(Summary) Advanced Pharmacotherapeutics MSN, Questions and Correct Answers With Complete Solution Guide For Your Exams. 2024/2025.
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Advanced Pharmacotherapeutics MSN,
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Advanced Pharmacotherapeutics MSN,
(Summary) Advanced Pharmacotherapeutics MSN, Questions and Correct Answers With Complete Solution Guide For Your Exams. 2024/2025.
Drug Safety
Maximum effect with minimum amount of side effects
FDA all medications must be approved by the FDA
anyone who prescribes needs an NPI (national pr...
(Summary) Advanced Pharmacotherapeutics
MSN, Questions and Correct Answers With
Complete Solution Guide For Your Exams.
2024/2025.
Drug Safety
Maximum effect with minimum amount of side effects
FDA all medications must be approved by the FDA
anyone who prescribes needs an NPI (national provider identifier)...used for electronic
tracking for anything or any prescription of medical devices (i.e. diabetic shoes, a cane,
etc.) > this is provided by the CENTERS FOR MEDICARE OR MEDICAIDE SERVICES
= CMS.
Phase I clinical trials
on healthy people (occurs after testing on animals)
Phase II clinical trials
the first time the drug is administered in patients with the actual disease process for
which the drug is intended to treat.
- effectiveness and tolerability
- multicentric
Phase III clinical control
randomized controlled with double-blinded arms. may also include dose-ranging
studies.
- multicentric
approved or rejected
Phase IV (phase four)
are we comparing this drug to another drug? post marketing studies. This is where we
see a lot of side effects because so many more people are taking it.
scheduled drugs
schedule is 1-5
(schedule 1 is the most intense = highest potential for abuse, highly addictive. little to no
therapeutic effect. i.e. heroin, cocaine) CANNOT BE PRESCRIBED
schedule 2 (high abuse high addictive..prescribed for very specific situations). needs a
paper prescription. no refills allowed). can't really be called in. print it out, hand sign and
date it (i.e. no "30" but "thirty") NEED DEA NUMBER
schedule 3 (lower addiction lower abuse but still some addiction) i.e. percocet. paper
prescripiton, signed and dated. New prescription each month just like schedule 2 NEED
DEA NUMBER
,schedule 4 (benzos, valium, ativan...less addictive still but still some potential) NEED
DEA NUMBER
schedule 5 (robitussin with codeine) NEED DEA NUMBER
DEA
US Drug Enforcement Agency (controls number and caliber of people who have the
license)
a patient can be affected if they go between brand name to generic or generic to
generic meds.
CAM
Complimentary or Alternative Medicine
sold as food supplements so not FDA approved
truth in labeling act, in 2004
ability to prescribe is determined by...
the state
African Americans
VERY responsive to Calcium channel blockers but NOT to ACE inhibitors
Nurse practitioner prescriptive authority is regulated by
The State Board of Nursing for each state
Rx Requirements (for practitioner)
Name and Title
Practice address and phone
License and NPI
DEA # if a controlled substance
...also name and number of collaborating physician but you don't need their NPI or DEA
number
Rx Requirements (for patient)
Patient Information (dob)
Medication and formulation
strength and frequency
Quantitity (may need to spell out)
refills
signature
Pharmacogenomics
Pharmacogenetics starts with an unexpected drug response result and looks for a
genetic cause
Pharmacogenomics on the other hand begins with looking for genetic differences within
a population that explain certain observed responses to a drug or susceptibility to a
health problem
First Pass Effect
,most drugs given orally must first pass through the liver.
Destroys part of the drug before its distributed widely
"dosage" refers the the amount of the drug that is absorbed by the body AFTER first
pass effect
Pharmacology
- The study of drugs
Drug
- Any substance that when taken into a living organism, may modify 1 or more of
its functions
- Any substance that when taken into a living organism, may modify 1 or more of its
functions
Pharmacotherapeutics
- Use of drugs to prevent, treat, or diagnose a disease
Pharmacokinetics
- How the body deals with the drug
- Absorption: Rate and efficiency depend on route of administration; Transfer of a drug
from the site of administration to the bloodstream
Bioavailability
- % of drug given that reaches the bloodstream in an un-metabolized form
- Ex: 100g of drug given, 50g enters bloodstream - the drug is 50% bioavailable
- Influenced by route of administration; IV drugs are 100% bioavailable
- Distribution
- Metabolism
- Elimination
Factors Effecting Absorption/Bioavailability
• Drug formulation influences rate of absorption
- Dissolution must occur before absorption
- Immediate release (IR) formulations dissolve quickly
- Extended, delayed release formulations dissolve slowly → absorbed over an extended
time
- Enteric coating (EC) delays absorption
• EC ASA dissolves in the intestines to prevent gastric irritation
ie aspirin can have an enteric coating. good for patients who have heart disease and
would benefit from aspirin but have a history of stomach ulcers. Aspirin is really acidic
and will increase the acidity of gastric contents.
WE NEVER REALLY KNOW WHAT IS GOING TO HAPPEN TO THE DRUG
• Rate of gastric emptying affects absorption
- ↑ gastric emptying → drug is delivered to the small intestine more quickly to enhance
absorption
• Blood flow to intestine is > than that of the stomach → ↑ absorption
• Diet and gastric emptying
, - High fat meals and solid foods = decreased gastric emptying
• Drugs that slow gastric motility = increased absorption
- Example is anticholinergics
• Laxatives and diarrhea = decreased absorption
• ↓ Gastric motility • Blood circulation
- Injected drugs into a hypoperfused arealimited bioavailability
- ↓ blood flow to GI mucosa
- ↓ blood flow to IM or SC area (i.e. chronic diabetics, HTN, etc)
Pharmacokinetics Absorption
• Rate and efficiency depend on route of administration
• Transfer of a drug from the site of administration to the bloodstream
- PO drugs: GI tract → bloodstream
Crossing the Cellular Membrane
• Passive diffusion
- Diffusion is the movement of drugs from an area
of higher concentration to lower concentration
- Deals with strength of the barrier, distance of travel, and size of the molecule
- Large particles can cross via facilitated diffusion, otherwise called active transport of
facilitated transport
• Lipid solubility
- The cell membrane is a lipid
- Solubility of the drug must match the solubility of the site
- Lipid-soluble drugs vs. water soluble drugs
a lipid soluble drug is also called a lipophilic drug
• PCN = Water soluble (so doesn't cross cellular membrane easily and doesn't cross
blood brain barrier easily)
• DIAZEPAM = Lipid soluble
• pH
- Non-ionized drugs cross the membrane barrier
more readily
- Weak acids vs. weak bases
weak acids cross barrier in an acidic environment better. a weak acid drug like aspirin
will be absorbed in the stomach easily. So drugs that absorbed easily in the acidic
environment of the stomach will not be well-absorbed if the pt is also taking an antacid
- Gastric acid effect on weak acids and intestinal effect of weak bases
- Acidic drugs are better absorbed in acidic environment (stomach); alkaline drugs are
better absorbed in alkaline environment (small intestine)
Pharmacokinetics (distribution)
• Process by which the drug leaves the bloodstream and enters cells of the tissues
• Volume of distribution (Vd)...this relates the total amount of drug in the body to its
plasma concentration. In other words, the amount distributed in the body
- Ratio of the amount of drug administered to the concentration of the drug in the
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