565 iMidterm iStudy iGuide
Week 1 i
• Drug iSchedules
- Descriptions iof ieach ischedule
• Examples iof idrugs iin ieach ischedule:
- Schedule iI: ihigh ipotential ifor iabuse: iheroin, ilysergic iacid idiethylamide i(LSD),
imarijuana i(cannabis), i3,4-methylenedioxymethamphetamine i(ectstasy),
imethaqualone, iand ipeyote.
-
- Schedule iII: ihigh ipotential ifor iabuse, ipotentially ileading ito isevere ipsychological
ior iphysical idependence. iThese idrugs iare ialso iconsidered idangerous;
icombination iproducts iwith iless ithan i15 imilligrams iof ihydrocodone iper idosage
iunit i(Vicodin), icocaine, imethamphetamine, imethadone, ihydromorphone
i(Dilaudid), imeperidine i(Demerol), ioxycodone i(OxyContin), ifentanyl, iDexedrine,
iAdderall, iand iRitalin
•
- Schedule iIII: iModerate ito ilow ipotential ifor iphysical ipsychological idependence;
iproducets icontaining iless ithan i90 imilligrams iof icodeine iper idosage iunit
i(Tylenol iwith icodeine), iketamine, ianabolic isteroids, itestosterone
Shedule iIV: iLow ipotential ifor iabuse iand ilow irisk iof idependence; iXanax, iSoma,
iDarvan, iDarocet, iValium, iAtivan, iTalwin, iAmbien, iTramadol
Schedule iV: ilow ipotential ifor iabuse iand icontain ilimited iquantities iof icertain
inarcotics; iantidiarrheal, iantitussive, iand ianalgesic ipurposes.
(focus ion ischedule i2,3, iand i4 iper itutor)
• Which iones ican iand icannot ibe iprescribed iby inurse ipractitioners?
- Prescriptive iAuthority
Understand iwhat iprescriptive iauthority iis iand iwho imandates iit. i:Practice iauthority iand
iprescriptive iauthority itogether iare idescribed ias ipractice i“enviornments” iaccording ito istate
ilaws iand iregulations.
o Full-practice iscope: iNurse ipractitioners ihave ithe iautonomy ito ievaluate ipatients,
idiagnose, iorder iand iinterpret itests, iinitiate iand imanage itreatments iand iprescribe
imedications, iincluding icontrolled isubstances iwithout iphysician ioversight.
o Reduced-Practice iscope: iNurse ipractitioners iare ilimited iin iat ileast ione ielement iof
ipractice. iThe istate irequires ia iformal icollaborative iagreement iwith ian ioutside
ihealth idiscipline ifor ithe inurse ipractitioner ito iprovide ipatient icare.
o Restricted ipractice iscope: iNurse ipractitioners iare ilimited iin iat ileast ione ielement iof
ipractice iby irequiring isupervision, idelegation, ior iteam imanagement iby ian ioutside
ihealth idiscipline ifor ithe inurse ipractitioner ito iprovide ipatient icare.
▪ What iproblems iarise iwhen iprescriptive iauthority iis ilimited? iLimited
iprescriptive iauthority icreates inumerous ibarriers ito iquality, iaffordable,
1
, 565 iMidterm iStudy iGuide
and iaccessible ipatient icare. iFor iexample ia irequirement ito iobtain ithe
iphysician’s icosignature ion iprescription ican iincrease ipatient iwaits.
• Know ithe iresponsibilities iof iprescribing i: iThe iability ito iprescribe imedications iis iboth ia
iPrivilege iand ia iburden. iThe ibest iway ito ikeep iyour ipatients iand iyourself isafe iis ito ibe
iprudent iand ideliberate iin iyour idecision imaking iprocess. iHave ia idocumented iprovider-
ipatient irelationship iwith ithe iperson ifor iwhom iyou iare iprescribing. iDo inot iprescribe ifor
ifamily ior ifriends ior ifor iyourself. iDocument ia ithorough ihistory iand iphysical iexaminationiin
iyour irecords.
• Know ipatient ireasons ifor imedication inon-adherence:
- Forgot ito itake iit
- Ran iout
- Was iaway ifrom ihome
- Was itrying ito isave imoney
- Didn’t ilike ithe iside ieffects
- Was itoo ibusy
- The imedicine iwasn’t iworking
• Know ihow iwhat itype iof ievidence iprescribers ishould iuse ito imake itreatment
irecommendations:
-
• Be ifamiliar iwith iphysiological ichanges iof iaging ithat iimpact ipharmacological
itreatments:
- Drug iaccumulation isecondary ito ireduced irenal ifunction
- Polypharmacy i(the iuse iof i5 ior imore imedications idaily)
- Greater iseverity iof iillness
- Presence iof icomorbidities
- Use iof idrugs ithat ihave ia ilow itherapeutic iindex i(e.g., idigoxin)
- Increased iindividual ivariation isecondary ito ialtered ipharmacokinetics
- Inadequate isupervision iof ilong-term itherapy
- Poor ipatient iadherence
-
• Be ifamiliar iwith iBeer’s iCriteria i: iThe iBeers iCriteria iinclude ifive ilists ithat idescribe
icertain imedications iand isituations iand iinclude:
- Potentially iinappropriate iMedication i(PIM) iuse iin iolder iadults
- Potentially iInappropriate iMedication i(PIM) iuse iin iolder iadults idue ito
imedication-disease ior imedication-syndrome iinteractions ithat imay iexacerbate
ithe idisease ior isyndrome
- Medications ito ibe iused icautiously iin iolder iadults.
- Clinically isignificant idrug iinteractions ithat ishould ibe iavoided iin iolder iadults
- Medications ito ibe iavoided ior idosage idecreased iin ithe ipresence iof iimpaired
ikidney ifunction iin iolder iadults
-
•
•
•
•
•
2
, 565 iMidterm iStudy iGuide
• Know iCYP450 iinducers iand iinhibitors:
- Inducers Inhibitors i(decrease imedication
metabolism)
Carbamazepine Sertraline i(Zoloft)50mg iworse i200mg
iRifampin iErythromycin
iAlcohol Terbinafine i(Lamisi)
iPhenytoin
iGriseofulvin Valporate
iPhenobarbital iIsoniazid
iSulfonylureas iSulfonamides
iAmiodarone
iChloramphenico
liKetoconazole
iGrapefruit iJuice
iQuinidine
-
-
• Be ifamiliar iwith iopioid iagonists i:
• Know ithe ioutcome iof ihaving ia ipoor imetabolism iphenotype
• Know ithe irole iof ithe igovernment iagencies iwhen iit icomes ito iprescription idrugs
Week 2 i
• Know iblack ibox iwarning ifor ivarious ipain imedications.
• Be ifamiliar iwith ipatient iindicators ithat iwould iput ithem iat irisk ifor ideveloping isubstance
iabuse idisorder.
• Be ifamiliar iwith iconditions ithat ido iand ido inot iwarrant iopioid itherapy.
• Know iwhat ia imorphine imilligram iequivalent iis iand iwhen ito iuse iit.
• Be ifamiliar iwith iPrescription iDrug iMonitoring iProgram i(PDMP) io iWhat iit iis ioiWhenito
iuse iit
• Know ithe ioutcomes iof irenal iand ihepatic iinsufficiency iwith iopioid itherapy.
• Know ithe irisk ifactors iof iopioid iuse idisorder.
• Know ithe isigns iof idrug idiversion.
• When iis iit iappropriate ito iprescribe inaloxone?
• Be ifamiliar iwith idrugs ithat iare inot isafe ito itake iwith iopioids.
• Be ifamiliar iwith ithe iPEG iAssessment iScale.
• Patient iand iprovider iresponsibilities iin iopioid idrug itherapy
• How ito iapproach iconversations iabout iOpioid iUse iDisorder
• What itypes iof ipain ican ibe itreated iby ipsychotropic imedications?
3
Week 1 i
• Drug iSchedules
- Descriptions iof ieach ischedule
• Examples iof idrugs iin ieach ischedule:
- Schedule iI: ihigh ipotential ifor iabuse: iheroin, ilysergic iacid idiethylamide i(LSD),
imarijuana i(cannabis), i3,4-methylenedioxymethamphetamine i(ectstasy),
imethaqualone, iand ipeyote.
-
- Schedule iII: ihigh ipotential ifor iabuse, ipotentially ileading ito isevere ipsychological
ior iphysical idependence. iThese idrugs iare ialso iconsidered idangerous;
icombination iproducts iwith iless ithan i15 imilligrams iof ihydrocodone iper idosage
iunit i(Vicodin), icocaine, imethamphetamine, imethadone, ihydromorphone
i(Dilaudid), imeperidine i(Demerol), ioxycodone i(OxyContin), ifentanyl, iDexedrine,
iAdderall, iand iRitalin
•
- Schedule iIII: iModerate ito ilow ipotential ifor iphysical ipsychological idependence;
iproducets icontaining iless ithan i90 imilligrams iof icodeine iper idosage iunit
i(Tylenol iwith icodeine), iketamine, ianabolic isteroids, itestosterone
Shedule iIV: iLow ipotential ifor iabuse iand ilow irisk iof idependence; iXanax, iSoma,
iDarvan, iDarocet, iValium, iAtivan, iTalwin, iAmbien, iTramadol
Schedule iV: ilow ipotential ifor iabuse iand icontain ilimited iquantities iof icertain
inarcotics; iantidiarrheal, iantitussive, iand ianalgesic ipurposes.
(focus ion ischedule i2,3, iand i4 iper itutor)
• Which iones ican iand icannot ibe iprescribed iby inurse ipractitioners?
- Prescriptive iAuthority
Understand iwhat iprescriptive iauthority iis iand iwho imandates iit. i:Practice iauthority iand
iprescriptive iauthority itogether iare idescribed ias ipractice i“enviornments” iaccording ito istate
ilaws iand iregulations.
o Full-practice iscope: iNurse ipractitioners ihave ithe iautonomy ito ievaluate ipatients,
idiagnose, iorder iand iinterpret itests, iinitiate iand imanage itreatments iand iprescribe
imedications, iincluding icontrolled isubstances iwithout iphysician ioversight.
o Reduced-Practice iscope: iNurse ipractitioners iare ilimited iin iat ileast ione ielement iof
ipractice. iThe istate irequires ia iformal icollaborative iagreement iwith ian ioutside
ihealth idiscipline ifor ithe inurse ipractitioner ito iprovide ipatient icare.
o Restricted ipractice iscope: iNurse ipractitioners iare ilimited iin iat ileast ione ielement iof
ipractice iby irequiring isupervision, idelegation, ior iteam imanagement iby ian ioutside
ihealth idiscipline ifor ithe inurse ipractitioner ito iprovide ipatient icare.
▪ What iproblems iarise iwhen iprescriptive iauthority iis ilimited? iLimited
iprescriptive iauthority icreates inumerous ibarriers ito iquality, iaffordable,
1
, 565 iMidterm iStudy iGuide
and iaccessible ipatient icare. iFor iexample ia irequirement ito iobtain ithe
iphysician’s icosignature ion iprescription ican iincrease ipatient iwaits.
• Know ithe iresponsibilities iof iprescribing i: iThe iability ito iprescribe imedications iis iboth ia
iPrivilege iand ia iburden. iThe ibest iway ito ikeep iyour ipatients iand iyourself isafe iis ito ibe
iprudent iand ideliberate iin iyour idecision imaking iprocess. iHave ia idocumented iprovider-
ipatient irelationship iwith ithe iperson ifor iwhom iyou iare iprescribing. iDo inot iprescribe ifor
ifamily ior ifriends ior ifor iyourself. iDocument ia ithorough ihistory iand iphysical iexaminationiin
iyour irecords.
• Know ipatient ireasons ifor imedication inon-adherence:
- Forgot ito itake iit
- Ran iout
- Was iaway ifrom ihome
- Was itrying ito isave imoney
- Didn’t ilike ithe iside ieffects
- Was itoo ibusy
- The imedicine iwasn’t iworking
• Know ihow iwhat itype iof ievidence iprescribers ishould iuse ito imake itreatment
irecommendations:
-
• Be ifamiliar iwith iphysiological ichanges iof iaging ithat iimpact ipharmacological
itreatments:
- Drug iaccumulation isecondary ito ireduced irenal ifunction
- Polypharmacy i(the iuse iof i5 ior imore imedications idaily)
- Greater iseverity iof iillness
- Presence iof icomorbidities
- Use iof idrugs ithat ihave ia ilow itherapeutic iindex i(e.g., idigoxin)
- Increased iindividual ivariation isecondary ito ialtered ipharmacokinetics
- Inadequate isupervision iof ilong-term itherapy
- Poor ipatient iadherence
-
• Be ifamiliar iwith iBeer’s iCriteria i: iThe iBeers iCriteria iinclude ifive ilists ithat idescribe
icertain imedications iand isituations iand iinclude:
- Potentially iinappropriate iMedication i(PIM) iuse iin iolder iadults
- Potentially iInappropriate iMedication i(PIM) iuse iin iolder iadults idue ito
imedication-disease ior imedication-syndrome iinteractions ithat imay iexacerbate
ithe idisease ior isyndrome
- Medications ito ibe iused icautiously iin iolder iadults.
- Clinically isignificant idrug iinteractions ithat ishould ibe iavoided iin iolder iadults
- Medications ito ibe iavoided ior idosage idecreased iin ithe ipresence iof iimpaired
ikidney ifunction iin iolder iadults
-
•
•
•
•
•
2
, 565 iMidterm iStudy iGuide
• Know iCYP450 iinducers iand iinhibitors:
- Inducers Inhibitors i(decrease imedication
metabolism)
Carbamazepine Sertraline i(Zoloft)50mg iworse i200mg
iRifampin iErythromycin
iAlcohol Terbinafine i(Lamisi)
iPhenytoin
iGriseofulvin Valporate
iPhenobarbital iIsoniazid
iSulfonylureas iSulfonamides
iAmiodarone
iChloramphenico
liKetoconazole
iGrapefruit iJuice
iQuinidine
-
-
• Be ifamiliar iwith iopioid iagonists i:
• Know ithe ioutcome iof ihaving ia ipoor imetabolism iphenotype
• Know ithe irole iof ithe igovernment iagencies iwhen iit icomes ito iprescription idrugs
Week 2 i
• Know iblack ibox iwarning ifor ivarious ipain imedications.
• Be ifamiliar iwith ipatient iindicators ithat iwould iput ithem iat irisk ifor ideveloping isubstance
iabuse idisorder.
• Be ifamiliar iwith iconditions ithat ido iand ido inot iwarrant iopioid itherapy.
• Know iwhat ia imorphine imilligram iequivalent iis iand iwhen ito iuse iit.
• Be ifamiliar iwith iPrescription iDrug iMonitoring iProgram i(PDMP) io iWhat iit iis ioiWhenito
iuse iit
• Know ithe ioutcomes iof irenal iand ihepatic iinsufficiency iwith iopioid itherapy.
• Know ithe irisk ifactors iof iopioid iuse idisorder.
• Know ithe isigns iof idrug idiversion.
• When iis iit iappropriate ito iprescribe inaloxone?
• Be ifamiliar iwith idrugs ithat iare inot isafe ito itake iwith iopioids.
• Be ifamiliar iwith ithe iPEG iAssessment iScale.
• Patient iand iprovider iresponsibilities iin iopioid idrug itherapy
• How ito iapproach iconversations iabout iOpioid iUse iDisorder
• What itypes iof ipain ican ibe itreated iby ipsychotropic imedications?
3
