Term
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Definition
| A voluntary partnership between an independent Px (Dr or Dentist) and a supplementary Px to implement an agreed patient specific clinical management plan with the patients agreement |
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Term
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Definition
| PGD's are for the supply and /or administration of a medicinal product or drug. PGD's are NOT prescribing |
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Term
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Definition
Proteins on cell service (where thy live)
Detect Natural chemicals in the body
Receptors are he sensing element in the chemical communications (neurotransmitters on hormones)
Chemical communication system- Drug mimics natural Ligand Binding to Recptor |
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Term
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Definition
A substance/Food (grapefruit Juice) inhibits the enzyme effects of the Drug so increases the dose.
Once drug is int he systemic system only takes 1 minute to go round) |
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Term
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Definition
Inactive drugs that once metabolised activate it.
EG Codeine metabolised in morphine in the liver
Cytochrome P450- Liver Cell |
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Term
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Definition
Not all administered drug gets into the body to have its effect
The proportion of the drug administered that reaches the systemic circulation
IV drugs have 100% bioavaliability as straight into the circulation
Affected by--Elderly and Young and Liver Disease
The proportion of drug administered that reaches the systemic circulation
It is the extent of drug absorption not the rate of drug absorbtion |
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Term
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Definition
Anything that has a chemical reaction to alter our pathophysiology and has an effect on the body
A drug is a chemical to treat a disease or elevate symptoms. |
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Term
| Complementary and alternative therapies |
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Definition
Alternative therapies Use instead of standard therapies
Complementary therapies used with conventional therapies |
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Term
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Definition
An order by a physician for the preparation and administration of a drug or device for a patient
6 repeat Px or 6 months elapsed since review. |
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Term
| Legal requirements for Px writing |
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Definition
Guidelines in BNF
Written legibly in ink
Dated
Signed by Px
Any alterations signed
Age and DOB be stated however legal requirement to state age if under 12
Full name of drug or product in full
Px indentifcation and contact no and GP practise
Strength and size
Dose and frequency
Quantity required
Cautionary and advisory labels
Allergies
Provide a full account of your `px decision
Documentation should be done within 48 hrs
Px for CDs only valid for 28 days. |
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Term
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Definition
Nanograms and micrograms to be written in full not to be abbreviated.
mg. g. mls can be abbreviated
Medication that is less than 2 yrs old identified by black triangle |
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Term
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Definition
| The mixing of drugs should be avoided unless essential to meet the needs of the patient and there are no interactions between the mixed drugs |
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Term
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Definition
| Preparing, supplying or administering the medication to the patient |
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Term
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Definition
Optimum dose of drug is increased enough to elicit desired effects but not increased enough to cause unwanted side effects.
The margin between these drugs is the therapeutic index
The higher the index the safer the drug
Calculated by the non toxic dose divided by the minimum effective dose |
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Term
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Definition
Sudden onset of rapid progression of symptoms
life threatening that affects airway/breathing/ circulation |
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Term
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Definition
Type A Dose related and predictable due to an excess of a drug 'wanted effects'. eg hypoglycaemia with insulin
Type B Unpredictable Non Dose related (idiosyncratic)
Increased mortality
Drug allergies
Rash
Teratogenic (pheldomide) |
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Term
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Definition
| MHRA AND COMMISSION OF HUMAN MEDICINE |
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Term
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Definition
The time taken for the concentration of drug in blood to fall by half
Important to determine when next dose is due |
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Term
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Definition
| Shared decision between Px and patient to chose to take meds |
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Term
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Definition
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Term
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Definition
| The study of the effects of chemical substances on the function of living things. Study of drugs and their interactions with the body |
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Term
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Definition
An inhert substance that forms a vehicle for the drug
Used to bind the contents of a pill or tablet |
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Term
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Definition
Is the effect the drug has on the body
Body functions are mediated by central systems which depend on:- receptors on the cell surface
carrier molecules
enzymes
specific macromolecules |
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Term
| Selective Action (Receptors) |
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Definition
Some drugs are non selective and act on different tissues and organs
Some highly selective and affect a single organ
Agonist- intrinisic efficacy/ stimulates receptor=response
Antagonist- bind to the receptor but doesnt activate them/ blocks the agonist |
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Term
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Definition
Stimulates Receptor-Response
Salbutamol Beta 2 agonist receptor. Binds to receptors on the smooth muscle in bronchioles causing bronchodilation |
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Term
| Complete and Partial Agonists |
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Definition
Complete Agonist can complete its maximum effect when all receptors are occupied
Particle agonist- only exert submaximal effect when all receptors are occupied. |
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Term
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Definition
Binds to receptor but doesn't activate a response- blocks the agonist
Eg Atenalol B adrenoreceptor antagonist used to block b effect of noradrenaline slaing the force of contractility |
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Term
| Competitive and competitive Antagonist |
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Definition
compete with natural ligand for receptor sites and forms a reversable bond. But does not activate them can increase dose do the agonist
Non competative- forms a bond at receptor site but bond s irreversible. EG no matter how much of the natural agaonist is present the antagonist still excerts its effect. |
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Term
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Definition
Is the study of the way in which drugs move through the body during
absorption
distribution
metabolism
excretion
How the body affects the drug with time. |
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Term
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Definition
Affected by the route of administration
Physiological or Physico chemical
Absorption is the process of drug movement from the administration site to the systemic circulation |
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Term
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Definition
Blood flow to the absorbing site
Total surface area for absorption
time of arrival and contact
Time at absorption site |
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Term
| Physico chemical absorption |
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Definition
solubility
Chemical stability
Lipid to water partition co-efficient
degres of ionization |
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Term
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Definition
determined by administration phsiochemical prop and exhipients
Affected by chemical- molecular wt,chemical nature and solubility in water
affected by physilogical- gastric mobility, Ph at absorption site, blood flow at site, ingestion with food. |
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Term
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Definition
Once absorbed distributed to their site of action
1. Volume distribution
2. Uptake into body tissues/organs (Blood Flow)
3. Extent of plasma protein binding
Barriers distribution
Drugs penetrate different tissues at different speeds depending on their ability to cross memebranes |
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Term
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Definition
Fat soluble drugs can cross cell membranes more quickly than water soluable drugs
Distribution- plasma, intracellular fluid, fat, transcellular fluid
Extensive protein binding slows elimination
Competiton between drugs for protein binding can lead to clincal important drug interactions. |
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Term
| Distribution cont...Blood flow |
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Definition
organ and tissue perfusion will affect distribution of drugs.
Raised blood perfusion eg heart kidney brain will rapidly receive a drug and have greater potential to receive adequate concentration of drug to have effect |
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Term
| Distribution...Protein binding |
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Definition
Most drugs in circulation are poorly soluable to move through the body they need to be carried
CARRIERS AR PLASMA PROTEINS. Drug molecules are free in the circulationor bound to these proteins
Only free drugs can cross plasma membranes
Bound drugs become free
Albumin is a plasma protein and attracts acidic drugs and acid drugs bind to glycoprotein
Warfarin is highly protein bound
Binding to plasma proteins is competative- if more than one drug is in the system they will compete for binding |
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Term
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Definition
For drugs to have an effect they must reach tissues. Drugs can access and accumulate in certain tissues and not access others due to barriers
Blood brain barrier made up of endothelial calls that only allow lipid soluable drugs to cross over to brain tissue. Poor lipid sol drugs will struggle to pass |
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Term
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Definition
when a drug is given and enters circulation it may bind to plasma proteins to be carried and distributed around the body.
Once in the circulation the drug can exert its effect by binding to specific receptor sites or bind to other tissues where no effect occurs
Volume of distribution is the exteent drug is distributed throughout the body. |
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Term
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Definition
or biotranformation of drugs is the process of metabolising the parent drug compound and occurs mainly in the liver to different compounds called metabolites.
Most drugs are metabolised before being lost from the body
Metabolism is the process by which a drug is chemically altered by the body. |
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Term
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Definition
The liver is the principle site of drug metabolism
metabolites are excreated
Chemically altering the molecule and activating the drug make water soluable by ionizing it.
Pro-drug- codiene metabolise ti morphine
Some chemicals induce (speeed up e smoking) and some inhibit (extend the life Grapefruit) metabolism. |
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Term
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Definition
oxidation, reduction or hydrolysis of a drug
oxidation most common catalysed by cytochrome P450 enzyme
Aims to make the drug less effective and more water soluble
Some drugs are activated here eg Enalapril is inactive but metabolite enalaprilat is active |
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Term
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Definition
| Drugs of phase 1 metabolites that are not sufficiently polar or still active are made more hydrophilic by conjugation. |
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Term
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Definition
Passive diffusion- movement from an area of high concentration to an area of low concentration
Small intestine - high concent
Moves into blood stream -low concent
Some drugs require transportation mechanisms to cross cell membranes
These active transport mechanisms ensure maintenance of cellular function by transport of ions eg sugars, amnio acids across cell walls |
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Term
| Rate and extent of Absoprtion |
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Definition
Absorption across cell wall membrane determined by Lipid solubility, surface area for absorption
gastric motility and emptying
first pass metabolism
time
blood flow |
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Term
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Definition
how lipid solubitlity- how easily it will cross cell memebrane
Cell membranes= double layer of phospholipids and so lipid soluble drugs will pass through membrane easier than water soluble drugs.
More lipid soluble easier to absorbed from small intestine after PO |
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Term
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Definition
Larger surface area= quicker process of absorption
Small intestine= large surface area due to lots of villi and rich blood supply
If pt has IBS and lower surface area then absorption will be reduced therefore less drug available in the circulation |
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Term
| Gastric motility and emptying |
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Definition
PO- disintergrated in the stomach and delivered via emptying of gastric content, into intensive. Anything that alters gastric motility=alters the rate of absorption
food present will slow gastric emptying. if drugs taken with food will slow their absorption |
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Term
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Definition
Oral medication
Absorbed in GI Tract (small intestine)
Via Hepatic portal vein (Liver)
Metabolised in the liver before they work
This removal of a drug by the liver before use is first pass
Some drugs totally inactivated by first pass EG GTN, Aspirin
Effects Bioavailability
Proprandol active after first pass due to active metabolites (active to 4- hydroxyproprandol) |
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Term
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Definition
The time a drug in contact with the walls of the small intestine will affect absorption
Anything that alters gut transit time eg gastroenteritis will affect absorption.
Hypomotility of the GI tract may result in higher concentrations of drug entering circulation |
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Term
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Definition
Blood flow in the gut is usually high and allows good absorbtion to circulation
Muscles have varying blood flow so absorption varys depending on other physical aspects of the patient to which may require blood flow to be increased or decreased. |
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Term
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Definition
Refers to the process by which the body eliminates the drug
Hepatic and renal system
Affect kidnet excereation- solubility, plasma binding, acidity in urine, renal disease, age. |
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Term
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Definition
Kidneys receive 1.5l of blood minute. 10-20% filtered by the glomerulus= filtrate
Some drugs can pass through now into kidneys but have to be small so drugs bound to plasma proteins cannot pass yet. |
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Term
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Definition
can be excreted through the liver in bile.
Then enters the duodenum via common bile duct then to small intestine.
Some drugs deconjugate by action of gut bacteria and reabsorbed back into blood stream. return to liver and remetabolised and back into bile- entrehepatic cycling. |
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Term
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Definition
Report via yellow card even herbal drugs
Get a sample of the drug
assess the risk to benefit
stop taking the medication
suggest alternative therapy
document in notes
treat patient symptoms
TOXBASE |
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Term
| Factors affecting drug Phamakinatics |
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Definition
Age and Weight
Renal and hepatic condition/function
Drug interactions
Genetics/ethnicity
Nutrition |
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Term
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Definition
Receptors
Enzymes
Transport systems
ION channels
messenger systems
non specific drug actions |
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Term
| Clinical Management plans |
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Definition
| Include: Name of pt, condition, class/description of medication, dose ranges and strengths, range restrictions, timescale over which medication is to be given. Ref to local and national guidelines. Allergies. How to report allergies, when and why to refer to IP. keep plan simple, universal language, date it starts dates of reviews by IP and SP. |
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Term
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Definition
Determine if a child <16 can give consent to treatment.
Can person understand info, advice, implications, of their decision.
Can the young person communicate their reasoning
is the decision rationally based on their beliefs and values
is there any influencing factors ie substance misuse
is the decision independent not cohered.
Are you confident the child is safeguarded
if service not provided would the person suffer physically and emotionally
is it in the best interest to provide service without parental consent |
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Term
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Definition
Contraceptive advice and treatment can be given to young person <16 if-
Person can understand nature implications of predisposed treatment
Young person cannot be persuaded to inform parents that they are seeking contraceptive advice
person likley to suffer physical, mental health unless contraception advice or treatment given
Likely to beginor contiue to have sex with or without contraception treatment
Advice on treatment is in best interest. |
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Term
| Hargis model of communication |
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Definition
Goals and motivation
mediating factors (cognitive emotion)
response
feedback |
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Term
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Definition
Initiate the session
Gathering information
Physical examination
explanation
Closing the consultation
Its about a systematic approach- therapeutic partnership. |
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Term
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Definition
W-Who is it for
W- What are the symptoms
H- How long have the symptoms been present
A-Any action taken so far
M- any other medication. |
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Term
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Definition
E-How effective is the product
A-how appropriate for the patient
S-how safe is it
W is the prescription cost effective |
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Term
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Definition
1. consider the patient
2. which strategy
3. Consider the choice of product
4. Negotiate a contract
5. Review
6. Record keeping
7. Reflect |
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Term
| CD's- IN Jersey nurses as per JNM Px policy can prescribe CDs in scope of practice. |
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Definition
Mis use of Drugs Act 1971- prohibits certain activities in relation to the manufacture, supply and possession.
Drugs are graded according to the harmfulness attributable to a drug when it is misused.
A- cocaine, methadone, morphine etc
B- Cannabis
C- Benzo's etc
Schedules- indicates as per misuse of drugs 2001, the gov requirements import, export supply etc that apply to them |
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Term
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Definition
Misuse of drugs act 2013
Medicines Law 2011
Medicines Order 2013
Health care law 2012. |
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Term
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Definition
NMC and HSS registered
V300 qualification
Nurse, Midwife, SCHP
Supervision in new jobs
Attend 4 out 6 supervisions a year
keep portfolio up to date
Access NMP lead support
New arrivals to island need NP support and supervision
Px BNF CD's
If doesn't Px for 6 months Px privilege revoked
Scope of practise declaration to be sent every 12 months
DMP in practice. |
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Term
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Definition
Any V300 can Px any licensed and unlicense off label medicine for a medical condition within their scope of practice.
As per hospital formulary
Technically anything within the BNK
CD's remember Misuse of Drugs Act |
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Term
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Definition
1968- Medicines Law Px by Drs, Dentist, Vets Px of medicine
1986- Neighbourhood Nursing- Cumberlege report gave limited Px rights to DN and HV
1989- 1st Crown report--- recommend NP for future
1992- Px by Nurses Act- Primary Legislation
1999- 2nd Crown report- review of Px
2000- Consultation on proposal to extend NP
2001- Health and Social care Act- Extended Nurse Formula
2003- Supplementary Prescribing
2006- The medicines for human use order- INMP to Px licensed Px only drugs within field of competence Plus some CDs
2006 - NIP- extended formulary discontinued nurse Px could Px any drug including some CD's |
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Term
| What are the 4 ethics guidelines? |
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Definition
Autonomy- freedom to choose
Beneficence - in the patients best interest
Non-malefience - do no harm
Justice - equity and no discrimination |
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Term
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Definition
Veracity - tell the truth
Fidelity - keep promises
Privacy- data protection
Confidentiality - data protection |
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Term
| List 5 stages of Calgary Cambridge |
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Definition
Initiate the session
Father the information
Physical examination
Explanation and planning
Close the session |
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Term
| List 5 stages of Neighbour |
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Definition
Connection
Summarising
Handing over
Safety netting
House keeping |
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Term
| List pertinent points regarding Practice standard 1 Licence |
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Definition
You must be a qualified
Be registerd with a V300 course
practice within your scope of practice only
and it's a privilege! |
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Term
| List pertinent points regarding practice standard 2 Accountability |
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Definition
Accountable for actions and omissions
Within your level of experience/ competency |
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Term
| List points re practice standard 3 Assessment |
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Definition
You must undertake a holistic assessment
And only prescribe if competent to do so |
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Term
| List points re practice standard 4 Need |
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Definition
| You must only prescribe when Genuine need |
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Term
| List points regarding practice standard 5 Consent |
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Definition
Gain paient informed consent
Follow The Code
Inform patient prescribing is not in isolation |
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Term
| List points regarding practice standard 6 communication |
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Definition
| Responsibility to Communicate with other practitioners effectively |
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Term
| List points regarding practice standard 7 Record keeping |
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Definition
Accurate
Comprehensive
Accessible
Document immediately, or in exceptional circumstances within 48 hours |
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Term
| List points regarding practice standard 8 CMP |
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Definition
The independent prescriber is a doctor or dentist
The supplementary prescriber holds correct qualification
The independent prescriber diagnoses and prescribes
In partnership with the supplementary prescriber and patient, with patients consent
If the supplementary prescriber prescribes outside the CMP it is a criminal offence and against The Code , 2015 and can result in disciplinary action |
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Term
| List points re practice standard 9 &10, prescribing and administration / supply/ dispensing |
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Definition
You should separate prescribing from administration / supply/ dispensing where ever possible.
If not possible, check the drug with a second appropriate health professional |
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Term
| List points re practice standard 11 Prescribing for family and others |
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Definition
You can not prescribe for yourself
You can not prescribe for family or friends UNLESS
..exceptional circumstances when there is no other appropriate prescriber available AND the patient is ;
1. Uncontrolable pain
2. Life threatening
3. Risk of significant deterioration of patients condition
document relationship between you and the patient and the reason surrounding the px episode |
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Term
| List points re practice standard 12 Computer generated prescribing |
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Definition
Computer needs the correct software
The computer has the ability to create an audit trail
You must sign the script immediately
You cannot pre sign scripts
You can not alter a script once printed |
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Term
| List points re practice standard 13 Evidence Based Practice |
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Definition
You should be aware of and apply guidelines and local and national prescribing policies
Prescribing should be evidence based |
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Term
| List points re practice standard 14 Delegation |
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Definition
You can delegate the administration of medication you have prescribed
The prescriber remains accountable |
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Term
| List points re practice standard 15 CPD |
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Definition
| It's your responsibility to remain up to date |
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Term
| List points re practice standard 16 CD's |
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Definition
Only prescribe what you are legally entitled to
Provide clear dosage instructuions on a px
Only px within your field of competency
You can use a computer generated px to prescribe CD's
You can not prescribe CD's for self and only px for someone you know in exceptional circumstances
Maximum px length 28 days |
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Term
| List points re practice standard 17 un-licensed and 18 off-label |
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Definition
There is no licensed alternative
There is evidence demonstrating the drugs safety and efficacy
The patient is fully informed and agrees
Clear documentation |
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Term
| list points re practice standard 19 Repeat Px |
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Definition
Jersey policy states you can not write a repeat px for patients whom the medication is being managed by their GP
To write a repeat px you must be sure it is safe, and appropriate
Is reviewed following a max of 6 repeat px or 6 months
It's going to the correct pt, correct drug/dose/ pt can be monitored |
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Term
| List points re practice standard 20 Remote px |
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Definition
Must have prior knowledge of pt
Are working in remote area
Be responsible for caring for pt
Have authority to access pts records
Are competent |
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Term
| List points re gifts and benefits practice standard 21 |
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Definition
Maintain register of interest in portfolio
Follow local policy
You can not accept gifts unless they are minimal cost from reps and just pens. Notebooks, mugs |
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Term
| What does Bolam Test refer to? |
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Definition
A breach in duty of care
Care given compared with accepted standards of equivalent trained professional |
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Term
| What does Bolitho refer to? |
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Definition
Medical negligence
Evidence required to support professional opinion and that evidence is judged to be
Reasonable
Responsible
Respectable |
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