NURS 615 EXAM 1 STUDY GUIDE

WEEK 1: CHAPTER 1-4 WEEK 2: CHAPTER 5, 7-10 WEEK 3: CHAPTER 14 1. What factors are associated with clinical judgment when prescribing medications? (pg, 5 & 30) Factors associated with clinical judgement when prescribing medications are done so based on a thorough assessment of the patient and the patient’s environment, the determination of medical and nursing diagnoses, a review of potential alternative therapies, and specific knowledge about the drug chosen and the disease process it is designed to treat. Generally, the best therapy is the least invasive, least expensive, and least likely to cause adverse reactions. The best choice is to have lifestyle, non-pharmacological, and pharmacological therapies working together. World Health Organization’s six step model of rational prescribing.  Define the patient’s problem  Specify the therapeutic objective  Choose the treatment  Start the treatment  Educate the patient  Monitor effectiveness 2. What are the criteria for choosing an effective drug? (pg, 6 & 31) Knowledge of drug limitations, medication choice for treatment. Before drug therapy is chosen, the indication for and necessity of using a drug should be carefully considered.  Indication  Contraindications  Precautions  Cost/Compliance  Efficacy  Adverse effects  Dose/Duration/Direction (I Can PresCribE A Drug’ mneumonic) 3. How does hypoalbuminemia affect the process of prescribing? (pg, 20-21) Albumin is a major protein in the blood and produced by the liver. This affects distribution to target tissues. Highly protein (albumin) bound drugs: (Prazosin), have higher tissue levels (less free drug, less excreted). Free drug is active drug. In patients with Low albumin, you have more-free drug, less excreted because you have less albumin to bind to. This results in higher blood levels and an increased risk of toxicity. When low levels exist, drugs that are usually protein bound are free in the plasma, allowing for higher drug levels, more rapid hepatic metabolism or both. Liver damage may cause hypoalbuminemia and cause drugs to be in higher concentrations due to less excretion from damage. Albumin carries the majority of protein bound drugs. These higher drug concentrations in the blood are due to this decreased binding. Treatment requires a lower drug dosage or to give albumin. 4. What is the drug’s half-life? (pg, 23-24) The time it takes for the plasma concentration of a drug to decrease by half. The time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words, after one half-life, the concentration of the drug in the body will be half of the starting dose. 5. What is meant by the onset of action, peak of action, duration of action of medications? Onset of action is the amount of time it takes for a drug’s effects to become apparent following administration, reach the minimum effective concentration after administration. Peak action is when the medication reaches its highest blood or plasma concentration. If drug exceeds the peak level it equals toxicity Duration of action is the period of time in which the medication has a pharmacological effect before it is metabolized and excreted. How long the drugs’ effects last, the length of time the drug has a therapeutic effect. 6. Explain first pass metabolism. (pg, 22) The rapid hepatic inactivation of certain oral drugs. When oral drugs are absorbed from the GI tract, they are carried directly to the liver via the hepatic portal vein. When drugs are highly metabolized during the first circulation to the liver (first pass), little to none of the active drug is sent to the peripheral circulation. Hepatic (liver) metabolism of part of the administered dose before it enters the systemic circulation. This is important because you have to increase the dose, use other route of administration, or