x
MN 553 Pharmacology Exam 1 2024
x x x x x x
Prescriptive xAuthority x- x*States xvary xin xtheir xlaws xrelated xto xprescriptive xauthority xfor x
APRNs. x
*Scope xof xpractice xis xdetermined xby xthe xindividual xNP's xlicense xunder xthe xnurse xpractice
xact xof xthe xlicensing xjurisdiction. xSome xhave xa xgraduated xscope xbased xon xexperience
xlevel. xNew xprescribers xneed xto xunderstand xthat xtheir xemployment xsites xmay xrestrict xthis
xlegal xscope xof xpractice xbut xcannot xextend xit. x
x
Prescribing x- x•Ensure xthat xprescribing xpractices xmeet xcurrent xstandards xof xmedical xcare. x
•Maintain xaccurate xand xthorough xdocumentation xof xprescribing xpractices. x
•Engage xin xinformative xand xinteractive xinformed xconsent xdiscussions xthat xallocate
xappropriate xresponsibility xbetween xphysician xand xpatient. x
•Evaluate xsplit xtreatment xarrangements xand xsupervisory xsettings xto xensure xthat xyour
xsupervisees xhave xthe xtraining, xability, xand xresources xto xprovide xhigh-quality xmedical
xcare. x
•Your xState xPractice xAct-What xare xyour xlimits xin xprescribing? x
•Your xState xBoard xof xNursing x
•Your xRole xand xLicensure x
•National xCertification xand xCredentialing x
*Prescribing xa xdrug xresults xfrom xclinical xjudgment xbased xon xa xthorough xassessment xof
xthe xpatient xand xthe xpatient's xenvironment, xthe xdetermination xof xmedical xand xnursing
xdiagnoses, xa xreview xof xpotential xalternative xtherapies, xand xspecific xknowledge xabout xthe
xdrug xchosen xand xthe xdisease xprocess xit xis xdesigned xto xtreat. xIn xgeneral, xthe xbest xtherapy
xis xthe xleast xin x
x
Writing xand xTransmitting xthe xPrescription x- x1. xUse xpreprinted xprescription xpads/electronic
xtemplates xthat xcontain xthe xname, xaddress, xtelephone xnumber, xand xNPI xnumber xof xthe
xprescriber. xThis xwill xallow xthe xpharmacist xto xcontact xthe xprescriber xif xthere xare xany
xquestions xabout xthe xprescription. x
2. Designate xthe xcomplete xdrug xname, xstrength, xdosage, xform xand xnumber xto xdispense. x
3. Indicate xthe xdate xof xthe xprescription. x
4. Use xmetric xunits xof xmeasure, xsuch xas xmilligrams xand xmilliliters; xavoid xapothecary
xunits xof xmeasure. x
5. Avoid xabbreviations. x
6. Avoid xthe xuse xof x"as xdirected" xor x"as xneeded." x
7. Include xthe xgeneral xindication, xsuch xas x"for xinfection." x
8. Indicate x"Dispense xas xWritten" xif xgeneric xsubstitution xis xnot xdesired. x
9. Include xthe xpatient xweight, xespecially xif xpediatric xor xgeriatric. x
10. Indicate xif xa xsafety xcap xis xnot xrequired, xas xmedications xwill xbe xdispensed xwith
xthem xby xdefault. x
x
ETHICAL xASPECTS xOF xPRESCRIBING x- xInformed xConsent x
-The xnotion xof xinformed xconsent xis xshorthand xfor xthe xpatient's xright xto xmake xinformed
xdecisions xabout xthose xthings xthat xwill xaffect xhim xor xher. x
x
Prescribing xfor xSelf, xFamily, xor xFriends x
-State xlaw xvaries xregarding xwhether xan xNP xcan xprescribe xfor xfamily xor xfriends. xFor xa
xprescription xto xbe xclinically xlegitimate, xa xpatient xmust xbe xassessed xand xthere xmust xbe xa
,xrecord xof xhis xor xher xassessment. xIt xis xclearly xunethical xto xprescribe xfor xoneself, xand
xmany xstates xpunish xthis xwith xsignificant xfines xor xboard xaction. xAlthough xit xmay xbe
xtechnically xlegal xto xprescribe xfor xfamily xor xfriends, xan xNP xneeds xto xconsider xwhether xit
xis xethical. xIf xthe xclinical xcircumstance xrequires xa xcontrolled xsubstance, xthe xjudicious
xprescriber xwill xrefer xa xfriend xor xfamily xmember xto xa xcolleague xfor xconfidential
xassessment xand xtreatment. xIt xis xnever xconsidered xethical xfor xa xmental xhealth xprovider xto
xengage xa xfamily xmember xor xclose xfriend xin xa xclinically xtherapeutic xrelationship, xwhether
xor xnot xprescribing x
x
First xPass xeffect x- x•Oral xmeds xare xgenerally xabsorbed xby xthe xGI xtract xand xcarried xto xthe
xliver. x
x
Drug xmay xundergo xextensive xmetabolism xleaving xlittle xfor xsystemic xuse. xThis xis xcalled
xthe
x
first xpass
xeffect.
x
Are xrapidly xmetabolized xby xthe xliver x& xmay xhave xlittle xif xany xdesired
xaction.
x
Loading xdose x- x-Rapidly xachieves xtherapeutic xlevels x
-Dose xof xmedication, xoften xlarger xthan xsubsequent xdoses, xadministered xfor xthe xpurpose xof
xestablishing xa xtherapeutic xlevel xof xthe xmedication. x
x
Peak xdrug xlevel x- x*Time xit xtakes xa xdrug xto xdemonstrate xits xfull xtherapeutic xeffect. x
*The xpeak xlevel xis xthe xhighest xconcentration xof xa xdrug xin xthe xpatient's xbloodstream. x x
**Note: xRandom xdrug xlevels xmay xbe xordered xand xare xappropriate xfor xmonitoring xdrug
xusage xif xdrug xis xbeing xadministered xby xcontinuous xIV xinfusion. x
x
Investigating xnew xdrugs x- x*New xdrug xinvestigation xis xfiled xwith xthe xUSDA xprior xto
xhuman xtesting xof xany xnew xdrug xentity. x
*An xInvestigational xNew xDrug x(IND) xis xa xdrug xdeveloped xby xa xpharmaceutical xor
xbiotech xcompany xor xother xorganization xthat xis xready xfor xclinical xtrials xon xhumans. xWhen
xa xdrug xreaches xthis xpoint, xthe xpharma xcompany xsubmits xan xapplication xto xget xthe
xconsent xof xthe xFood xand xDrug xAdministration x(FDA) xto xbegin xthese xtrials. x
x
Being xan xInterpreter x- x*Use xreliable xperson xat xhospital x(employee) x
*Use xcertified xinterpreters xfor xlanguage, xhearing xand xspeech ximpairments. xProvider xliable
xfor xpoor xoutcomes xif xlay xinterpreter xis xused x
x
Nonadherence x- xChoose xdrugs xwith xhigher xtolerability x& xfewer xSE xsuch xas xn/v, x&
xdizziness. x
x
Contributing xfactors: x
-poor xcommunication x
-forgetfulness x(especially xif xit xis xa xside xeffect xof xa xdrug), xlack xof xknowledge, xdementia,
xmental xhealth xproblems, xsimple xprocrastination, xor xan xoverextended xlifestyle. x
-Adverse xDrug xReactions. x
-Cognitive xImpairment xand xPsychiatric xIllness. x
-Complexity xof xDrug xRegimen xand xPolypharmacy. x
x
Top x4 xReasons xfor xNon-Adherence x
•Side xEffects x
•Cost x
, •Too xComplex xand/or xForgetfulness x
•"I'm xCured" xComplex x
x
Poor xhealth xoutcomes xin xvulnerable xpopulations x- x-Discrimination, xcultural xbarriers, xand
xlack x
x
of xhealth
xcare.
x
- xChronically xill xand
xdisabled
-Low-income xand/or xhomeless xindividuals x
-Certain xgeographical xcommunities x(rural xareas), xNative xAmericans xliving xon xreservations
xare xalso xvulnerable. x
-LGBTQ+ xpopulation x(have xfaced xor xfear xfacing xdiscrimination). x
-Children x& xelderly x
x
Tamoxifen x- x- xSelective xestrogen xreceptor xmodulator x(SERM) xclass xused xto xtx xconditions
xthat xrespond xto xadding xor xwithdrawing xestrogen. x x
-Tamoxifen xblocks xestradiol-induced xcancer xcell xgrowth x(in xbreast xtissue) xinhibiting xthe
xtumor xblood xsupply. x(A xprovider xmay xtest xthe xpt xfor xCYP2D6 xvariants xprior xto xstarting
xTamoxifen xto xreduce xthe xlikelihood xof xtherapeutic xfailure xw/tx) x
x
Cont. xTamoxifen x- x-Tamoxifen xcan xincrease xyour xrisk xof xstroke xor xblood xclots. x
*Pharmacodynamics: xComplete xwith xestrogen xfor xbinding xsites xin xtissues xhigh xin
xesterogen xreceptors, xsuch xas xbreast xtissues. xThis xmechanism xdeprives xestrogen-sensitive
xtumors xof xestgerogen. xIt xalso xinhibits xthe xgrowth xof xmost xcancer x& xother xepithelioid
xcells. xContraindications/precautions: xCaution xin xthose xwith xmyelolsuppression xand xwho
xare xpregnancy xor xbreast-feeding. x
x
*Adverse xeffects: xhot xflashes x(in xpremenopausal xwomen), xmild xnausea, xHA, xlight-
headedness, x
x
weight xgain, xvaginal xbleeding/discharge, xvisual xside xeffects, xskin
xrash.
x
*Drug-drug xoral xanticoagulants xand xbromociptine. xDietary: xgrapefruit xand xtangerines
xcan x
x
lessen xthe xeffectiveness xof
xtamoxifen.
x
*May xincrease xlevels xof: xcalcium, xcholesterol x& xtriglycerides. x
x
*Assess xfor xs/sx: xN/V, xconstipation, xhypotonicity xof xmuscles, xand xdeep xbone xand xflank
xpain. x
x
*PATIENT xTEACHING- xWomen xshould xbe xadvised xnot xto xbecome xpregnant xwhile
xtaking x
x
tamoxifen xand xshould xuse xbarrier
xcontra
x
Ginseng x- xOTC xto xhelp ximprove xmemory, xcan xpotentiate x(increase xpower xor xeffect
xof) x
x
INSULIN.
x
MN 553 Pharmacology Exam 1 2024
x x x x x x
Prescriptive xAuthority x- x*States xvary xin xtheir xlaws xrelated xto xprescriptive xauthority xfor x
APRNs. x
*Scope xof xpractice xis xdetermined xby xthe xindividual xNP's xlicense xunder xthe xnurse xpractice
xact xof xthe xlicensing xjurisdiction. xSome xhave xa xgraduated xscope xbased xon xexperience
xlevel. xNew xprescribers xneed xto xunderstand xthat xtheir xemployment xsites xmay xrestrict xthis
xlegal xscope xof xpractice xbut xcannot xextend xit. x
x
Prescribing x- x•Ensure xthat xprescribing xpractices xmeet xcurrent xstandards xof xmedical xcare. x
•Maintain xaccurate xand xthorough xdocumentation xof xprescribing xpractices. x
•Engage xin xinformative xand xinteractive xinformed xconsent xdiscussions xthat xallocate
xappropriate xresponsibility xbetween xphysician xand xpatient. x
•Evaluate xsplit xtreatment xarrangements xand xsupervisory xsettings xto xensure xthat xyour
xsupervisees xhave xthe xtraining, xability, xand xresources xto xprovide xhigh-quality xmedical
xcare. x
•Your xState xPractice xAct-What xare xyour xlimits xin xprescribing? x
•Your xState xBoard xof xNursing x
•Your xRole xand xLicensure x
•National xCertification xand xCredentialing x
*Prescribing xa xdrug xresults xfrom xclinical xjudgment xbased xon xa xthorough xassessment xof
xthe xpatient xand xthe xpatient's xenvironment, xthe xdetermination xof xmedical xand xnursing
xdiagnoses, xa xreview xof xpotential xalternative xtherapies, xand xspecific xknowledge xabout xthe
xdrug xchosen xand xthe xdisease xprocess xit xis xdesigned xto xtreat. xIn xgeneral, xthe xbest xtherapy
xis xthe xleast xin x
x
Writing xand xTransmitting xthe xPrescription x- x1. xUse xpreprinted xprescription xpads/electronic
xtemplates xthat xcontain xthe xname, xaddress, xtelephone xnumber, xand xNPI xnumber xof xthe
xprescriber. xThis xwill xallow xthe xpharmacist xto xcontact xthe xprescriber xif xthere xare xany
xquestions xabout xthe xprescription. x
2. Designate xthe xcomplete xdrug xname, xstrength, xdosage, xform xand xnumber xto xdispense. x
3. Indicate xthe xdate xof xthe xprescription. x
4. Use xmetric xunits xof xmeasure, xsuch xas xmilligrams xand xmilliliters; xavoid xapothecary
xunits xof xmeasure. x
5. Avoid xabbreviations. x
6. Avoid xthe xuse xof x"as xdirected" xor x"as xneeded." x
7. Include xthe xgeneral xindication, xsuch xas x"for xinfection." x
8. Indicate x"Dispense xas xWritten" xif xgeneric xsubstitution xis xnot xdesired. x
9. Include xthe xpatient xweight, xespecially xif xpediatric xor xgeriatric. x
10. Indicate xif xa xsafety xcap xis xnot xrequired, xas xmedications xwill xbe xdispensed xwith
xthem xby xdefault. x
x
ETHICAL xASPECTS xOF xPRESCRIBING x- xInformed xConsent x
-The xnotion xof xinformed xconsent xis xshorthand xfor xthe xpatient's xright xto xmake xinformed
xdecisions xabout xthose xthings xthat xwill xaffect xhim xor xher. x
x
Prescribing xfor xSelf, xFamily, xor xFriends x
-State xlaw xvaries xregarding xwhether xan xNP xcan xprescribe xfor xfamily xor xfriends. xFor xa
xprescription xto xbe xclinically xlegitimate, xa xpatient xmust xbe xassessed xand xthere xmust xbe xa
,xrecord xof xhis xor xher xassessment. xIt xis xclearly xunethical xto xprescribe xfor xoneself, xand
xmany xstates xpunish xthis xwith xsignificant xfines xor xboard xaction. xAlthough xit xmay xbe
xtechnically xlegal xto xprescribe xfor xfamily xor xfriends, xan xNP xneeds xto xconsider xwhether xit
xis xethical. xIf xthe xclinical xcircumstance xrequires xa xcontrolled xsubstance, xthe xjudicious
xprescriber xwill xrefer xa xfriend xor xfamily xmember xto xa xcolleague xfor xconfidential
xassessment xand xtreatment. xIt xis xnever xconsidered xethical xfor xa xmental xhealth xprovider xto
xengage xa xfamily xmember xor xclose xfriend xin xa xclinically xtherapeutic xrelationship, xwhether
xor xnot xprescribing x
x
First xPass xeffect x- x•Oral xmeds xare xgenerally xabsorbed xby xthe xGI xtract xand xcarried xto xthe
xliver. x
x
Drug xmay xundergo xextensive xmetabolism xleaving xlittle xfor xsystemic xuse. xThis xis xcalled
xthe
x
first xpass
xeffect.
x
Are xrapidly xmetabolized xby xthe xliver x& xmay xhave xlittle xif xany xdesired
xaction.
x
Loading xdose x- x-Rapidly xachieves xtherapeutic xlevels x
-Dose xof xmedication, xoften xlarger xthan xsubsequent xdoses, xadministered xfor xthe xpurpose xof
xestablishing xa xtherapeutic xlevel xof xthe xmedication. x
x
Peak xdrug xlevel x- x*Time xit xtakes xa xdrug xto xdemonstrate xits xfull xtherapeutic xeffect. x
*The xpeak xlevel xis xthe xhighest xconcentration xof xa xdrug xin xthe xpatient's xbloodstream. x x
**Note: xRandom xdrug xlevels xmay xbe xordered xand xare xappropriate xfor xmonitoring xdrug
xusage xif xdrug xis xbeing xadministered xby xcontinuous xIV xinfusion. x
x
Investigating xnew xdrugs x- x*New xdrug xinvestigation xis xfiled xwith xthe xUSDA xprior xto
xhuman xtesting xof xany xnew xdrug xentity. x
*An xInvestigational xNew xDrug x(IND) xis xa xdrug xdeveloped xby xa xpharmaceutical xor
xbiotech xcompany xor xother xorganization xthat xis xready xfor xclinical xtrials xon xhumans. xWhen
xa xdrug xreaches xthis xpoint, xthe xpharma xcompany xsubmits xan xapplication xto xget xthe
xconsent xof xthe xFood xand xDrug xAdministration x(FDA) xto xbegin xthese xtrials. x
x
Being xan xInterpreter x- x*Use xreliable xperson xat xhospital x(employee) x
*Use xcertified xinterpreters xfor xlanguage, xhearing xand xspeech ximpairments. xProvider xliable
xfor xpoor xoutcomes xif xlay xinterpreter xis xused x
x
Nonadherence x- xChoose xdrugs xwith xhigher xtolerability x& xfewer xSE xsuch xas xn/v, x&
xdizziness. x
x
Contributing xfactors: x
-poor xcommunication x
-forgetfulness x(especially xif xit xis xa xside xeffect xof xa xdrug), xlack xof xknowledge, xdementia,
xmental xhealth xproblems, xsimple xprocrastination, xor xan xoverextended xlifestyle. x
-Adverse xDrug xReactions. x
-Cognitive xImpairment xand xPsychiatric xIllness. x
-Complexity xof xDrug xRegimen xand xPolypharmacy. x
x
Top x4 xReasons xfor xNon-Adherence x
•Side xEffects x
•Cost x
, •Too xComplex xand/or xForgetfulness x
•"I'm xCured" xComplex x
x
Poor xhealth xoutcomes xin xvulnerable xpopulations x- x-Discrimination, xcultural xbarriers, xand
xlack x
x
of xhealth
xcare.
x
- xChronically xill xand
xdisabled
-Low-income xand/or xhomeless xindividuals x
-Certain xgeographical xcommunities x(rural xareas), xNative xAmericans xliving xon xreservations
xare xalso xvulnerable. x
-LGBTQ+ xpopulation x(have xfaced xor xfear xfacing xdiscrimination). x
-Children x& xelderly x
x
Tamoxifen x- x- xSelective xestrogen xreceptor xmodulator x(SERM) xclass xused xto xtx xconditions
xthat xrespond xto xadding xor xwithdrawing xestrogen. x x
-Tamoxifen xblocks xestradiol-induced xcancer xcell xgrowth x(in xbreast xtissue) xinhibiting xthe
xtumor xblood xsupply. x(A xprovider xmay xtest xthe xpt xfor xCYP2D6 xvariants xprior xto xstarting
xTamoxifen xto xreduce xthe xlikelihood xof xtherapeutic xfailure xw/tx) x
x
Cont. xTamoxifen x- x-Tamoxifen xcan xincrease xyour xrisk xof xstroke xor xblood xclots. x
*Pharmacodynamics: xComplete xwith xestrogen xfor xbinding xsites xin xtissues xhigh xin
xesterogen xreceptors, xsuch xas xbreast xtissues. xThis xmechanism xdeprives xestrogen-sensitive
xtumors xof xestgerogen. xIt xalso xinhibits xthe xgrowth xof xmost xcancer x& xother xepithelioid
xcells. xContraindications/precautions: xCaution xin xthose xwith xmyelolsuppression xand xwho
xare xpregnancy xor xbreast-feeding. x
x
*Adverse xeffects: xhot xflashes x(in xpremenopausal xwomen), xmild xnausea, xHA, xlight-
headedness, x
x
weight xgain, xvaginal xbleeding/discharge, xvisual xside xeffects, xskin
xrash.
x
*Drug-drug xoral xanticoagulants xand xbromociptine. xDietary: xgrapefruit xand xtangerines
xcan x
x
lessen xthe xeffectiveness xof
xtamoxifen.
x
*May xincrease xlevels xof: xcalcium, xcholesterol x& xtriglycerides. x
x
*Assess xfor xs/sx: xN/V, xconstipation, xhypotonicity xof xmuscles, xand xdeep xbone xand xflank
xpain. x
x
*PATIENT xTEACHING- xWomen xshould xbe xadvised xnot xto xbecome xpregnant xwhile
xtaking x
x
tamoxifen xand xshould xuse xbarrier
xcontra
x
Ginseng x- xOTC xto xhelp ximprove xmemory, xcan xpotentiate x(increase xpower xor xeffect
xof) x
x
INSULIN.
x
