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Summary NURS 6234 - Midterm Exam Study Guide
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NURS 6234 - Midterm Exam Study Guide /NURS 6234 - Midterm Exam Study Guide
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1NURS6234 Midterm Study Guide
1.Clinical judgment and decision making as an APRN prescribing medications.
Roles and responsibilities of APRN prescribers:
●APRN is responsible for the final decision on which drug to use for a patient
●Autonomy in this role varies from state to state based on the nurse Practice Act of that
state
●All states have title protection for NPs. Only Oregon has mandated third party
reimbursement parody for NP services
●In all but five states, the control of practice and licensure is within the sole authority of
the state's Board of Nursing. These five states have joint control in the Board of Nursing
and the Board of Medicine.
●Scope of practice is determined by the individual NP’s license under the nurse Practice
Act of the licensing jurisdiction. Employment sites may restrict this legal scope of
practice but cannot extend it.
●In 17 States and the District of Columbia, NP's have independent scope of practice and
prescriptive Authority without a requirement or attestation for physician collaboration,
consultation, delegation, or supervision.
●Six States have fully autonomous practice and prescriptive authority following a period
of post licensure/post certification supervision or collaboration.
Advanced knowledge:
●It is the role and responsibilities of the NP to determine the diagnosis for which a drug
will be ordered, prescribed the appropriate drug, monitor the expected outcome of the
drug, and incorporate a holistic assessment of the impact of disease and therapy on
patient lives.
●The NP will need additional knowledge about prescriptive authority and which drug fits
within the legal authority of an NP to prescribe in his or her state.
●The NP needs to be aware of new drugs that come on the market, medication alerts, and
label changes due to post marketing analysis.
Clinical judgment in prescribing:
●The best therapy is the least invasive, least expensive, and least likely to cause
adverse reactions.
●The best choice is to have lifestyle, non-pharmacological, and pharmacological
therapies working together.
Current issues and trends in healthcare and their effect on prescriptive authority:
●Autonomy and prescriptive authority- battles continue between APRN and physicians at
national and many state levels over physician supervision requirements and co-signatures
on prescriptions. The AMA continues to stress the need for physician supervision and
final authority for the patient even for APRNs who hold the DNP.
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●Interdisciplinary teams-would provide care of higher quality with better patient outcomes
if the strength of each team member were fully utilized.
●Level of Education of team members
●Reimbursement
2.Basic principles of pharmacology
Pharmacology is the study of drugs and their actions.
Drugs are any chemical substance that produce a measurable biological response. They may be
prescription medications, non-prescription medications, botanicals, drugs of abuse, and poisons.
Pharmacogenomics is the study of how individual variations and drug targets or metabolism affect drug
therapy. These studies can identify factors that are responsible for beneficial or adverse effects an
individual patients.
Ideal drug properties:
● convenient route of administration, probably taken by mouth
● established dosage
● immediate onset of action
● produces a single desired biological action
● produces no unwanted effects
● convenient duration of action
● dosage unaffected by loss of kidney or liver function or by disease state
● improve quality of life
● prolongs patient survival
Clinical stages of new drug development:
●Phase I clinical trials - establish biological effects as well as safe dosages and pharmacokinetics
in a small number of healthy patients
●Phase II clinical trials - new drugs are used to treat disease in a small number of patients and to
establish the potential of the drug to improve patient outcomes.
●Phase III clinical trials - compares the new medication to standard therapy in a larger number of
patients studied at sites across the country. New drugs must be at least as good as, and it is hoped
better than, other available therapies.
Throughout the process, pharmaceutical companies work with the FDA. After being approved by the
FDA, drugs are continuously monitored through post-marketing surveillance. Health professionals are
encouraged to report adverse events which are studied by both pharmaceutical companies and the FDA.
Drug Responses
Homeostasis is the tendency of a cell, tissue or the body. Before a medication can produce a response, it
often must overcome homeostatic mechanisms. Measurement of biological responses when we administer
medication is important. The following is ways to express and compare drug activity so that we can
describe the action or effect of drugs, compare the effects of different drugs, and predict their
pharmacological effects.
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Dose- Response Curves -The higher the concentration of a drug at its site of action, the more the drug will
bind to the receptor and the greater the response. With a greater number of drug molecules in the vicinity,
more of them are likely to interact with the receptor. Drug responses are directly related to the fraction of
receptors that are occupied, or bound, by a drug, so that 50% of the maximum response occurs at a blood
level or concentration at which a drug occupies 50% of its receptors. However fewer receptors may be
needed to produce a maximum effect depending on the number of receptors in the tissue and the drugs
binding ability.
Types of Drug Responses - There are two basic types of drug responses; they differ in how they are
measured and dictate dosing decisions to achieve the desired effect.
1.Quantal- Responses that may or may not occur; designated as occurring or absent (ex.
convulsions, pregnancy, rash, sleep, death); data from a population of patients is used to establish
appropriate dosage or blood levels to predict quantal effects in a large number of patients.
2.Graded- most responses are graded; these responses are biological effects that can be measured
continually up to the maximum responding capacity of the biological system (ex. blood pressure,
heart rate, diuresis, bronchodilation, FEV1, pain [scale 1-10], coma score); these responses are
easier to manage clinically because we can see how each patient responds to a particular dose of
medication and alter the dosage to achieve a greater or lesser response.
Expressing Drug Responses - Showing the relationship between dose or concentration and drug effect
using graphs that show the dose-response relationship, or dose response curve. Pharmacologist compare
drugs and their actions in several ways (potency, efficacy, intrinsic activity, and selectivity).
●Potency -the expression of how much drug is
needed to produce a biological response;
describes the difference in concentration or
dosage of different drugs required to produce a
similar effect. Drugs that differ in potency differ
in their horizontal position on the dose-response
curve.
● Efficacy- the ability of a drug to produce a
maximum effect at any dosage; the expression of
the maximum effect a drug can produce.
●Intrinsic activity - very similar to efficacy in that
it represents the ability of a drug to produce a
large response; used to describe the ability of a
drug to produce a response once it has occupied
specific receptors.
Drug Selectivity- a ratio of the dose or concentration producing the undesired effects to the dose or
concentration producing the desired effect (how many times the therapeutic dosage needs to be increased
to produce the undesired effect).
●Therapeutic index (TI) -a special ratio describing drug selectivity; ratio of the lethal dose of a drug
to the therapeutic dose of a drug; provides fixed comparison for drug safety; TI of drugs on the
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