What are the two components of prescriptive authority
The right to prescribe independently
And the right to prescribewithout limitation
The regulation for prescriptive Authority comes from
The State Board of Nursing
The State Board of Medicine
State Board of Pharmacy
What is the most importantfunction to evaluate when prescribing a medication
Hepatic and renal function
What must you pay attention to when performing a refill
1. Is this a newer medication for a patient
2. changing the dose of frequency
3. am I adding new medicines to their regimen
4. is this patient having undesired effects
5. How long has it been since I've seen the patient
6. Is this a Schedule II medication
*If the answer to any of these questions is yes consider a shorter time period for a refill (one to
three months)
What should be included in the teaching for drug monitoring
What test is needed
When is test required
Where will testing take place
Why is testing necessary
How does the patient prepare for testing
What periodic Laboratory Testing is needed with Ace and ARB
Potassium/ creatinine
These drugs can cause hyperkalemia
Renal perfusion is dependent on Angiotensin in some patients increased creatinine may require
a change in medication
,What LaboratoryTesting is required with amiodarone
Liver function, thyroid function, pulmonary function and chest x-rays
Hepatoxicity is an adverse effect
Either hypo or hyperthyroidism may occur
Pulmonary toxicity is not uncommon, affects maybe permanent
What Laboratory Testing is required with anticonvulsants
Serum drug levels-some have a very narrow therapeutic index
What Laboratory Testing is required with lithium
CBC, lithium level, thyroid function, renal function, serum electrolytes
This drug has a narrow therapeutic margin,
lithium can cause leukocyte elevation
Both hypo and hyperthyroidism may occur
Renal damage is a serious adverse effect
Nephrogenic diabetes insipidus May occur, and hyponatremia can create complications
What are the four basic pharmacokinetic processes
absorption, distribution, metabolism, excretion
What is the combination of metabolism and excretion called
Elimination
What determines the concentration of a drug at its site of action
The four pharmacokinetic processes acting in concert
What are the three ways for drugs to cross the cell membrane
Passage through channels or pores
Passage with the aid of a transport system
Direct penetration of the membrane
Of all three direct penetration of the membrane is most common
,What is an example of a drug that can pass through a Channel or poor
Sodium or potassium
What are common drug transporters
Pgp- P - glycoprotein
What is the general rule in chemistry
dissolve like Membranes are composed primarily of lipids-therefore to directly penetrate
membranes a drug must be lipid soluble or lipophilic
What is a kind of moleculethat is not lipid soluble and therefore cannot penetrate membranes
Polar molecules and ions
What is a polar molecule?
a molecule in which the charges are unevenly distributed
Example is water
What are ions
Charged particles that have a net electrical charge
determined by the pH of the surrounding medium.
Acids tend to ionize and basic alkaline media, whereas bases tend to ionize in acidic media
Therefore drugs that are weak acids are best absorbed in an acidic environment such as gastric
acid
Example is aspirin
what is the pH partitioning or ion trapping
The process whereby a drug accumulates on the side of a membrane where the pH most favors
its ionization
acidic drugs accumulate on the ______ side
alkaline
basic drugs accumulate on the ______ side
, acidic
What are the two terms associated with absorption of drugs
Chemical equivalence and bioavailability
What is bioavailability
Fraction of administered drug that reaches systemic circulation unchanged.
What are the factors that affect drug absorption
rate of dissolution, surface area, blood flow, lipid solubility, pH partitioning
What is a major detriment of the rate of absorption
Surface area
When the surface area is larger absorption is
Faster
The small intestine is a larger area because of the microvilli,the stomach is a relatively small
surface area
Absorption of orally administered drugs is usually greatest in the
Small intestine
Drugs are absorbed most rapidly from sites where
Blood flow is high because blood containing a newly absorbed drug would be replaced rapidly
by drug free blood thereby maintaining a large gradient between the concentration of drug
outside the blood and the concentration of drug in the blood
The greater the concentration gradient
The more rapid absorption will be
What is the rule of lipid solubility
Highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is low
The movement of drugs from the systemic circulation to the site of drug action
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