Midterm pharm Study Guide

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Pace University *

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Oct 30, 2023

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Module 1 Lecture 1: Prescribing Authority  Federal Law - Established if a drug requires a prescription - Determines who may prescribe  State Law - Prescriptive authority varies - Regulation of education - Provider dispensing  Federal Facilities such as VA, Indian Health Service - Requires state-based license - May practice in a facility different from state of origin under the same license - Exempt from DEA fees  NYS Regulation - Ability to prescribe all classes - Granted with licensure - No physician oversight is required - Authority to prescribe: written collaborative agreement (contractual)  Collaborative relationship: eligible when > 3600 hours  Independent practice after >3600 hours  WHO Model for Rational Prescribing 1. Define the patient’s problem 2. Specify the Therapeutic Objective 3. Choose the Treatment (EBP vs tailored treatment) 4. Start the Treatment 5. Educate the patient 6. Monitor the effectiveness  ICPCEAD (CHECK BEFORE PRESCRIBING) I C AN P RESCRIBE C OMPLIMENTING E FFECTIVE A WESOME D RUGS I: indication C: Contraindication P: Precaution C: Cost/Compliance E: Efficacy A: Adverse Effects D: Dose/Duration/Direction

Schedule Control Substanc e Description Examples CI Ex. Street Drugs; No accepted medical use in US High abuse potential Heroin, LSD, mescaline, peyote, MDMA CII Ex. Narcotic; may lead to severe physical or physchological dependence High abuse potential Max Call-In Supply: 5 days Opioids: hydrocodone, hydromorphone, methadone, meperidine, morphine, oxycodone, fentanyl, codeine Stimulants: amphetamines, methylphenidates NYS: benzodiazepines CIII May lead to moderate or low physical dependence or high psychological dependence Max Call-in Supply: 5 days Anabolic steroids, ketamine, Tylenol w/ codeine Fiorinal (NOT fioricet) CIV Low potential for abuse Max call-in supply: 30 days or 100 doses Benzodiazepines, carisoprodol, phenobarbital, tramadol, eszopiclonem zaleplon, zolpidem CV Lowest abuse potential; may be available in OTC in some states Max call-in supply: 5 days Lomotil, pregabalin, Phenergan Patient factors: EtOH abuse/substance abuse; abrupt discontinuing; plan for taper especially in opioids and benzodiazepines Best Practice: spell out quantity and strengths; indicate earliest fill date; limit quantity and duration iStop: Drug monitoring Program, cross-state wide search, requires patient’s full name and DOB; views patient’s controlled substance history for the past 6 months (day supply, prescriber, drug name and strength, cash/insurance, Rx location dispensed. Calling in for Emergency Supply of CS : Must provide Rx to pharmacy within 72 hours (written or E-Rx) w/ “For emergency dispensing” on script; include date and time of call

Controls: - Name - Address - DOB/age - Sex - Date - Expire 30 days from date written - Provider DEA - MDD All Non-Controlled Scripts: - Name - Date - Expire 1 year from date written - NYS Medicaid EXPIRE 6 months from date - Provider credentials - Inscription, Sig, Subscription Questions: 1. Which of the following scenarios does NOT describe a situation for which a NYS Prescriber can issue a written prescription in place of e-scribing? - The prescription is in response to a non-patient specific standing order - The prescription is for a patient who does not have a preferred pharmacy on file - The prescription will be dispensed at a pharmacy outside of NYS - The prescription is for a medication that is commonly backordered as per current drug shortage

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2. Which of the following statements does NOT coincide with the prescriptive authority of a NP in NYS? - NPs can prescribe all schedule classes for controlled substances - The ability for an NP to precribe comes with licensure and does not require physician oversight - Schedule II CS must be prescribed under the collaborating physician’s DEA number - NPs are required to have a written practice agreement or be approved to practice with a collaborative physician relationship.

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When ordering >30 Day Supply for CS: Codes CODE A PANIC DISORDER CODE B Minimal brain dysfunction of ADHD CODE C Debilitating neurological condition characterized as a movement disorder or exhibiting seizure, convulsive/spastic activity CODE D Relief of pain for patients 65+ from conditions or diseases considered chronic or incurable CODE E narcolepsy CODE F Hormone deficiency in males, gynecological conditions that are responsive to treatments with anabolic steroids or HCG, metastatic breast CA, anemia, and angioedema Ex. Anabolic steroids <6 months Module 1 Lecture 2: Pharm Principles Time Course of Drug Response  MEC: minimum effective drug concentration; onset of action  MTC: minimum toxic concentration; ADRs & toxicity  TI: therapeutic index - Range between MEC and MTC - Independent of route Ex: BP, HR, Diuresis, Bronchodilation, FEV1, Pain Scale, COMA score Types of Drug Responses  Graded: effects are able to be measured continually (Ex. HR, BP, pain)  Quantal: occurring or not (All or nothing) - Population > individual - Large scale Ex: convulsions, pregnancy, rash, sleep, death

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Drug Receptor Interaction Theories  Modified Occupancy Theory: accounts for potency and efficacy  Intrinsic Activity: receptor activation  Affinity: strength of drug attraction  Drug Receptor Interaction Theories - Single Occupancy Theory: intensity of response  Selective Drugs- increased affinity for specific target receptors; Fewer ADEs  Drug-receptor:lock-key  Inter-patient variability ED50- dose at which 50% of population exhibit desired response LD50- lethal dose to 50% of population TI- LD50/ED50  Repeated administration  decreases response  Metabolic tolerance: accelerated metabolism via CYP450; MEC not affected  G-protein coupled receptors: intracellular tail -  ,  ,  - Isotypes  Beta-adrenoceptors: mediate effects of EPI- increased HR  Receptor-less drugs include: NaHCO3, antacids, ethyl ETOH, antiseptics, MgSO4, dimercaprol, chelating agents Pharmacokinetics  Study of drug movement throughout the body  Based on 4 Processes o Absorption o Distribution o Metabolism o Excretion  Effect of Liver on Absorption - 1 st pass effect: PO drugs  GI tract  portal vein  Liver  IV: most rapid and complete absorption  IM: slower onset than IV; permits depots  SQ ~ IM

 Oral: enteral route; GI lining & capillary walls as barriers - SL & BUCC - ODT & RDT  Rectal  Ophthalmic & otic  Topical  Transdermal  Inhalation  Peak blood Levels: speed at which the drug enters bloodstream - Slow infusion: aminoglycosides, vancomycin  Peak: after distribution; efficacy  Trough: lowest point; PX toxicity  Narrow TI: continuous infusions; depots, decreased dose and interval  Distribution: process of drug movement throughout the body  Required for ALL drugs to undergo metabolism and excretion  Passive Diffusion: through partially permeable barriers  Direct Penetration depends on drug solubility - Lipophilic/hydrophilic: lipid soluble - Lipophobic/hydrophobic- H2O soluble - Like dissolves like  Protein-bound drugs: circulate in bloodstream