NR 508 Midterm Study Guide
, NR 508 Midterm Study Guide
1. Chapter 1: The Role of the Advanced Practice Nurse as Prescriber
Roles and responsibilities of APRN prescribers
Prescriptive authority is different in all states. Responsibility of final decision and which drug to
use is the PRESCRIBER’s. Nurse Practitioner Journal releases legislative updates every January.
IOM called for removing all practice barriers and allowing NPs to practice to their full scope of
practice based upon education and training.
Clinical judgement in Prescribing
Prescribing a drug results from clinical judgment 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. In general, the best therapy is the least invasive, least expensive,
and least likely to cause adverse reactions. Frequently, the best choice is to have lifestyle,
nonpharmacological, and pharmacological therapies working together. When the choice of
treatment options is a drug, several questions arise.
Collaboration with other providers-
No one member of the health-care team can provide high-quality care without collaborating with
other team members. They most often collaborate with physicians, pharmacists, podiatrists,
mental health specialists, therapists, and other providers, including APRNs who are not NPs,
physician assistants, and other nurses
Autonomy and Prescriptive authority
Long hard battle to obtain rights, with a long road ahead. Call to professionalism and excellence.
2. Chapter 2: Review of Basic Principles of Pharmacology
Metabolism: Metabolism & Half Life
, Pharmacogenomics is the study of how individual variations in drug targets or metabolism affect
drug therapy. Pharmacogenomic studies can identify factors that are responsible for beneficial or
adverse effects in individual patients.
Metabolism is the process of changing one chemical into another, and the process usually either
creates or uses energy. Metabolism of drugs can occur in every biological tissue, but it occurs
mostly in the smooth endoplasmic reticulum of cells in the liver. The liver is a major organ for
drug metabolism because it contains high amounts of drug-metabolizing enzymes and because it
is the first organ encountered by drugs once they are absorbed from the gastrointestinal tract.
Metabolism by the liver following oral administration is called first-pass metabolism and is
important in determining whether a drug can be orally administered.
The rate of drug metabolism depends on the blood levels of drug in relation to the affinity of the
drug for its metabolism enzymes. Most drugs are present at concentrations below their Km for
metabolism (the concentration at which metabolism is half of maximum). Under these
conditions, metabolism is related to drug concentration so that a fixed fraction of drug is
metabolized per hour. This is called first-order metabolism and is characterized by a half-life, the
time period over which the drug concentration will decrease by half. So, blood levels decrease
50% in one half-life, 75% in two half-lives, and 87.5% in three half-lives. As a general rule,
drugs tend to be administered at dosing intervals that are close to their half-life.
Drug Responses
Before a medication can produce a response, it often must overcome homeostatic mechanisms.
Drug effects depend on the amount of drug that is administered. If the dose is below that needed
to produce a measurable biological effect, then no response is observed; any effects of the drug
are not sufficient to overcome homeostatic capabilities. If an adequate dose is administered, there
will be a measurable biological response. With an even higher dose, we may see a greater
response. At some point, however, we will be unwilling to increase the dosage further, either
because we have already achieved a desired or maximum response or because we are concerned
about producing additional responses that might harm the patient. Because pharmacology is the
study of substances that produce biological responses, measurement of what happens when we
administer medications is important. We will need ways to express and compare drug activity so
, NR 508 Midterm Study Guide
1. Chapter 1: The Role of the Advanced Practice Nurse as Prescriber
Roles and responsibilities of APRN prescribers
Prescriptive authority is different in all states. Responsibility of final decision and which drug to
use is the PRESCRIBER’s. Nurse Practitioner Journal releases legislative updates every January.
IOM called for removing all practice barriers and allowing NPs to practice to their full scope of
practice based upon education and training.
Clinical judgement in Prescribing
Prescribing a drug results from clinical judgment 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. In general, the best therapy is the least invasive, least expensive,
and least likely to cause adverse reactions. Frequently, the best choice is to have lifestyle,
nonpharmacological, and pharmacological therapies working together. When the choice of
treatment options is a drug, several questions arise.
Collaboration with other providers-
No one member of the health-care team can provide high-quality care without collaborating with
other team members. They most often collaborate with physicians, pharmacists, podiatrists,
mental health specialists, therapists, and other providers, including APRNs who are not NPs,
physician assistants, and other nurses
Autonomy and Prescriptive authority
Long hard battle to obtain rights, with a long road ahead. Call to professionalism and excellence.
2. Chapter 2: Review of Basic Principles of Pharmacology
Metabolism: Metabolism & Half Life
, Pharmacogenomics is the study of how individual variations in drug targets or metabolism affect
drug therapy. Pharmacogenomic studies can identify factors that are responsible for beneficial or
adverse effects in individual patients.
Metabolism is the process of changing one chemical into another, and the process usually either
creates or uses energy. Metabolism of drugs can occur in every biological tissue, but it occurs
mostly in the smooth endoplasmic reticulum of cells in the liver. The liver is a major organ for
drug metabolism because it contains high amounts of drug-metabolizing enzymes and because it
is the first organ encountered by drugs once they are absorbed from the gastrointestinal tract.
Metabolism by the liver following oral administration is called first-pass metabolism and is
important in determining whether a drug can be orally administered.
The rate of drug metabolism depends on the blood levels of drug in relation to the affinity of the
drug for its metabolism enzymes. Most drugs are present at concentrations below their Km for
metabolism (the concentration at which metabolism is half of maximum). Under these
conditions, metabolism is related to drug concentration so that a fixed fraction of drug is
metabolized per hour. This is called first-order metabolism and is characterized by a half-life, the
time period over which the drug concentration will decrease by half. So, blood levels decrease
50% in one half-life, 75% in two half-lives, and 87.5% in three half-lives. As a general rule,
drugs tend to be administered at dosing intervals that are close to their half-life.
Drug Responses
Before a medication can produce a response, it often must overcome homeostatic mechanisms.
Drug effects depend on the amount of drug that is administered. If the dose is below that needed
to produce a measurable biological effect, then no response is observed; any effects of the drug
are not sufficient to overcome homeostatic capabilities. If an adequate dose is administered, there
will be a measurable biological response. With an even higher dose, we may see a greater
response. At some point, however, we will be unwilling to increase the dosage further, either
because we have already achieved a desired or maximum response or because we are concerned
about producing additional responses that might harm the patient. Because pharmacology is the
study of substances that produce biological responses, measurement of what happens when we
administer medications is important. We will need ways to express and compare drug activity so
