Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and responsibilities of APRN prescribers  Advanced practice  Final decision for meds  Degree of authority and autonomy decided by state by state  Every year updated titling, roles, and prescriptive authority  Scope of practice determined by NP license and licensing jurisdiction  Understand that employment sites may restrict this legal scope but cannot extend it Clinical judgement in Prescribing  Is a prescription the right treatment?  What are the effective drugs for the disease?  Goals of therapy?  Monitoring to see if drug it meeting goals?  Duplications in medications patient is taking?  OTC vs prescription drugs  Cost?  Sources of information  Evidence based  Clinical judgement  Best therapy least invasive, least expensive, least likely cause abuse  Usually best for lifestyle, no pharm, and pharm therapies  Is clear indication for drug therapy? o B4 beginning ask if necessary  Drugs are effective in treating disorder o Which one best  Goal of therapy with this drug o Cure disease or lifestyle, adverse effects  Not meeting goals? o When consult therapist  Unnecessary duplication with other drugs already taken  Over the counter drug ok?  What about cost? o Pay for out of pocket  Where is info to answer questions o Journals, FDA, eval reliable drug info Collaboration with other providers  Physicians, pharm, ARNP, PA, nurses Autonomy and Prescriptive authority  All states different authority and scope of practice Chapter 2: Review of Basic Principles of Pharmacology Metabolism: Metabolism & Half Life  Metabolism can increase, decrease onset duration of action, and toxicity of medications  Change one chemical into another  First pass metabolism: liver major organ for drug metabolism because it contains high amounts of drug metabolism enzymes and because it is the first organ encountered by the drug once they are absorbed by the GI tract. Determines if can be given orally.  Rate of drug metabolism depends on drug blood level and the affinity of the drug to be metabolize by the metabolizing enzyme.  The metabolism of the drug is related to the concentration of the drug. A fixed fraction of the drug is metabolized per hour. First order metabolism is time drug decreases by half (half-life). In other words, when the drug reaches half of the concentration, then we can call it first order metabolism  50% at one half-life 75 at two half-lives and 87.5 at three half lives Drug Responses  Before a medication can produce a response, it often must overcome homeostatic mechanisms.  Homeostasis is when the cell or tissue does NOT respond to the drug and instead maintains the environment by keep doing what it knows best, fix itself.  Pharmacology is the study of substances that produce biological responses, measurement of what happens when we administer medications is important. Receptors: agonists, antagonists  Agonists: drugs that produce receptor stimulation and change what they bind o Agonist is a chemic that binds to a receptor and activates the receptor to produce a biological response. o Agonist causes an action in the body; The Antagonist blocks the action of the agonist. By occupying the receptor