565 Midterm Study Guide
Week 1
• Drug Schedules
- Descriptions of each schedule
• Examples of drugs in each schedule:
- Schedule I: high potential for abuse: heroin, lysergic acid diethylamide (LSD),
marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ectstasy),
methaqualone, and peyote.
-
- Schedule II: high potential for abuse, potentially leading to severe psychological
or physical dependence. These drugs are also considered dangerous;
combination products with less than 15 milligrams of hydrocodone per dosage
unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone
(Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine,
Adderall, and Ritalin
•
- Schedule III: Moderate to low potential for physical psychological dependence;
producets containing less than 90 milligrams of codeine per dosage unit
(Tylenol with codeine), ketamine, anabolic steroids, testosterone
Shedule IV: Low potential for abuse and low risk of dependence; Xanax, Soma,
Darvan, Darocet, Valium, Ativan, Talwin, Ambien, Tramadol
Schedule V: low potential for abuse and contain limited quantities of certain
narcotics; antidiarrheal, antitussive, and analgesic purposes.
(focus on schedule 2,3, and 4 per tutor)
• Which ones can and cannot be prescribed by nurse practitioners?
- Prescriptive Authority
Understand what prescriptive authority is and who mandates it. :Practice authority and
prescriptive authority together are described as practice “enviornments” according to state
laws and regulations.
o Full-practice scope: Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments and prescribe
medications, including controlled substances without physician oversight.
o Reduced-Practice scope: Nurse practitioners are limited in at least one element
of practice. The state requires a formal collaborative agreement with an outside
health discipline for the nurse practitioner to provide patient care.
o Restricted practice scope: Nurse practitioners are limited in at least one element of
practice by requiring supervision, delegation, or team management by an outside
health discipline for the nurse practitioner to provide patient care.
▪ What problems arise when prescriptive authority is limited? Limited
prescriptive authority creates numerous barriers to quality, affordable,
1
, 565 Midterm Study Guide
and accessible patient care. For example a requirement to obtain the
physician’s cosignature on prescription can increase patient waits.
• Know the responsibilities of prescribing : The ability to prescribe medications is both a
Privilege and a burden. The best way to keep your patients and yourself safe is to be
prudent and deliberate in your decision making process. Have a documented provider-
patient relationship with the person for whom you are prescribing. Do not prescribe for
family or friends or for yourself. Document a thorough history and physical examination
in your records.
• Know patient reasons for medication non-adherence:
- Forgot to take it
- Ran out
- Was away from home
- Was trying to save money
- Didn’t like the side effects
- Was too busy
- The medicine wasn’t working
• Know how what type of evidence prescribers should use to make treatment
recommendations:
-
• Be familiar with physiological changes of aging that impact pharmacological
treatments:
- Drug accumulation secondary to reduced renal function
- Polypharmacy (the use of 5 or more medications daily)
- Greater severity of illness
- Presence of comorbidities
- Use of drugs that have a low therapeutic index (e.g., digoxin)
- Increased individual variation secondary to altered pharmacokinetics
- Inadequate supervision of long-term therapy
- Poor patient adherence
-
• Be familiar with Beer’s Criteria : The Beers Criteria include five lists that describe
certain medications and situations and include:
- Potentially inappropriate Medication (PIM) use in older adults
- Potentially Inappropriate Medication (PIM) use in older adults due to
medication-disease or medication-syndrome interactions that may exacerbate
the disease or syndrome
- Medications to be used cautiously in older adults.
- Clinically significant drug interactions that should be avoided in older adults
- Medications to be avoided or dosage decreased in the presence of impaired
kidney function in older adults
-
•
•
•
•
•
2
, 565 Midterm Study Guide
• Know CYP450 inducers and inhibitors:
- Inducers Inhibitors (decrease medication
metabolism)
Carbamazepine Sertraline (Zoloft)50mg worse 200mg
Rifampin Erythromycin
Alcohol Terbinafine (Lamisi)
Phenytoin
Griseofulvin Valporate
Phenobarbital Isoniazid
Sulfonylureas Sulfonamides
Amiodarone
Chloramphenicol
Ketoconazole
Grapefruit Juice
Quinidine
-
-
• Be familiar with opioid agonists :
• Know the outcome of having a poor metabolism phenotype
• Know the role of the government agencies when it comes to prescription drugs
Week 2
• Know black box warning for various pain medications.
• Be familiar with patient indicators that would put them at risk for developing substance
abuse disorder.
• Be familiar with conditions that do and do not warrant opioid therapy.
• Know what a morphine milligram equivalent is and when to use it.
• Be familiar with Prescription Drug Monitoring Program (PDMP) o What it is o When
to use it
• Know the outcomes of renal and hepatic insufficiency with opioid therapy.
• Know the risk factors of opioid use disorder.
• Know the signs of drug diversion.
• When is it appropriate to prescribe naloxone?
• Be familiar with drugs that are not safe to take with opioids.
• Be familiar with the PEG Assessment Scale.
• Patient and provider responsibilities in opioid drug therapy
• How to approach conversations about Opioid Use Disorder
• What types of pain can be treated by psychotropic medications?
3
Week 1
• Drug Schedules
- Descriptions of each schedule
• Examples of drugs in each schedule:
- Schedule I: high potential for abuse: heroin, lysergic acid diethylamide (LSD),
marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ectstasy),
methaqualone, and peyote.
-
- Schedule II: high potential for abuse, potentially leading to severe psychological
or physical dependence. These drugs are also considered dangerous;
combination products with less than 15 milligrams of hydrocodone per dosage
unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone
(Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine,
Adderall, and Ritalin
•
- Schedule III: Moderate to low potential for physical psychological dependence;
producets containing less than 90 milligrams of codeine per dosage unit
(Tylenol with codeine), ketamine, anabolic steroids, testosterone
Shedule IV: Low potential for abuse and low risk of dependence; Xanax, Soma,
Darvan, Darocet, Valium, Ativan, Talwin, Ambien, Tramadol
Schedule V: low potential for abuse and contain limited quantities of certain
narcotics; antidiarrheal, antitussive, and analgesic purposes.
(focus on schedule 2,3, and 4 per tutor)
• Which ones can and cannot be prescribed by nurse practitioners?
- Prescriptive Authority
Understand what prescriptive authority is and who mandates it. :Practice authority and
prescriptive authority together are described as practice “enviornments” according to state
laws and regulations.
o Full-practice scope: Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments and prescribe
medications, including controlled substances without physician oversight.
o Reduced-Practice scope: Nurse practitioners are limited in at least one element
of practice. The state requires a formal collaborative agreement with an outside
health discipline for the nurse practitioner to provide patient care.
o Restricted practice scope: Nurse practitioners are limited in at least one element of
practice by requiring supervision, delegation, or team management by an outside
health discipline for the nurse practitioner to provide patient care.
▪ What problems arise when prescriptive authority is limited? Limited
prescriptive authority creates numerous barriers to quality, affordable,
1
, 565 Midterm Study Guide
and accessible patient care. For example a requirement to obtain the
physician’s cosignature on prescription can increase patient waits.
• Know the responsibilities of prescribing : The ability to prescribe medications is both a
Privilege and a burden. The best way to keep your patients and yourself safe is to be
prudent and deliberate in your decision making process. Have a documented provider-
patient relationship with the person for whom you are prescribing. Do not prescribe for
family or friends or for yourself. Document a thorough history and physical examination
in your records.
• Know patient reasons for medication non-adherence:
- Forgot to take it
- Ran out
- Was away from home
- Was trying to save money
- Didn’t like the side effects
- Was too busy
- The medicine wasn’t working
• Know how what type of evidence prescribers should use to make treatment
recommendations:
-
• Be familiar with physiological changes of aging that impact pharmacological
treatments:
- Drug accumulation secondary to reduced renal function
- Polypharmacy (the use of 5 or more medications daily)
- Greater severity of illness
- Presence of comorbidities
- Use of drugs that have a low therapeutic index (e.g., digoxin)
- Increased individual variation secondary to altered pharmacokinetics
- Inadequate supervision of long-term therapy
- Poor patient adherence
-
• Be familiar with Beer’s Criteria : The Beers Criteria include five lists that describe
certain medications and situations and include:
- Potentially inappropriate Medication (PIM) use in older adults
- Potentially Inappropriate Medication (PIM) use in older adults due to
medication-disease or medication-syndrome interactions that may exacerbate
the disease or syndrome
- Medications to be used cautiously in older adults.
- Clinically significant drug interactions that should be avoided in older adults
- Medications to be avoided or dosage decreased in the presence of impaired
kidney function in older adults
-
•
•
•
•
•
2
, 565 Midterm Study Guide
• Know CYP450 inducers and inhibitors:
- Inducers Inhibitors (decrease medication
metabolism)
Carbamazepine Sertraline (Zoloft)50mg worse 200mg
Rifampin Erythromycin
Alcohol Terbinafine (Lamisi)
Phenytoin
Griseofulvin Valporate
Phenobarbital Isoniazid
Sulfonylureas Sulfonamides
Amiodarone
Chloramphenicol
Ketoconazole
Grapefruit Juice
Quinidine
-
-
• Be familiar with opioid agonists :
• Know the outcome of having a poor metabolism phenotype
• Know the role of the government agencies when it comes to prescription drugs
Week 2
• Know black box warning for various pain medications.
• Be familiar with patient indicators that would put them at risk for developing substance
abuse disorder.
• Be familiar with conditions that do and do not warrant opioid therapy.
• Know what a morphine milligram equivalent is and when to use it.
• Be familiar with Prescription Drug Monitoring Program (PDMP) o What it is o When
to use it
• Know the outcomes of renal and hepatic insufficiency with opioid therapy.
• Know the risk factors of opioid use disorder.
• Know the signs of drug diversion.
• When is it appropriate to prescribe naloxone?
• Be familiar with drugs that are not safe to take with opioids.
• Be familiar with the PEG Assessment Scale.
• Patient and provider responsibilities in opioid drug therapy
• How to approach conversations about Opioid Use Disorder
• What types of pain can be treated by psychotropic medications?
3
