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NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
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NR508 Midterm EXAM QUIDE Outline 2022 UPDATEChapter 1: The Role of the Advanced Practice Nurse as Prescriber
Roles and responsibilities of APRN prescribers
• The responsibility for the final decision on which drug to use and how to use it is
in the hands of the APRN prescriber.
• The degree of autonomy in this role and the breadth of drugs that can be
prescribed vary from state to state based on the nurse practice act of that state.
Clinical judgement in Prescribing
• Prescribing drug results from
o clinical judgment based on a thorough assessment of the patient and the
patient's environment,
o the determination of medical and nursing diagnoses,
o a review of potential alternative therapies,
o specific knowledge about the drug chosen and the disease process it is
designed to treat
Collaboration with other providers
• collaborate with physicians, pharmacists, podiatrists, mental health specialists,
therapists, and other providers, including APRNs who are not NPs, physician
assistants (PAs), and other nurses.
Autonomy and Prescriptive authority
• More states are broadening and expanding the legal, reimbursement, and
prescriptive authority to practice for all APRNs, including NPs.
Chapter 2: Review of Basic Principles of Pharmacology
How Drugs are Developed
Preclinical Stage: Identification of promising drugs and their testing in animals
• Medicinal chemists - new chemical compounds.
• Preclinical studies are performed on cells, isolated tissues and organs, laboratory
animals
• FDA Approval: Drugs approved by the FDA must be both safe and effective.
Screened by pharmacologists, toxicologists
Clinical Stage: The safety and effectiveness of new products in humans must be
established.
NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
, NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
• Phase I Clinical Trials: Establish biological effects, 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 determine the potential of the drug to improve patient outcomes.
If the drug looks promising phase III will occur.
• Phase III Clinical Trials: Comparison of the new medication to the standard
therapy in a larger number of patients at various sites across the country. New
drugs must be at least as good or better than other available drugs.
Post-Marketing Surveillance: Health professionals- report adverse events --more
people receive the drug than in the clinical trials, and sometimes much more is learned
about additional adverse effects that occur infrequently with use of the drug.
Drug Responses
• before a drug can produce a response it must first overcome homeostasis
• Dose-Response Curves provide information on the relationship between
dosage or concentration and responses for one or more drugs.
o Graphs showing drug responses will show the response on the vertical
axis and the concentration or dose on the horizontal axis.
• Quantal Responses: May or may not occur. For example, seizures occur or they
do not. A rash occurs or it does not. A response that is either occurring or absent.
o Prediction of drug dosages or blood levels that produce quantal effects is
more reliable for a population of patients than for an individual patient.
o Data from a population of patients is used to establish appropriate doses
or blood levels to predict quantal effects in a large number of patients.
Drug examples: oral contraceptives and seizure medications.
• Graded Responses: Biological effects that can be measured continually up to
the maximum responding capacity of the biological system.
o Most drug responses are graded. For example, changes in BP are
measured in mmHg, and patients may experience small or large changes
in BP following treatment with drugs. If the patient’s BP is too high or too
low, we can adjust the dosage based on the patient’s individualized
response to the medication. Examples: BP, HR, diuresis, bronchodilation,
pain scale 1-10).
• Potency: Difference in concentration or dosage of different drugs required to
produce a similar effect.
o Drugs that are more potent require a lower dosage or concentration to
produce the same response.
o For example, compare doses of non- prescription drugs that relieve
headache: 200 mg ibuprofen, 325 mg aspirin, and 50 mg ketoprofen.
Because ketoprofen requires the lowest dose, it has the highest potency.
• Efficacy: Expresses the ability of a drug to produce a maximum effect at any
dosage.
o There are many drugs that will relieve mild pain. No matter how high we
increase the dosage, drugs that work well for mild to moderate pain are
NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
, NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
usually ineffective for treating more severe cancer-related pain, for
example.
o Treatment of severe pain requires the use of stronger drugs, such as the
opioid analgesics morphine or oxycodone. Morphine or oxycodone have
higher efficacy for pain relief than ibuprofen.
o Drugs with high efficacy can produce greater effects than lower-efficacy
drugs can.
• Intrinsic Activity: The ability of a drug to produce a response once it has
occupied specific receptors.
o some drugs produce the maximum receptor stimulation once they occupy
receptors; their response is limited by how many drug molecules occupy
receptor sites.
o Other drugs with lower intrinsic activity can occupy the same number of
receptors but will produce a lesser response.
o Drugs can also occupy receptors and produce no receptor stimulation;
they merely block the action of neurotransmitters or other drugs.
• Drug Selectivity: A ratio of the dose or concentration producing the undesired
effect to the dose or concentration producing the desired effect.
o This is the same as determining how many times the therapeutic dosage
needs to be increased to produce the undesired effect.
o A medication that requires one tablet to produce the desired response and
does not produce undesirable effects unless five tablets are used would
have a selectivity ratio of 5.
• Therapeutic Index: Ratio of the lethal dose of a drug to the therapeutic dose of
a drug.
o The therapeutic index of drugs on the market is, of course, always greater
than 1; a therapeutic index of less than 1 means that the drug kills before
it cures.
o The therapeutic index ranges from 2 for some drugs (cancer
chemotherapy, lithium carbonate) to 6,000 for others (penicillin in
nonallergic patients)
• Brand vs. Generic Differences between brand and generic preparations can
occur in the inactive ingredients of the tablet or capsule, such as coloring or filler
materials.
o There are also differences in the speed or rate of absorption.
Receptors: agonists, antagonists
• Receptors are the large molecules, usually proteins, that interact with and
mediate the action of drugs. Receptors are important because they determine the
relationship between dose and effect, the selectivity of drugs, and the actions of
pharmacological antagonists.
• Agonists: Drugs that produce receptor stimulation and a conformational change
every time they bind.
NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
, NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
o Full agonists do not need all of the available receptors to produce a
maximum response. Some agonists can produce their maximum response
by binding to less than 10% of the available receptors. The receptors that
are left over and not needed for a response are called spare receptors.
• Partial Agonists: Bind to receptors, but when they occupy the receptor sites,
they stimulate only some of the receptors. This is sometimes called intrinsic
activity.
o they can act as part agonist and part antagonist.
o Partial agonists would require all of the available receptors to produce
their full response, and the maximum response for a partial agonist is less
than that for a full agonist.
o The beta blockers acebutolol, penbutolol, and pindolol are partial agonists.
Administration can block the effects of adrenergic nerves on heart rate,
but partial agonist activity keeps heart rate from falling too low, as might
occur following administration of a pure beta-adrenoceptor antagonist
• Antagonists: Drugs that occupy receptors without stimulating them.
o Antagonists occupy a receptor site and prevent other molecules, such as
agonists, from occupying the same site and producing a response.
o Antagonists produce no direct response.
o The response we see following administration of antagonists results from
their inhibiting receptor stimulation by agonists.
o For example, beta blockers such as propranolol and atenolol act as
antagonists at the beta-adrenoceptor. Adrenergic nerve activity can raise
heart rate, and patients with high heart rates experience a significant drop
in heart rate following administration of beta blockers. The same
administration may have little effect on patients who lack adrenergic nerve
activity and already have a lower heart rate.
o The effect of antagonists is dependent on the background receptor activity
that it can block.
o Antagonists produce a shift in the concentration–effect relationship for
agonists acting at that same specific receptor as the antagonist; they
make agonists for the same receptor appear less potent.
o The effect of an antagonist is dependent on its blood levels and its affinity
for the receptor.
o Most antagonists in clinical use are competitive reversible antagonists,
and it is possible to overcome the antagonist effects with higher
concentrations of the competing agonist.
o A very small number of antagonist drugs (e.g., echothiophate,
phenoxybenzamine) act by irreversibly binding to the receptor; their
antagonism remains until new receptors can be produced by the cell.
Pharmacokinetics
Absorption
NR508 Midterm EXAM QUIDE Outline 2022 UPDATE
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