MSN 571 Questions & answers 2022

Prescriptive authority legal authority granted to advanced practice nurses to prescribe medication; DETERMINED BY STATE LAW Rational Drug Selection based on individual patient and addresses disease specific information: ONLY A GUIDELINE Drug Selection includes analysis of cost, guidelines, avaibalbility, interactions, side effects, allergies, hepatic and renal function, need for monitoring, special precautions i.e elderly medication education basic components medication name purpose dosing regimen administration adverse effects any storage needs associated labs testing food & drug interactions duration of therapy medication adherence barriers to adherence= forgetfulness lack of planning cost dissatisfaction altered dosing Phamacokinetics study of drug movement throughout body principles of pharmacokinetics absorption distribution metabolism excretion Passage of drugs across membranes - channels and pores - transport systems (P-glycoprotein) - direct penetration of the membrane Absorption of drugs Transfer of drugs from site of administration across cell membrane into the blood stream factors that affect absorption of drugs rate of dissolution- how easy dissolves surface area- surface area moves faster blood flow- blood flow moves faster lipid solubility - lipid easily cross membrane ph partitioning - Distribution of drugs movement of drugs from systemic circulation to site of drug action factors that determine drug flow blood flow to tissues ability to exit vascular system ability to enter cell Drug ability to exit vascular system capillary bed- typical blood brain barreier placenta drug transfer protein binding - albumin drug ability to enter cell binds with receptors on external surface of cell membrane drug metabolism the enzymatic biotransformation of a drug structure most occur in liver by P450 system first pass effect rapid hepatic inactivation of drug on its first pass through liver drug excretion elimination of a drug from the body Drug Excretion Routes renal breast milk bile lungs sweat saliva therapeutic drug range range of drug between minimum effective dose and toxic dose. larger index - safer dose smaller index- harmful dose drug half life the time required for the amount of drug in the body to decrease by 50% Phamacodynamics biochemical and physiological effects of drugs on body dose-response relationship the relationship between the size of an administered dose and the intensity it produces Drug selectivity drug is effective in intended use w/out harmful effects but causes undesired effects (BP but nausea) ease of administration increases convenience and adherence and decreases administration efforts Drug affinity strength of attraction between a drug and its receptor Drug intrinsic activity ability of drug to activate receptor upon binding. Agonist everts effects by activating receptor sites ; can make process so faster or slower Antagonist produce effects by preventing receptor activation partial agonist has only moderate intrinsic activity can act as agonist or antagonist Drugs that do not require receptor antacids saline laxatives cheating agents antiseptics drug therapeutic index measure of drug safety drug-drug interactions when the effect of a medication is changed, enhanced, or diminished when taken with another drug; caution w/ OTC, herbal, poly pharmacy, illicit drugs Drug-Food Interactions occur when a drug reacts with a food; grapefruit juice major interaction adverse drug reaction any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages (as opposed to overdose) adverse drug reaction examples allergic reaction, carcinogenic, teratogenic, hepatotoxic, affect QT interval ways to avoid adverse drug reactions monitor liver and kidney function monitor serum and creating clearance beers criteria black box warning REM's guideline black box warning strongest safety warning drug can have. placental drug transfer -all drugs can cross the placenta -some can cross more easily than others lipid soluble-easy others -not easy Teratogenesis and Stage of Development weeks 3-8 gross malformation - first trimester most dangerous weeks 9-38 function disruption Drug therapy and breast feeding take meds after breasfeeding take drugs with short half life Drug Therapy in Pediatric Patients Pediatrics includes all patients under age 16 absorption oral drug- pediatric delayed gastric emptying births to (6-8m) decease acidity from birth to 2 years absorption IM drug - pediatric slow and erratic b/c of low blood flow absorption Transdermal drug - pediatric rapid and complete bc striatum corner of infant skin is very thin, distribution - pediatric drug easily assess blood brain barrier protein binding - amount of albumin is low metabolism - pediatric hepatic metabolism - begins 1 month after birth; mature by 1 year old but. metabolism elevated until 2 years may need more frequent drug Amin excretion- pediatric renal excretion low at birth, reaches adult levels by 1 year. adverse drug reaction-reaction-pediatric glucocorticoids- growth supression tetracyc