NURS615 Advanced Pharmacotherapeutics Exam I Study Guide
NURS615 Advanced Pharmacotherapuetics
Exam I Study Guide
1. Identify the stages of drug development and how the drugs are tested at each phase. Pg. 33
Phase 1: (establish biological effects as well as safe dosages and pharmacokinetics in small
numbers of health patients-p. 12). Testing of a new compound in health subjects, for the
purpose of establishing the tolerance of health human subjects at different doses, defining its
pharmacological effects at anticipated therapeutic levels, and studying its absorption,
distribution, metabolism, and excretion patterns in humans. Phase 2: Controlled clinical
evaluation is done on patients with a specific disease or disorder to determine the medications
possible uses and short term risks. Usually the study is conducted on only several hundred
subjects or less. Phase 3: Controlled and uncontrolled clinical trials of a drug’s safety and
efficacy in hospital and outpatient settings. Gather precise information on drugs efficacy for
specific indications to determine if there is a wider range of adverse effects on those that it did in
a small study. They try to identify what way the drug is best administered (PO,IV,IM).If the drug
is approved this information forms what goes on the drug label. Phase 3 solidifies phase 2.
2. Differentiate between the prescribing of medications by physicians, nurses, and physician’s
assistants. PAGES 4, 6, 7, 8
Physicians can prescribe prescriptions as long as they have a current license; must have a DEA
for narcotics-schedule l & ll and they must follow the rules and regs of their states medical
board. Nurses cannot prescribe prescriptions unless they are a licensed APRN and have
prescriptive authority-must follow their state laws-each state varies; APRN’s must have a DEA
for prescribing narcotics. Physician assistants can prescribe as long as they have a current
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license/work under a physician and have a DEA for narcotics and follow their states prescribing
rules.
Research has shown that adherence is better for prescriptions given by NPs, as they have a
holistic approach in care and educate their patients. All states have title protection. Depending
upon state, practice may be autonomous in prescriptive authority. NPs have their own DEA
number and most states permit schedules II to V prescribing. PAs have title protection in all
states. Depending upon state, some have limits by protocol created by the supervising physician.
Some states permit PA prescribing of schedule III to V drugs. Practice oversight or supervision
must be present by physician. Pas often have their own DEA number with wide scope of practice
that is defined by their supervising physician.
3. What factors are associated with clinical judgment when prescribing medications? Pg 25-26
Evidenced-based guidelines are the gold standard for initial drug selection, but providers need to
examine the drugs recommended in the guideline for their clinical utility with the individual
patient. The provider must consider several factors regarding the drug and the patient who will
be receiving the medications: pharmacokinetics, pharmacodynamics, therapeutic issues, safety,
and cost.
Pharmacodynamic factors of a drug must be specific and selective to the target tissues affected
by the disease to have the greatest therapeutic effect with the least adverse effects. The
relationship between the drugs desired therapeutic effects and its adverse effects is called its
therapeutic index. Drugs with the low therapeutic index may require close monitoring for
toxicity and versus facts, where drugs with a wide therapeutic index are fairly safe and require
less monitoring. Pharmacodynamics means the study of the effects of the drug on the body.
Pharmacokinetic factors. This is how the body reacts to the drug. It is the study and analysis of
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the time course of the drug in the body. How well are the drugs absorbed and eliminated.
3.)therapeutic factors 4.)safety 5.)Cost 6.) patient factors 7.) adverse drug reactions 8.) Provider
factors
4. What are the criteria for choosing an effective drug? Pg 26, 27, 28
Safety, cost, patient factors, previous adverse drug reactions, health beliefs, current drug therapy,
patient age, pregnancy; Provider factors include ease of prescribing or monitoring and
formularies
5. How does hypoalbuminemia affect the process of prescribing? Pg. 945, 1359 patho book
Because most medications are bound to serum albumin, the patient with hypoalbuminemia may
demonstrate exaggerated pharmacological response because of excess free drug. This increases
your patients risk for drug toxicity. In the presence of renal failure, elimination half-life of this
drug may be prolonged, protein binding decreased, and peak plasma levels increased.
ANS: Reduced drug dosages may be indicated in these cases.
http://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/plasma_proteins/6.html In a pt with
hypoalbuminemia drugs especially antibiotics are unable to bind as needed with albumin which
means there is more of the drug free in the plasma then there would be in a pt with a normal
albumin level.Drug-plasma protein binding forms a "reservoir" of drug, but only the free
(unbound) drug is available to the tissues to exert a therapeutic effect. This condition appears to
be associated with alterations in the degree of protein binding of many highly protein-bound
antibacterials, which lead to altered pharmacokinetics and pharmacodynamics, although this
topic is infrequently considered in daily clinical practice. The effects of hypoalbuminaemia on
pharmacokinetics are driven by the decrease in the extent of antibacterial bound to albumin,
which increases the unbound fraction of the drug. Unlike the fraction bound to plasma proteins,
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