1. Be familiar with prescriptive authority for nurse practitioners (Ch. 2, pg. 10)
Beginning in 1995, nurse practitioner programs developed greater standardization, relying on
criteria developed by accrediting agencies, the American Association of Colleges of Nursing, and
the National Organizati...
chamberlain college of nursingnr 508nr508 week 2 study guide
Written for
Chamberlain College Of Nursing
NR 508
All documents for this subject (311)
Seller
Follow
Themanehoppe
Reviews received
Content preview
NR508 Week 2 Study Guide
1. Be familiar with prescriptive authority for nurse practitioners (Ch. 2, pg. 10)
Beginning in 1995, nurse practitioner programs developed greater standardization, relying on
criteria developed by accrediting agencies, the American Association of Colleges of Nursing, and
the National Organization of Nurse Practitioner Faculties. One publication that had an influence
on the preparation of NPs for prescriptive practice was the NONPF task force–developed
Curriculum Guidelines and Criteria for Evaluation of Pharmacology Content to Prepare Family
Nurse Practitioners for Prescriptive Authority and Managing Pharmacotherapeutics in Primary
Care (NONPF, 1997). This is now available as Curriculum Guidelines and Regulatory Criteria for
Family Nurse Practitioners Seeking Prescriptive Authority to Manage Pharmacotherapeutics in
Primary Care (Yocom et al, 1999). The Pharmacotherapeutic preparation of NPs had been one of
the most variable components of curricula. A few programs accepted whatever courses nurses
had taken in their undergraduate program, whereas other programs required 6 to 7 hours of
biochemistry and advanced pharmacology taken with medical students. With more states
passing legislation for NP prescriptive authority, NPs wanted to be well prepared for the legal
and professional responsibilities associated with writing prescriptions. The move to more clearly
specify content in the area of pharmacotherapy was intended to help dispel any criticism that
NPs might not have received adequate preparation to prescribe. Box 2-1 provides recommended
course content and program competencies in pharmacotherapeutics for Family Nurse
Practitioner programs. Prescriptive authority in the United States is primarily controlled and
regulated by state legislatures and regulatory bodies. They determine the types of drugs to be
prescribed, the degree of prescriptive authority to be granted, the regulatory bodies involved in
controlling prescriptive practice, and the educational standards that must be met to obtain
prescriptive privileges. Changes to prescriptive practices occur through the coordinated efforts of
health care providers and other interested groups in working with legislators. The primary
differences among states include the degree of professional autonomy or independence
recognized by each state and the range of drugs from which NPs are permitted to select, largely
because of the influence of organized medicine (Safreit, 1992).
2. Know the mechanisms of action of Tetracycline’s (Ch. 61, pg. 683-684)
The basic tetracycline structure is a hydronaphthacene nucleus that contains four fused six-
carbon rings. Tetracyclines differ in terms of substitutions on the fifth, sixth, or seventh position
of the basic tetracycline structure. These substitutions affect lipid solubility, serum half-life, and
the effect that food has on bioavailability of the drug. The tetracyclines are bacteriostatic
antibiotics. Their mechanism of action is to inhibit protein synthesis in the susceptible organism
by binding to the 30S ribosome subunit, thereby impeding the binding of aminoacyl tRNA to the
receptor site on the messenger RNA ribosome complex. Tetracycline’s also may reversibly bind to
50S ribosomal subunits and may alter cytoplasmic membranes of susceptible organisms,
resulting in leakage of cytosolic nucleotides. This action requires active microbial growth that
distinguishes tetracyclines as bacteriostatic rather than bactericidal agents.
3. Know the uses of Tetracycline antibiotics (Ch. 61, pg. 684)
Little difference in microbial activity is noted between the different tetracyclines. Tetracyclines
are wide-spectrum antibiotics that are useful for empirical therapy. They are one of the drugs of
first choice for acute bacterial exacerbation of COPD, chlamydia, and rickettsial infection, and
they provide a second-line consideration for many other infections, especially in a patient with
allergy to other antibiotics.
, The choice between tetracyclines is made by determination of drug characteristics. Doxycycline
and minocycline are the two most commonly used tetracyclines. Most tetracyclines must not be
taken with milk or antacids; however, minocycline and doxycycline do not have this complicating
factor, so it is easier to get the patient to take them correctly. Also, doxycycline has a longer half-
life than tetracycline. Doxycycline produces less gastrointestinal disturbance than the other
tetracyclines, although it can cause diarrhea. Overall, doxycycline is the most useful tetracycline
in primary care; however, it is imperative that pregnant women not take tetracyclines.
Nonantibiotic actions of tetracyclines result in anti-inflammatory processes,
immunosuppression, inhibition of lipase and collagenase, enhancement of gingival fibroblast cell
attachment, and wound healing.
How to monitor:
Obtain baseline tests for renal and hepatic function and a CBC every 3 months for
patients on long-term therapy. May cause increased AST, ALT, serum alkaline
phosphatase, bilirubin, and amylase concentrations. Additionally, all tetracyclines except
doxycycline may increase serum BUN.
Loss of appetite, jaundice, or abdominal pain may indicate possible hepatotoxicity.
Minocycline: A change in mental status could indicate possible intracranial hypertension.
4. Know Contraindications of oral contraceptive pills (OCP) (Ch. 54, pg. 620 Ch. 55, pg. 635)
Box 54-5 Clinical Considerations in Contraceptive Choice:
Suggested
Condition Considerations Solution Contraceptive
Age over 40 Increased cardiovascular risk 35 mcg or less of EE or Low-estrogen COCPs,
POP transdermal or vaginal
ring, POPs, IUD—either
hormonal or
nonhormonal, implant,
DMPA
Adolescent Risk for noncompliance Individualize to patient's Low-estrogen COCPs,
needs transdermal or vaginal
ring, POPs, implant,
DMPA
Cardiovascular risk Assess risk factors, asymptomatic COCP safe with Low-estrogen COCPs,
disease superficial varicosities transdermal, vaginal ring,
Mitral valve prolapse other methods preferable:
POPs, IUD—either
hormonal or
nonhormonal, implant,
DMPA
Diabetes mellitus Estrogen ↓ glucose tolerance COCP safe with no end- Low-dose COCP, low
Progestins ↑ glucose resistance stage disease progestin; no POPs
Hypercoagulable; Estrogen increases coagulability Safe if treated with POPs, DMPA, Mirena
coagulation anticoagulants IUD, implant, barrier
disorders COCPs, transdermal and methods
vaginal ring
contraindicated
Dysmenorrhea Estrogens increase dysmenorrhea, Low or no estrogen POPs, continuous cycling
flow COCPs, DMPA,
transdermal, vaginal ring,
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Themanehoppe. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.49. You're not tied to anything after your purchase.
