation. Basically its when the drug is metabolized in the liver
and the drugs bioavailability is decreased before reaching systemic
circulation. AKA the rapid hepatic inactivation of certain oral drugs. The
solution to avoid the first pass effect is to give meds IV or IM to skip the
liver all together and enter systemic circulation faster. When drugs are
absorbed in the GI tract (oral meds), they go to the liver before entering
systemic circulation. A drug that undergoes rapid hepatic metabolism is
Chapter 1 Prescriptive Authority (The legal right to prescribe drugs)
State Law Impact: State laws determine the scope of NP practice. Some
states NPs may have full practice authority and other states they may have
restricted authority and have to be supervised by an MD or DO. Physicians
have full practice authority. APRN’s are educated to practice independently.
Full Practice Authority: The legal right to prescribe independently
without limitation. The ability to prescribe meds is both a privilege and a
burden. Be PRUDENT and DELIBERATE in decision making. Physicians
have full practice authority. If limitations/restrictions, prescribing would be
monitored by MD or DO. Limited authority *creates barriers to healthcare
by limiting quality, affordable, accessible patient care. Nurse prac’s can
prescribe schedule II-V (2 through 5).
Role of Prescriptive Authority: Prescriptive authority is a critical
component of autonomous practice. *Safe and competent practice of
prescribing and managing meds requires sound understanding of drugs and
the conditions they are used to manage. A nurse prac could have full
practice authority in one state but be limited in another so that could be
confusing for contract workers who go state to state (locum tenens).
Prescriptive authority is not regulated by the government, it is regulated by
the state board.
Chapter 2 Drug Interactions and Formularies
When in doubt follow the current guidelines for treatment of a
particular disease or symptom.
Assessing Drug Interactions: Evaluate patient med lists for potential
interactions that may alter therapeutic effects or increase the risk of
adverse effects. Polypharmacy greatly increases the risk of
reaction/interactions so ask about all drugs taken even OTC and herbal
supplements. Hepatic and renal dysfunction usually requires a change of
dosage due to decrease in function. Be sure to have a documented provider-
patient relationship.
Prescriptions: A complete prescription includes the following:
Prescribers names, license number and contact information
prescribers DEA number if prescribing a controlled substance
Patient name, DOB and full address
,Patient allergies
Name of medication
Indication of medication (example is atenolol for hypertension)
Medication strength (25mg)
Dose of medication and frequency (25mg once a day)
Quantity dispensed
Any refills available
EMR USE: E- prescribing makes it less likely to cause error due to direct
transmission.
Role of Formularies: A formulary is a list of medications that are approved
for use by a healthcare system or insurance plan. They help guide cost
effective and evidence based prescribing decisions. Each facility/pharmacy
provides a list of drugs according to a formulary. They are selected by
pharmacists and providers and will need to follow guidelines created by
regulatory agencies like the centers for medicare and Medicaid services.
May depend on drug costs, available rebates and the presence of generic
meds on the market. *The drug you want may not be available in your
facility or at a specific pharmacy.
Impact of Drug Selectivity on Side Effects: Drugs with high selectivity
bind only to specific receptors, reducing off target effects and minimizing
adverse reactions. Low selectivity increases risk of side effects. All drugs
have side effects, some adverse and some beneficial, monitor and ask
questions after starting any drug.
Chapter 3 Generic Vs. Brand Name Drugs
Value of Knowing: Providers need to be aware of drug names and what
they are for bc some patients may say “blood pressure pill”. Generic drugs
must meet bioequivalence standards by having the same active ingredient,
strength, dosage form and route as brand name. Understanding this helps
reduce cost without sacrificing effectiveness. The most important provider
action is medication education and to explain importance and expel rumors.
Keep a list of meds on you at all times. The patients need to know generic
and brand name. *Patients are more likely to take meds if they know the
outcome is positive. Knowing will help them follow through with the med
plan.
Duration of Therapy: Providers must determine appropriate length of time
a med should be taken based on condition treated. *Failure to recognize the
need for prolonged therapy is a common reason patients stop meds
, prematurely when a prescription runs out.. Example is antibiotics for
infection or thyroid hormone therapy for hypothyroidism.
Chapter 4 Pharmacokinetics and Receptor Action
Pharmacokinetics: The study of biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects
produce. Study of drug movement through the body.
Excretion Process:Removal of drugs from the body, primarily through the
kidneys. Can also exit through urine, bile, sweat, saliva, breast milk, expired
air. Mostly the kidneys! If the kidneys are damaged the duration and
intensity of drug responses may increase. Kidneys account for most of drug
excretion. Factors like patients age, drug competition and renal disease
affect excretion. Drugs that are excreted through bile leave in feces.
Breastmilk can affect infants.
Metabolism Process: Metabolism is biotransformation. Most drugs are
metabolized in the liver via enzyme systems, especially cytochrome P450
systems (CYP450). Which is a hepatic enzyme system that helps metabolize
drugs. There are lots of enzyme systems/families but only CYP1, CYP2,
CYP3 metabolize drugs. *The most important consequence of drug
metabolism is the promotion of renal drug excretion. The most common
result of drug metabolism is drug inactivation where drug metabolism can
convert pharmacologically active compounds to inactive forms. Infant
metabolism is limited bc the liver is not fully developed. Infants and older
adults are sensitive and may need reduced doses. Metabolism can increase
the effectiveness of some drugs like converting codeine into morphine.
Tylenol can cause liver toxicity due to metabolism. If someone has liver
damage, they may have poor metabolism. Lipid soluble drugs are
reabsorbed easily while polar/ionized drugs are excreted.
First-pass effect- Also known as first pass metabolism. Is the process by
which a drugs concentration is significantly reduced before it reaches the
systemic circulation. Basically its when the drug is metabolized in the liver
and the drugs bioavailability is decreased before reaching systemic
circulation. AKA the rapid hepatic inactivation of certain oral drugs. The
solution to avoid the first pass effect is to give meds IV or IM to skip the
liver all together and enter systemic circulation faster. When drugs are
absorbed in the GI tract (oral meds), they go to the liver before entering
systemic circulation. A drug that undergoes rapid hepatic metabolism is
