Advanced Pharmacology and Prescriptive Authority
NRNP 6568 – Week 4 Study Notes
Advanced Pharmacology and Prescriptive Authority
1. Introduction
Week 4 emphasizes the pharmacological knowledge and prescriptive authority required for Nurse Practitioners (NPs). Safe prescribing is a cornerstone of advanced practice, requiring mastery of drug mechanisms, therapeutic uses, side effects, interactions, and regulatory frameworks.
2. Principles of Pharmacology
Pharmacokinetics (PK): How the body affects drugs.
Absorption: Entry into bloodstream.
Distribution: Transport to tissues.
Metabolism: Breakdown, mainly in liver.
Excretion: Removal via kidneys, bile, lungs, skin.
Pharmacodynamics (PD): How drugs affect the body.
Mechanism of action.
Dose-response relationships.
Therapeutic vs toxic effects.
Therapeutic Index (TI): Ratio of toxic dose to effective dose. Narrow TI drugs (e.g., warfarin, lithium) require close monitoring.
3. Prescriptive Authority
Definition: Legal ability of NPs to prescribe medications.
State Variability:
Full Authority: Independent prescribing (e.g., Oregon, Washington).
Reduced Authority: Requires physician collaboration (e.g., New York).
Restricted Authority: Requires physician supervision (e.g., Texas).
Controlled Substances:
DEA registration required.
Schedule II–V drugs regulated.
Documentation and monitoring essential.
4. Clinical Decision-Making in Prescribing
Steps:
Assess patient condition.
Identify therapeutic goals.
Select appropriate drug.
Consider contraindications and interactions.
Determine dosage and route.
Educate patient.
Monitor outcomes and side effects.
Patient-Centered Approach: Incorporate patient preferences, lifestyle, and financial considerations.
5. Classes of Medications Commonly Prescribed by NPs
a) Cardiovascular Drugs
Antihypertensives: ACE inhibitors, ARBs, beta-blockers, calcium channel blockers.
Diuretics: Loop, thiazide, potassium-sparing.
Anticoagulants: Warfarin, DOACs.
b) Endocrine Drugs
Insulin and oral hypoglycemics.
Thyroid hormone replacement.
Corticosteroids.
c) Respiratory Drugs
Bronchodilators: Beta-agonists, anticholinergics.
Inhaled corticosteroids.
Leukotriene modifiers.
d) Infectious Disease Drugs
Antibiotics: Penicillins, cephalosporins, macrolides, fluoroquinolones.
Antivirals: HIV, influenza, herpes.
Antifungals.
e) Psychiatric Drugs
Antidepressants: SSRIs, SNRIs, TCAs, MAOIs.
Antipsychotics: Typical and atypical.
Mood stabilizers: Lithium, anticonvulsants.
Anxiolytics: Benzodiazepines, buspirone.
6. Special Populations
Pediatrics: Adjust doses by weight; avoid aspirin (Reye’s syndrome risk).
Geriatrics: Polypharmacy risk; altered PK/PD due to organ decline.
Pregnancy: FDA pregnancy categories; avoid teratogenic drugs.
Renal/Hepatic Impairment: Dose adjustments required.
7. Adverse Drug Reactions (ADRs)
Types:
Type A: Predictable, dose-dependent (e.g., hypoglycemia from insulin).
Type B: Idiosyncratic, unpredictable (e.g., anaphylaxis to penicillin).
Monitoring:
Educate patients on warning signs.
Report serious ADRs to FDA MedWatch.
8. Drug Interactions
Pharmacokinetic Interactions: Affect absorption, metabolism, excretion.
Pharmacodynamic Interactions: Additive, synergistic, or antagonistic effects.
Examples:
Warfarin + antibiotics → increased bleeding risk.
SSRIs + MAOIs → serotonin syndrome.
9. Ethical and Legal Considerations
Informed Consent: Patients must understand risks/benefits.
Documentation: Record rationale, dosage, patient education.
Accountability: NPs are legally responsible for prescriptions.
Avoiding Overprescribing: Especially opioids and antibiotics.
10. Patient Education
Importance of adherence.
Proper administration techniques.
Recognition of side effects.
Lifestyle modifications complementing pharmacotherapy.
11. Case Example
Scenario: 60‑year‑old female with hypertension and diabetes.
Assessment: BP 160/95, HbA1c 8.2%.
Plan: Initiate ACE inhibitor for BP, metformin for diabetes.
Education: Monitor BP and glucose, report cough (ACE inhibitor side effect).
Outcome: Improved BP and glucose control after 3 months.
12. Integration of Evidence-Based Practice
Use clinical guidelines (e.g., JNC for hypertension, ADA for diabetes).
Apply research evidence to drug selection.
Incorporate patient preferences into prescribing decisions.
13. Interprofessional Collaboration
Pharmacists: Drug interactions, dosing.
Physicians: Complex cases.
Nurses: Monitoring adherence.
Social workers: Address financial barriers.
14. Summary
Advanced pharmacology and prescriptive authority are essential NP competencies.
Safe prescribing requires knowledge of PK/PD, drug classes, special populations, ADRs, and interactions.
Ethical, legal, and patient-centered approaches ensure effective care.
Quiz: NRNP 6568 Week 4 (15 Questions)
Instructions: Multiple-choice format. Select the best answer.
Pharmacokinetics refers to:
a) How drugs affect the body
b) How the body affects drugs
c) Drug interactions only
d) Patient preferences
Which drug has a narrow therapeutic index?
a) Acetaminophen
b) Warfarin
c) Amoxicillin
d) Ibuprofen
DEA registration is required for prescribing:
a) Antibiotics
b) Controlled substances
c) OTC medications
d) Vaccines
Which antihypertensive may cause a persistent cough?
a) Beta-blocker
b) ACE inhibitor
c) Calcium channel blocker
d) Diuretic
Pediatric dosing is typically based on:
a) Age
b) Weight
c) Gender
d) Organ function only
Which drug is contraindicated in pregnancy due to teratogenicity?
a) Folic acid
b) Warfarin
c) Insulin
d) Amoxicillin
Type A adverse drug reactions are:
a) Unpredictable
b) Dose-dependent and predictable
c) Rare and idiosyncratic
d) Always allergic
Warfarin combined with antibiotics increases risk of:
a) Hypertension
b) Bleeding
c) Hypoglycemia
d) Constipation
SSRIs combined with MAOIs may cause:
a) Hypertension
b) Serotonin syndrome
c) Hypoglycemia
d) Bradycardia
Which principle requires patients to understand risks/benefits of medications?
a) Confidentiality
b) Informed consent
c) Justice
d) Autonomy
Which population is most at risk for polypharmacy?
a) Pediatrics
b) Geriatrics
c) Pregnant women
d) Healthy adults
Which inhaled medication is first-line for asthma control?
a) Beta-blocker
b) Inhaled corticosteroid
c) Antibiotic
d) Anticoagulant
Which lab test monitors warfarin therapy?
a) HbA1c
b) INR
c) TSH
d) CBC
Which professional is most helpful in identifying drug interactions?
a) Social worker
b) Pharmacist
c) Nurse
d) Radiologist