Test #1 Flashcards
The Role of the NP in Prescribing (gen)
The NP role requires basic knowledge of a drug and combining it with advanced knowledge about a medical diagnosis you make and the pathophysiology of the disease or illness.
The Role of the NP in Prescribing (List)
Includes knowledge of bioequivalence
Cost of the drug
Generic versus Brand
Enzyme systems in metabolism that can lead to drug interactions
Pharmacokinetics of the drug/class/genetics
Legal authority of NP to write the drug
Constraints to write the drug. Health plan or no health plan.
What period is most teratogenic in fetal development
3-9 weeks (embryonic period)
4 Pharmokinetic Actions
Absorption
Metabolism
Elimination
Distribution
Most important aspect of NP when she is prescribing for a woman who is pregnant:
LActmed website use, and educate the pt on the use.
Pharmacodynamics
Processes through which drugs affect the body
What vaccines should pregnant woman receive
Hepatitis A - risk vs. benefit.
Hepatitis B - Some circumstances.
Influenza (Inactivated) - Recommended.
Meningococcal (ACWY) - May be used if otherwise indicated.
Meningococcal (B) - risk vs. benefit.
PCV13 - No recommendation.
PPSV23 I- No recommendation.
Polio - May be used if needed.
Td Should be used if otherwise indicated (Tdap preferred).
Tdap - Recommended.
When is Tdap given
3rd Trimester
27 and 36 weeks
SOAPP
Screener and Opioid Assessment for Patients with Pain
What is SOAPP
Questionnaire designed to help providers evaluate the patients’ relative risk for developing problems when placed on long-term opioid therapy.
Contract’s for opioid use
Between NP and the patient, provides a systematic approach to opioid administration
Narrow therapeutic index drugs
Anticonvulsants (phenytoin) Oral hypoglycemic medicines (glibenclamide (Diabeta)) Oral anticoagulants (acenocumarol, warfarin) Antifungals (amphotericin B) Antidysthrymic medicines (quinidine) Aminoglycosides (gentamicin) Anticancer medicines (5 fluorouracil) Digitalis glycosides (digoxin) Lithium carbonate (lithium) Immunosuppressive medicines (cyclosporine) Antiretrovirals (zidovudine) Theophylline
Pharmokinetic Absorption:
First, the drug is absorbed from the site of administration and permits entry of the therapeutic agent (either indirectly or directly) into the plasma.
Pharmokinetic Distribution:
Second, the drug may then reversibly leave the bloodstream and distribute into the interstitial and intracellular tissues.
Pharmokinetic Metabolism:
Third, the drug may be biotransformed by metabolism by the liver (prodrug), or by other tissues.
Pharmokinetic Elimination:
Final step, the drug and its metabolites are eliminated from the body.
First-Pass Effect
The phenomenon by which a drug first passes through the liver for degradation before distributed to the tissues.
Schedule 3-5 Restrictions
Schedule III drug prescriptions can be refilled up to five times within 6 months.
Examples of Schedule III drugs include many narcotics containing codeine (Tylenol #3) and nonbarbiturate sedatives. Also can include hormones (Testosterone)
Schedule 4
Can be refilled up to five times within 6 months.
Examples of Schedule IV drugs include nonnarcotic analgesics and antianxiety agents such as lorazepam (Ativan), alprazolam (Xanax)
Schedule 2 Restrictions
No refills permitted
Written prescriptions only (no telephone orders)
Prescription expires in 72 h if not filled.
Narcotics (morphine, codeine, meperidine, opium, hydromorphone, oxycodone, oxymorphone, methadone)
Stimulants (cocaine, amphetamine, methylphenidate)
Depressants (pentobarbital, secobarbital)
DEA Drug Schedule
The Drug Enforcement Agency (DEA), established in 1973, is a branch of the U.S. Department of Justice. The DEA evaluates substances along with the FDA to see if they meet the criteria to be a scheduled drug. If so, they then classify these drugs into five schedules according to their abuse potential
Controlled Substances Act
Comprehensive Drug Abuse Prevention and Control Act was made law in 1970.
Title II is the legal foundation of narcotics enforcement in the United States. The Controlled Substances Act regulates the manufacture, possession, movement, and distribution of certain drugs
Does an NP needs co-signer on prescription script?
Not in NY
Who gives prescriptive authority
Individual states
Most important aspect of NP when she is prescribing for a woman who is pregnant
LActmed website use, and educate the pt on the use.
Best practices in drug prescribing
Follow up in short amount of time
Cytochrome P450 (CYP450) - 6 Familys
CYP1A2
CYP2C9
CYP2C19
CYP2D6
(approx 25% many antidepressant drugs)
CYP2E1
CYP3A4
(approx 35-40%)
CYP2D6
CYP2D6 is a highly variable gene with 77 different alleles and is a major determinant of the interindividual variability among patients in plasma concentrations of Tricyclic antidepressants (e.g., Amitriptyline) and Selective Serotonin Reuptake Inhibitors (SSRI’s) (e.g., Prozac).
Vaccine Information Statement VIS
before the vaccination, comes in 30 languages
How to manage the person diagnosed with HTN
lifestyle,
meds, generic meds when possible
education
cheaper drugs
How to manage someone pregnant with UTI or might be pregnant
urine culture
Pregnant woman if injured should receive in the first or second trimester
Hepatitis B immune globulin (HBIG)
Vaccine Recommendation Not Safe In Pregnancy
Human Papillomavirus (HPV) -Not recommended.
Influenza (LAIV) - Contraindicated.
MMR - Contraindicated.
Varicella - Contraindicated.
Zoster - Contraindicated.
CYP1A2
Sub - acetome, Estradiol, Caffeine
Inducer - Tabacco, Grill Meats, Insulin
inhibitor - Cimetidine, Amiodarone, Ticlopidine
CYP2C19
Sub - Daizepam, Omeprazole, progesterone
Inducer - Prednione, Riframpin
inhibitor - Cimetidine, Ketokonazole, Omeprazole
CPY2D6
Sub - Debrisoquine, Ondansatron , amphetamine
Inducer - Dex?, Riframpin
inhibitor - Cimetidine, Fluoxetine, Methadone
CYP3A4-5-6
Sub - Cyclosporin, Clarithomicin , hydrocortisone, Vincristine
Inducer - Barbituates, Glucocotocsteriods St Johns Wort ?, Riframpin
inhibitor - Cimetidine, Clarithomicin Ketokonazole, Grapefruit
