NURS 615/NURS615 Exam 1 Study Guide Compilation

. What factors are associated with clinical judgment when prescribing medications? a. Laws: federal & state b. State board of nursing c. History & physical d. Diagnostics e. Follow up – is the drug working? Is your diagnosis correct? i. Sometimes additional drugs need to be added (ex. HTN) ii. You’d go from 1st, 2nd to 3rd lines of therapy or add adjunctive therapy iii. Prescribe the least expensive medication & most effective & least harm or adverse effects iv. Is it the right dosage? f. Sometimes nonpharmacological tx can be used g. Consider pt allergies & their reactions (vs adverse reaction) h. Has the patient already tried something for what you’re treating i. What other medications are they taking (including supplements) are their drug interactions? j. Consider abilities to store drug and comply with therapy k. Less frequency is better l. Are you giving the drug via the best route (ex. vanc stays in get when oral) m. Duration of treatment – life long? Short term? n. And time to get to a therapeutic effect o. Genomics & metabolism p. Can they afford the therapy? 2. What are the criteria for choosing an effective drug? a. Is the therapy efficacious for the patient b. 6 step WHO model pus AAFP added a couple steps i. Define patient problem ii. Therapeutic objective iii. Choose drug/treatment iv. Initiate therapy. Are there any nonpharmacologic adjunctive therapies? v. give information, instructions, and warnings vi. Follow up regularly to evaluate treatment effectiveness vii. Drug cost viii. Use computers & other tools to reduce prescribing errors 3. Describe the process of passive diffusion and the factors that affect a drug's ability to passively diffuse across a cell membrane. a. High to low concentration area until equilibrium is achieved (no energy required) b. Small, non-charged (non-ionized), lipid-soluble drugs can move most easily via passive diffusion 4. How does hypoalbuminemia affect the process of prescribing? a. Albumin is the primary carrier of drugs in the body b.  albumin =  free drug  need to decrease the dose of medications c. CA pts, pts w/ Liver disease, malnourished pts, pts in certain infectious states d. Drugs that are minimally bound penetrate better than those that are highly protein bound but are also excreted much faster. e. Protein-bound drugs tend to stay in the plasma & stay in circulation but are not able to bind to the receptor until it is unbound – this protects the proteinbound drugs from metabolism and excretion