Week 1 -
Welcome to NR508 Advanced Pharmacology. This week will include an overview of pharmacology materials, including
pharmacokinetics, principles of
... [Show More] drug action, adverse drug reactions and drug-induced diseases, prescriptive practices, and pharmacy
law. We will take a closer look at the foundations and role of the nurse practitioner.
Reading:
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advance Practice Nurse prescribers (4th ed.). Retrieved from
http://bookshelf.vitalsource.com
Chapter 1: The Role of the Advanced Practice Nurse as Prescriber
Chapter 2: Review of Basic Principles of Pharmacology
Chapter 3: Rational Drug Selection
Chapter 4: Legal and Professional Issues in Prescribing
Chapter 5: Adverse Drug Reactions
Chapter 6: Factors that Foster Positive Outcomes
Chapter 7: Cultural and Ethnic Influences in Pharmacotherapeutics
Chapter 9: Nutrition and Nutraceuticals
Chapter 12: Pharmacoeconomics
Chapter 13: Over-the-counter Medications
Chapter 24: Drugs Used in Treating Infectious Diseases
The Role of the Nurse Practitioner as Prescriber; Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, and DrugOTC-Herbal Interactions; Drugs Used in the Treatment of Infectious Disease
Introduction Welcome to Advanced Pharmacology. Pharmacology can be an overwhelming subject for many prospective
advanced practice nurses, and it can be overwhelming just to look at the number of medications. Remember that it is impossible to
learn every single detail about every medication. It may be helpful to focus on identifying classes of medications and their functions
and potential side effects. Be sure to admit when you are unsure of knowledge on a medication and take the time to look up your
answer from a credible source of information. Your knowledge of advanced pharmacology will continue to grow. This week will
include an overview of pharmacology materials, including pharmacokinetics, principles of drug action, adverse drug reactions and
drug induced diseases, prescriptive practices, and pharmacy law. Finally, we will explore the many antibiotics and anti-protozal
treatments used in the treatment of infectious diseases.
Prescriptive Authority and Nurse Practitioner Role Implementation There is an increased need for professionals who can provide
cost-effective healthcare. Healthcare needs to be accessible and available. Advanced practice nurses are fulfilling this role.
Historically, physicians were among the few healthcare providers with prescriptive authority. Much of what we know today is based
on physician prescriptive behaviors. With advanced practice nurses possessing prescriptive authority, advanced practice nurses will
be compared to traditional physicians in prescribing practices. It is important to examine therapeutic practice among different
prescribers. These rigorous methods to examine therapeutic practice with different providers in healthcare, such as physicians and
advanced practice nurses, are in development.
Pharmacokinetics and Pharmacodynamics
Part 1
My name is Lynne Palma, and I've been teaching pharmacology now for about 15 years. I love the science of pharmacology, and I
have great respect for both the positive and negative effects that drugs can provide. I try to keep abreast of all the new drugs that
come to market, so that I can inform students.
I never get tired of the study of drugs. Additionally, I practice as a family nurse practitioner and I'm responsible for prescribing the full
range of pharmacologic agents. I have a special interest in diabetes and I'm certified as a CDE. And a few years ago I passed another
more advanced exam, board certification and advanced diabetes management.
I hope this presentation is helpful for you as you being this very challenging course. It is important to have a good grasp of the basic
principles of pharmacology. After completing the learning activities in this unit, the student will be able to identify the primary
processes of pharmacokinetics and pharmacodynamics.
And explain the mechanisms by which drugs cross plasma membranes, discuss factors that affect drug absorption, distribution,
metabolism and excretion. And explain what half-life is, plateau, therapeutic range and ED50. In addition, the learner should be able
to distinguish between an agonist, a partial agonist, and antagonist. And be able to differentiate between adverse effects and side
effects.
To be able to create a plan to minimize adverse drug reactions and medication errors. To define the study of pharmacogenomics, and
also identify genetic, gender, and racial variants that alter drug metabolism. Additional concepts include first pass, induction and
inhibition of metabolizing enzymes. And the identification of major drug reactions that occur in the process of drug metabolism.
And, also, the identification of genetic testing that is available. The first part of the presentation covers what an ideal drug is. The
development and regulation of the naming of drugs, resources that you will want to use, direct-to-consumer advertising, over-thecounter, pharmacokinetics and pharmacodynamics, drug interactions, and, also, medical errors. I'd like to start out by saying that it is
rare if ever that a drug is considered ideal.
Especially in the realm of psychopharmacology, many of these drugs have side effects profiles that are not easily tolerable. However,
in most cases, the benefit is profound and individuals, in general, will need to be on these medications in order to live a full and
functioning existence. It's interesting to me that we started with 5 rights and now we're up to 9 and maybe in a few years we'll have
10 or 20 responsibilities or rights according to drugs and their administration.
I think the right of the patient to have education and to refuse care was a good addition to these five, now nine rights. Briefly, I would
like to discuss some of the landmark drug legislation that has come about over the years. And, also, how drugs are developed, how
they're named and how they get the status of over-the-counter.
And, also, some of the sources of drug information that I'm going to recommend. This is a list of some of the landmark drug
legislation that has tightened up the requirements that drugs have to undergo in order to come to market. The most recent is the
Family Smoking Prevention and Tobacco Control Act of 2009
I am fairly confident in the drugs that I prescribe because I know that they have gone through a rigorous process required by the
FDA. They have to show efficacy, and they have to use controls, randomization and have blinding. So that if they're comparing a drug
to placebo, the participants as well as the providers are not aware of whether not they are in the placebo group or the actual drug
group.
This does become a bit of a problem when patients are in groups receiving drugs for mental illness. And the reason for that is that,
even if they are taking a placebo, they are still meeting, and perhaps going through psychotherapy every week. And we know that
that is a huge placebo effect.
So as you study the drugs used for situations such as depression, you will see that even though these drugs are shown to be effective,
it's not much more than placebo. However, the placebo effect in most cases is quite large, especially for these types of drugs. As you
know, drugs in this country are extremely expensive, and one of the reasons is that it takes years and lots of funds in order to bring
these drugs to market.
They have to first go through preclinical testing, then clinical testing, and phases I, phases II through III. And then they have to, once
they are approved, go through postmarketing surveillance. Many of the studies now include both women and children. But there's
definitely less information on these two groups of individuals.
And, even though drug studies are quite rigorous, they often fail to detect all of the adverse effects. That's why the postmarketing
surveillance is required. Once hundreds of thousands of people begin to take these drugs, some of these adverse effects are
uncovered. It's often said that providers should neither be the first to adopt the new nor the last to abandon the old, there must be
a balance between the potential benefits against the inherent risks.
And many times these new drugs generally present greater risk than old ones. As you know, drugs have a chemical name, a generic
name, as well as a trade name. Throughout instruction in pharmacology courses, we are asked to make sure that students know the
generic Names of these drugs because certifying examinations do not include the brand name.
I tend to talk in both generic as well as brand names, because as you get out into the public sector, people throw around the trade
names and students can be lost. And I hope that this does not enable you including both the generic and the trade names as long as
you understand that it is the generic name that will be present on your certifying exam.
There are more problems with generic names and that there are more complicated than trade names. And that's why patients and
some providers prefer to call drugs by their trade name. But it is problematic, you might have two over-the-counter medications that
both have acetaminophen in them. Some of these drugs that have combinations, so in general it's appropriate just to call the drug by
its generic name.
This is just a sample of a chemical generic, and you can see the trade name, and you can see how many different choices there are
for the trade names. I work in a clinic and have patients from all over the world, and they often bring in drugs that they're taking
from their country of origin.
And it can be very confusing, you can Google a lot of these drugs and you will get what the ingredients are even if it is an
international drug. But as you can see, this can be very confusing allegra, which is an antihistamine. In Germany, it's Frovatriptan,
which is a drug used to treat migraine headaches.
It's always important to know what over-the-counter drugs are being taken by the patient. Many drugs move to over-the-counter
status because they're considered safe, it's deemed that the individual can diagnose these symptoms. And if the drugs are safe
enough and there's no monitoring requirement, that's how drugs get to that particular status.
But it is important to know which over-the-counter drugs they are taking, for instance, non-steroidal anti-inflammatories. If these
drugs were brought to market this year, they probably would not be in the category of over-the-counter because. There are so many
issues and complications with non steroidal anti-inflammatories. There are many sources of drug information, I highly recommend
the Prescriber's Letter.
It comes on a monthly basis and I believe it's over a $100 a year. At this point, it will give you unbiased information about the drugs,
it's a very quick read and I highly recommend it. I don't leave home without my smartphone, it has Epocrates installed, and that is a
free install.
If you get the deluxe version, it has an up-to-date search that you can use that's more than just drug information. I've been using it
for years, it keeps improving every year with it's readability and the things that they include in it. The other source that I use is the
Sanford Guide to Antimicrobial Therapy, I use Medcor which is turquoise with the cross on it.
And I also use the 5 Minute Clinical Consult, which is again very similar to Up to Date, some of you may have access to that through
your hospital. If you purchase it privately it's about $400 a year. The 5 Minute Consult is over $100 but it's a very quick read and it
can be very helpful.
You can put in a search for a particular disorder that you are not familiar with, then a very quick read along with the medications
recommended. And then you take those medications and search them out on Epocrates to get more information. So using all of
these together can be very helpful.
If you watch any television program you can count up to six to ten advertisements for drugs within an hour period. And these are
very expensive for the drug companies to put up there, very controversial. In that patients are coming asking for these drugs which
are often very expensive. On their behalf, they do let individuals know what new drugs are out there.
But in general, the FDA is trying to curb what is availabl [Show Less]