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Primary Care Provider 1 2

The tasks included in providing health care are ______ ________ _______ __________. prevention, diagnosis, prescription, treatment (1)
Fueled the growth of teritary care. Medicare (2)
Powerful weapons against disease. Medications (2)
"Caution: Federal law prohibits dispensing without a prescription" Legend drugs (7)
Government who controls over who may prescribe, dispense, or administer drugs. State. The role belongs solely to the state not federal government. (7)
Requires the nurse to perform under the direction of a physician, mandates the inital physician - patient relationship and is legally based in medical practice acts. Delegable authority (7)
Can NP recommend nonprescription medications? Yes. Without delegated authority, the nurse cannot legally prescribe medications under any circumstances but can recommend OTC. (8)
Requires the physician retain ultimate authority through countersignature of prescriptions and/or by a written agreement between NP and physician. Dependent authority (8)
Allows NP to prescribe alone. May still be restricted, for example, by excluding controlled substances or limits drugs. Independent authority (8)
What state can NPs not prescribe legend drugs and write various schedules of controlled substances? Florida. Allowed in 50 states and District of Columbia. (1/5)
Which schedules can NPs write for? Schedules III-V as of May 2013. (1/5)
Federal definition is an order for medication that is dispensed to or for an ultimate user. Prescription (9)
79 weekly prescriptions Physician assistants average (1/6)
66 weekly prescriptions NPs average per week (1/6)
Top 5 Drug Classes prescribed by PAs and NPs generate 8.5 million weekly Rxs. Antibiotics, anti-hypertensives, cholesterol/lipid lowering agents, oral diabetes therapy, non-injectable narcotic analgesics (1/7)
All Nurses must adhere to their _____________ and practice within their legal role. State Nurse Practice Act (1/8)
Review your _____________ for guidance and privileges or restrictions in prescribing. State's Nurse Practice Act (1/10)
NPs ______ write for narcotics for family and non-narcotics are considered _______ of good judgement according to Federal law. CAN NOT, lack (1/11)
NP's in Alabama ________ write for patients seen in their practice. can only, Risky. You are responsible for what happens and don't have full information. (1/11)
NP's according to Federal Law _________ write narcotics for SELF. CAN NOT, Other non-narcotics for self generally considered lack of good judgement (1/11)
Ethical Issues resulting in Legislation Kick-backs, avoiding fraud and abuse, banning of pharm gifts in med schools (1/12)
Can't refer a patient and receive a benefit. Stark Law (1/12)
2010 law requiring financial ties between manufacturers and medicine to be disclosed. Physician Payment Sunshine Act (1/12)
Gifts must be reported from manaufacture and recipient and will be viewable by general public by ______ and greater than $______. 2014, $10.00 (1/12)
1)Autonomy 2)Non-maleficence, 3) Beneficence, 4) Justice (and Equality) Key Ethical Principles (1/13)
Patients have right to decide to follow your advice or not....may supplement or partially follow Respect for Autonomy (1/13)
S/E, interaction with other meds/foods, amount given if risk of overdose Non-Maleficence (Do not harm) (1/13)
Most appropriate treatment/ professional updates Beneficence (Seek to do good) (1/13)
Times of limited supplies - distribution/financial help Justice (and Equality) (1/13)
4 Ethical Rules 1)Tell the truth (Veracity),2)Provide pt privacy, 3)Maintain confidentiality, 4)Fidelity (1/14)
Need to know with patient's permission to share info vs. need to know Maintain confidentiality (1/14)
Concerned with faithfully executing the "duty to care even in difficult circumstances" Fidelity (1/14)
Who controls the prescription privileges and autonomous practice? Board of Nursing, not Joint Committee (1/15)
Authorization for prescriptive privileges is dictated by _________. State law. (1/17)
What are the 3 types of medications? OTC, Legend Drugs, Controlled Substances (1/18)
The _____ ______ _____ maintains oversight over controlled substances, monitors for potential misuse, abuse by patients and providers. Relies on the state to say who can receive/is qualified. DEA - Drug Enforcement Administration (1/18)
The DEA provides a number for ____ years and is tied to place of employment. 3 years (1/18)
A prescription for a controlled substance must be dated and signed on the date when issued. The prescription must include ________, and the __________, ______, and ____________. patient's full name and address, practitioner's full name, address, and DEA registration number. (1/20)
The prescription must also include_______,______,________,_______,_______,and ________. 1)drug name 2)strength 3)dosage form 4) quantity prescribed 5)directions for use 5)number of refills (if any) authorized (1/20)
Controlled substance prescription for Schedules III, IV, and V issued by a NP may be communicated either _______, _____, ______, and _____________. orally, in writing, or by facsimile to pharmacist, if so authorized on the prescription or by call-in (1/21)
Schedule III and IV controlled substances may be refilled up to _______ times within _____ months after the date on which the prescription was issued. five, six (1/21)
After _____ refills or after _____ months; whichever comes first, a new prescription is required. five, six (1/21)
Controlled Substances are Schedules ___ thru ____. I-V. (1/22)
No current acceptable medical use in US. Lack of safety even under medical supervision. HIGH potential for abuse. SCHEDULE I (1/23)
Examples of Schedule I substances are ______, ______, _______. LSD, Heroin, Ecstacy (1/23)
NPs can not write this Schedule substance in Alabama. Schedule II. (1/24)
High Abuse Potential, leading to severe physicial or psych dependence. Includes narcotics, stimulants, depresants. Schedule II (1/24)
Must contain warning label: "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed". Schedule II (1/24)
Written only - Pharmacist can NOT take oral order. NO REFILLS Schedule II (1/24)
Examples of Schedule II substances are ______,_____, _________,______,_____,______,_____,______, _______, and ________. CRAPMMFH 1)Fentanyl 2)Morphine, 3)Certain amts of Codiene, 4)Ritalin, 5)Adderall, 6)Dexedrine, 7)OxyContin, 8)Percocet, 9)Meperidine (Dermerol), 10) Hydromorphone (Dilaudid)
Potential for abuse, but less than Schedules I and II. Abuse can lead to moderate or even low physical dependent, possibly high psych dependence. Schedule III (1/25)
May contain limited quantities of narcotic and non-narcotics. Schedule III (1/25)
Written or Oral Rx. Prescription must expire within 6 months - only 5 refills max in 6 months. Schedule III (1/25)
Container must carry warning regarding federal law prohibiting transfer of this drug to another. Schedule III (1/25)
Examples of Schedule III are _______, _______, _____, and _________. VTDD 1)not more than 90 mg of codeine per unit dose (Tylenol with Codeine), 2)Didrex, 3)Certain anabolic steroids (Depo-Testosterone) (1/25)
Low potential for abuse when compared to Schedule III. Must contain federal warning label not to transfer drug. Schedule IV (1/25)
Written or Oral Rx, Rx max 6 months with 5 refills. Schedule IV (1/25)
Examples of Schedule IV are _____,_____,______,______,_____, and ______. DACTML 1)Alprazolam (Xanax), 2)Clonazepam (Klonopin), 3) Diazepam (Valium), 4) Lorazepam (Ativan), 5)Triazolam (Halcion), and 6) Midazolam (Versed).
Low potential for abuse compared to substances in Schedule IV and above. Limited quantities of narcotics may be present. Schedule V (1/27)
May have small doses of narcotics or stimulants used for anti-tussive, anti-diarrhea, and analgesic purposes. Schedule V (1/27)
Does not have to contain federal law prohibiting transfer of the drug. Schedule V (1/27)
In SOME states may be sold OTC, most require written Rx. Schedule V (1/27)
Examples of Schedule V are _______, _______, ______,and _______. 1) Loperamide, 2)Cough preparations less than 200 mg of codeine per 100 ml or per 100 grams 3)Robitussin AC, and 4)Phenergan w Codeine (1/27)
Alprazolam (Xanax) Clonazepam (Klonopin) Ambien (Zolpidem What Schedule? Schedule IV (1/28)
Methylphenidate (Ritalin) Oxycdone (Oxylcontin) Cocaine What Schedule? Schedule II (1/28)
Ask for narcotic by name, says its only thing that will help, caries copies of tests to support pain, calls frequently seeking refills w increasing larger amts, and loses or spills medicine and needs refill. Suspicious Behavior (1/29)
Does illegal behavior need to be reported to the police? Yes (1/29)
Patients have how long to fill a Rx for controlled for non-controlled substance unless Medicare/Medicaid - usually have only 10 days but states vary? 120 days (1/31)
Superscription: Rx means? from Latin word meaning "take" (1/31)
What does Inscription contain? Contains drug ingredients and quantities, strength or concentration (1/31)
What does signature marked by "S" mean? means Signa (also Latin) which means basically the directions for use (1/31)
What ingredients are similar or same in generic vs brand drugs? Have same bioequivalent active ingredients. Inactive ingredients may vary. (1/37)
When does a drug go generic? When it loses it's patient. (1/37)
Which saved 80-85% less and in 2010 saved $158 billion, research proves work same, cheaper, must pass the same quality standards? Generic (1/37)
Who requires same performance and quality for generic and brand name medications? FDA (1/37)
Matches patients to the right drugs. Pharmacoenomics (1/41)
Potential to dramatically reduce the estimated 100,000 deaths and 2 million hospitalizations that occur each year in the US as result of ADRs. Pharmacogenomics (1/41)
Move to Personalized Medicine - Better, Safer Drugs the First Time Pharmacogenomics (1/41)
Pharmacogenomics NPs and doctors will be able to analyze a patient's genetic profile and prescribe the best available drug therapy from the beginning. (1/41)
Take guesswork out of finding the right drug. Speed recovery time. Increase safety as the likelihood of ADRs is eliminated. Pharmacogenomics (1/41)
Targeted to specific diseases that consider our personal genetic code. Pharmacogenomics (1/41)
Better vaccines - will active immune system and not cause Disease, will be inexpensive, easy to store, stable, and able to carry several strains of pathogens at once. Pharmacogenomics (1/41)
CYP 450 Oxidase enzyme system operates throughout the body, but is primarily located in the ______, _____, and ______. liver, intestine, lungs (1/46)
Do patient's metabolize certain drugs faster than other people? Yes (1/46)
CYP 450 Oxidase name comes from length of wave of light these enzymes absorb. The enzyme is chemically a _________ (sugar plus protein). glycoprotein (1/46)
Major groups are dived into _________ and further divided according to their chemical structure: ______________(called subfamily/group). Then ABC groups divided into subgroups named __________. 1,2,3, and 4; ABC; 1,2,3 etc - reflects #enzyme within the subfamily/system (1/46)
CYP 450 enzymes can be ________ or ________. inhibited, induced.
Any drug that causes the enzyme to metabolize more slowly or decreases the capacity of the enzyme pathway. Inhibitors (1/47)
A drug that causes enzymes to metabolize the substrate more quickly (more common than inhibition). These drugs make the path work more quickly and thus cause substrate drug to be deactivated more rapidly. Inducers (1/47)
All anticonvulsants should be considered as possible ____________. Inducers (1/47)
Important because when drugs are combined with other drugs they can be completely inactivated, potentiated, have a lessor effect, toxic, or be lethal when activated upon by the system. CYP 450 Oxidase (1/48)
Rifampin induces ________ which increases metabolism of estrogen ___________ and reduces the effectiveness of birth control pills. CYP 3A4, CYP 3A4 (1/48)
How many different CYP 450 Enzymes are present in liver that participate as catalysts in oxidation of drugs? 40 (1/49)
How many primary enzymes are responsible for most all drugs? Six (1/49)
Metabolizes 50% of all drugs. Most abundant enzymes and clinically significant Needed to metabolize many antihistamines, antibiotics, lipid-lowering drugs, anti-hypertensives, protease inhibitors, and azole anti-fungals. Which primary enzyme? CYP 3A4 (1/49)
Metabolizes 30% of all drugs 2nd most abundant SSRIs, pain relievers, B-blockers, and (converts codeine into morphine) Which primary enzyme? CYP 2D6 (1/49)
Metabolizes proton pump inhibitors, NSAIDS (not necessarily every one of them), and B-blockers CYP 2C19 (1/50)
Metabolizes sulfonylureas, NSAIDS, warfarin, and sidenafil citrate (Viagra) CYP 2C9 (1/50)
Metabolizes acetaminophen, R warfarin, theophylline, caffeine, diazepam (Valium, and verapamil CYP 1A2 (1/50)
Metabolizes acetaminophen, ethanol, inactivation of toxins, and dextromethorphan CYP 2E1 (1/50)
If possible, use s/e profile of one drug to treat other symptoms, ie if depression and insomina - give _______ instead of zoloft or prozac. trazadone (1/51)
Intake of more than 1 drug you increase risks for side effects/reactions - real problem especially in elderly - common drug reactions? Polypharmy (1/52)
Combined effects of multiple drugs produce result that is equal to the sum of the individual effects of each agent. Summative - common drug reaction (1/52)
Combined effect of multiple drugs is greater than the sum of each individual agent acting independently. Synergistic - common drug reaction (1/52)
One drug increases the effect of the other drug. Potentiating - common drug reaction (1/52)
ALWAYS ALWAYS ASK about CAM, OTC, current or recently discontinued drugs, commonly eaten foods especially if interact with any meds and consider _________. their overall health status (1/53)
Inhibits CYP P450 enzyme in intestine. Affects within several hours of taking Lipitor (atorvastatin), Mevacor (lovastatin), or Zocor (simvastatin) results in medicine not breaking down and having an extreme accumulation - can be fatal. GRAPEFRUIT (1/58)
Grapefruit affects these but not as bad - Crestor (rosuvastatin), Pravachol, Lesco, and ________. Livalo (1/58)
Interfere with most Statins (all substrates or inhibitors). OCP's - increase caffeine effects. GREEN TEA (1/58)
Too many to name .....especially problematic for CNS agents. CAFFEINE (1/59)
Too many to name (acute/chronic intake varies response). Acute - inhibits metabolism (increasing drug circulating and risk s/e). ALCOHOL (1/59)
Chronic - activates metabolism (decreasing drug availability). Once enzymes activated can continue to be for weeks even in absence of________. ALCOHOL (1/59)
What interacts with Coumadin? Green leafy vegetables, Vit K, clotting (1/60)
What does St. John's Wort interact with and cause? Can be fatal? SSRI's - Selective Sertonin Reuptake Inhibitors (antidepressants) cause Serotonin Syndrome (1/60)
What herbs or foods affect anticoagulants or anti-platelet medications? Ginkgo, ginseng, garlic (1/60)
Chamomile, Dong quai, Dan shen, and ginger are know to have multiple interactions. True or False True (1/60)
Inhibits multiple enzyme pathways. Very problematic. Cimetadine (OTC -histamine H2 blocker for duodenal ulcer, gastric ulcer.... (1/60)
Tyramine containing foods (fatal)!!! MAOI - Monoamine oxidase inhibitor - inhibits MO enzyme for tx of depression, ie selegiline, pheneizine, tranylcypromine (1/61)
Created by: mareed3