NUR 635 Advanced Pharmacologic Essay
You are tasked with developing an insulin protocol for your patient. Discuss some of the key components you would include. What will be your recommended blood glucose target range? Provide literature that would identify ethnic, cultural, and genetic differences in patients, and how this may affect the safety or efficacy of medications used. Support your recommendations with the most current evidence and treatment guidelines.
NUR 635 Advanced Pharmacologic Essay
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It is important for APRNs to know what medication errors occur and the cause of these errors in order to reduce them. Review research studies performed within the last 3-5 years regarding medication errors. Provide an overview of the chosen study. Discuss the primary reason for the medication error and the suggested steps implemented to prevent it. Discuss what steps you will initiate in your clinical practice to prevent prescribing errors.
NUR 635 Advanced Pharmacologic Essay
“Electronic prescribing (e-prescribing) is an important part of the nation’s push to enhance the safety and quality of the prescribing process. E-prescribing allows providers in the ambulatory care setting to send prescriptions electronically to the pharmacy and can be a stand-alone system or part of an integrated electronic health record system. The methodology for this study followed the basic principles of a systematic review.” (Porterfield, Engelbert, &Coutasse, 2014) In a study reviewing 47 different sources e-prescribing was analyzed to reveal potential benefits and barriers and research indicates that e-prescribing reduces errors, increases efficiency and helps to save on health care costs. “Studies have shown that CPOE is effective in reducing medication errors. It involves entering medication orders directly into a computer system rather than on paper or verbally.” (FDA, 2017) As a part of an integrated electronic health record with clinical decision-making support there are additional checks and balances as well as guidance along the way to aid prescribers in writing accurate, uniform and legible orders. It is also possible for the e-prescribing system to indicate costs of each option which helps the patient to participate in the process thereby saving them money and increasing the chances that they will be compliant with the treatment. Integration of this type of system can be a costly endeavor however and there are federally funded incentives in some cases to assist with this cost. In my practice, I plan to integrate EHR and e-prescribing as much as possible, and in instances where this is not possible it is recommended that writing out words and the alphabetic spelling of numbers instead of numerals and abbreviations will reduce miscommunication errors as will giving clear and precise directions without the use of phrases such as “take as directed’ or “as needed”.NUR 635 Advanced Pharmacologic Essay
Amber Porterfield, MS; Kate Engelbert, MS; and Alberto Coustasse, DrPH, MD, MBA. “Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting.” Perspectives in Health Information Management (Spring 2014): 1-13.
Center for Drug Evaluation and Research. (n.d.). Information for Consumers (Drugs) – Strategies to Reduce Medication Errors: Working to Improve Medication Safety. Retrieved January 20, 2018, from https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm
Pharmacodynamics is the study of how drugs have effects on the body. The most common mechanism is by the interaction of the drug with tissue receptors located either in cell membranes or in the intracellular fluid. The extent of receptor activation, and the subsequent biological response, is related to the concentration of the activating drug (the ‘agonist’). This relationship is described by the dose–response curve, which plots the drug dose (or concentration) against its effect. This important pharmacodynamic relationship can be influenced by patient factors (e.g. age, disease) and by the presence of other drugs that compete for binding at the same receptor (e.g. receptor ‘antagonists’). Some drugs acting at the same receptor (or tissue) differ in the magnitude of the biological responses that they can achieve (i.e. their ‘efficacy’) and the amount of the drug required to achieve a response (i.e. their ‘potency’). Drug receptors can be classified on the basis of their selective response to different drugs. Constant exposure of receptors or body systems to drugs sometimes leads to a reduced response (i.e. ‘desensitization’).NUR 635 Advanced Pharmacologic Essay
Pharmacology drugs are classified into four main categories: depressants, narcotics, stimulants, and hallucinogens. The class a substance falls under depends on the effect it has on the body. The effect a drug can have on the body ranges depending on the drug. Also, the method of administration used and the rate of absorption a drug produces in the body will have an effect of the symptoms produced from the substance. NUR 635 Advanced Pharmacologic Essay
Classification of Drugs
Depressants are substances that slow the activity of the brain, resulting in relaxing sensations. Examples of depressants include alcohol, benzodiazepines, and barbiturates. Doweiko (2109) explains, “The barbiturates will depress the level of neural activity, as is seen with alcohol ingestion, but they also have a minor impact on the heart, muscle tissues, and the respiration process” (6-7). Like barbiturates, alcohol has the similar slowing response to the brain and nervous system because they are both classified as depressants.
Narcotics are used medically to treat pain and coughs. Within the narcotics/opiates classification, there are three sub-categories. The sub-categories are natural opiates, semisynthetic opiates, and synthetic opiates. Natural opiates are opiates that are obtained from the poppy plant, and these drugs include morphine and codeine (Doweiko, 2019). Semisynthetic opiates are derived from natural opiates. Heroin is the most commonly used semisynthetic narcotic (Doweiko, 2019). Synthetic opioids are developed in laboratories, like methadone. NUR 635 Advanced Pharmacologic Essay
Stimulants are drugs that accelerate the activity of the central nervous system (Doweiko, 2019). Drugs that are included in the stimulant category include methamphetamine and cocaine. Stimulants are the second most popular type of drugs, behind marijuana, because of their affect they have on the body. Stimulants are popular, especially in college students, because they aid in working harder and providing more motivation to complete tasks.
Hallucinogens are drugs that alter someone’s perception of reality by altering the balance of neurotransmitters in their brain (Doweiko, 2019). Examples of hallucinogens include lysergic acid diethylamide (LSD), phencyclidine (PCP), and ecstasy (MDMA).
Routes of Absorption
Doweiko (2019) explains that one of the major facts influencing a drug’s intensity is the manner in which it is introduced to the body (3-4a). The manner of which a drug is introduced into the body matters when talking about absorption because different types of injection methods product different results.
An enteral route of absorption is a drug that is administered in an oral form, such as pills. Doweiko (2019) states, “The most common form of enteral drug administration is in tablet form, which is essentially a selected dose of a compound mixed with a binding agent that gives it shape and holds its form until it enters the gastrointestinal (GI) tract” (3-3a). Once the drug reaches the GI tract, the compounds are then absorbed into the stomach or small intestine.
Another route of absorption is sublingually, which is a type of oral digestion that utilizes the tissues under the tongue. This drug absorption method surpasses a “fist-pass metabolism” effect. This effect is defined as “a safety mechanism the body develops in which materials absorbed through the gastrointestinal tract are first carried to the liver, so that toxic compounds ingested might be subjected to detoxification before they can injure the body” (Doweiko, 2019, 3-3a).
Injecting an illicit substance using the parenteral method is injecting it directly in the body. Methods of injecting the substance directly in the body can be by injecting the substance into a muscle or intravenously. Intravenous injection is one of the most common and frequently used ways to administer a drug (Doweiko, 2019, 3-3a).NUR 635 Advanced Pharmacologic Essay
Subcutaneous methods of drug administration is also knows as injecting a drug directly under the skin, or skin-popping. Skin-popping is directly injecting a substance underneath the skin (Doweiko, 2019, 3-3a). Allowing a drug to be administered this way produces a slower rate of absorption than an intravenous method.
Learning about the pharmacology of substances and the methodology of addiction has changed my outlook on addiction completely. Before starting this class, I believe that addiction was a choice, not a disease. After studying different substances and the effects they have on the body and the brain have showed me that addiction is a serious problem and is a disease that people need assistance with. One of my favorite bible verses about addiction comes from 1 Corinthians 10:13-14. It states, “13 No temptation has overtaken you except what is common to mankind. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can endure it.” To me, this bible verse is saying that people may fall into addictions without meaning to, but there will always be God to help you endure whatever you are going through and he will give you nothing greater than what you can come out of.
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