Pharmacotherapeutics for Nurse Practitioner Prescribers 3rd Edition

Book Preface

The increasing volume of pharmacology-related information presents a challenge to acquire and maintain current knowledge in the area of pharmacotherapeutics. The number of new drugs coming on the market each year, the changes in “the best” drugs to use for any given disease state based on the latest research, the influence on patient and practitioner alike of advertising and promotion, and the increasing incursion of managed care and restricted formularies into practice decisions about drug selection are phenomenal. This book is designed to provide nurse practitioner students and the nurse practitioner in the primary care setting with a thorough, current, and usable pharmacology text and reference to address these challenges.

The design of this book assumes knowledge of basic pharmacology from one’s undergraduate education in nursing. Although a brief review of basic pharmacology is presented in Chapter 2, the focus of the book is on advanced pharmacology and the role of the advanced practice nurse in pharmacotherapeutics. The authors of the text are practicing nurse practitioners or selected specialists in a field. The book is by nurse practitioners, for nurse practitioners and other health-care providers who prescribe drugs

ORGANIZATION

This book is organized around four distinct content areas: The Foundation, Pharmacotherapeutics With Single Drugs, Pharmacotherapeutics With Multiple Drugs, and Special Drug Treatment Considerations.

The Foundation

The 13 chapters in Unit I provide the foundation of advanced pharmacology and the link between this knowledge and professional practice. Chapter 1 discusses the role of the nurse practitioner in both the United States of America and Canada as prescriber and the knowledge needed to actualize this role. Current issues about the evolving role and education of these providers are also presented in this edition including discussion of the Doctorate of Nursing Practice.

Discussion of the roles of other advanced practice nurses and physicians assistants in prescribing has also been added. Factors involved in clinical judgment related to prescribing are a central focus, and collaboration with other health-care providers is also presented. The pharmacology knowledge required for rational drug selection requires more depth than that given in undergraduate pharmacology, where the focus is on safe administration of drugs prescribed by someone else.

Advanced pharmacology information on receptor reserve and regulation, bioavailability and bioequivalence, metabolism of drugs including a focus on the cytochrome P450 microsomal enzyme system, half-life, and steady state are provided in Chapters 3 and 8. Information central to the prescribing role includes an in-depth discussion of volume of distribution and therapeutic drug monitoring.

Volume of distribution is important in prescribing drugs with very large or very small volumes of distribution and for selecting drugs for patients with cardiac or renal failure, during pregnancy, or when a patient is underweight or obese. Knowing what tests to order and when to order them to assess plasma drug levels by bioassay and to monitor for adverse drug reactions is necessary to make choices about when or if dosage alterations are required or drugs need to be stopped. These are also covered in Unit I.

Legal and professional aspects of the prescriber role are presented in Chapter 4. Issues surrounding the legal authority of a nurse practitioner to prescribe a drug, the conditions under which the prescription may be written, and how to write the prescription are presented. Risk management issues are also discussed, including informed consent, dealing with multiple providers, and substance abuse and drug-seeking behaviors.

Nurse practitioners have a history of high levels of patient satisfaction with the care provided. This is related, in part, to their holistic approach to each patient. Several chapters are devoted to information that reflects this approach. Cost, knowledge deficits, dealing with complex treatment regimens, and negotiating a shared responsibility for drug management are discussed in Chapter 6. Many patients choose to use complementary therapies such as herbal remedies. Chapter 10 discusses herbal therapy and other complementary therapies and provides a list of resources in this area.