Pharmacokinetics: • Understand the implications of changing renal function on creatinine and drug dosing. • What is the impact of the following on drug levels and dosing: o Cirrhosis o Protein binding o Drug interactions o Half-life Routes of Administration and Dosage Forms: • Understand the different routes of administration and dosage forms and some of the challenges and benefits associated with these routes and forms. • Understand when it is OK to crush (or not crush) certain dosage forms and why. • Which routes of administration have the fastest and slowest rates of absorption? • Know the relative onset, monitoring and appropriate use of various dosage forms including: o Patches (ie; fentanyl, rivastigmine) o Suppositories (ie; acetaminophen) o Sublingual tablets o Tablets o Liquid (know common measures) o Injectables o Sublingual o Nasogastric o Elixir (contains alcohol) Therapeutics: Gastrointestinal, Cardiac, Respiratory, Neurology, Musculoskeletal Understand the mechanism of action, side effects, appropriate use and contraindications for the classes of drugs and individual drugs listed below. Also, know the key patient education points including cautions, expected effects, and appropriate use (with food, empty stomach, etc.). • Anti-diarrheals (diphenoxylate HCl with atropine sulfate, loperamide, bismuth subsalicylate) • Laxatives (fiber, osmotics, stimulants, other) • Therapy for various gastrointestinal disorders including antiemetics, ulcers, irritable bowel syndrome, Crohn’s ulcerative colitis (ie; alosetron, PPIs like omeprazole, Mesalamine, ranitidine, etc.) • Cough, cold, and sinus therapies including antihistamines and cough suppressants (ie; dextromethorphan, loratadine, fexofenadine, nasal decongestants) • Cardiac Medications – Digoxin (understand toxicity, dosing, use), Statins, Colestipol, Nitroglycerin • Blood pressure medications (calcium channel blockers, ACE Inhibitors, diuretics, beta-blockers, nitroprusside, others) • Diuretics (spironolactone, furosemide, hydrochlorothiazide) • Inhalers (albuterol, ICS, LABA, anticholinergics) • Asthma – Theophylline, zafikurlast, steriods • Gout and arthritis therapies (allopurinol, etanercept, sulfinpyraxone, methotrexate) • Hyperlipidemia (statins, bile-acid-binding resins, cholesterol absorption inhibitors, fibrates, niacin, omega-3 fatty acid supplements) • Anticholinergics/cholinergics agents • Agents for thyroid disease (Levothyroxine, methimazole) • Multiple sclerosis therapies (Dantrium, Glatirimer, Baclofen, Tizanidine, others) • Antiepileptics (phenytoin, ethosuximide, diazepam, others) • Osteoporosis (calcitonin, others) • Hypoglycemics (glyburide, glipizide, metformin, insulin, etc.) • Pain (opioids, muscle relaxants, NSAIDs, acetaminophen, topical lidocaine, etc.) • Orlistat • Adrenergic agonists Terminology: • Efficacy • Pharmacokinetics • Pharmacodynamics • Drug tolerance • Addiction • Dependence • Withdrawal • First pass effect • Idiosyncratic response • Medication Reconciliation Other Topics: o Which drug classes produce withdrawal if stopped abruptly? When is withdrawal life threatening? o Understand the appropriate use of herbal therapies o Understand components of cultural competence o How can adverse drug events be minimized? o Why do drugs require clinical study and FDA approval? o Know common teaspoon, tablespoon, and milliliter conversions o Know DEA schedules and examples of therapies in each scheduled class (1-5). What are the special prescribing restrictions for these various classes? o Which medications should be taken with food? Which on an empty stomach? o What is the purpose of the MedWatch Program? o Symptoms and treatment of drug intoxication from cocaine, opioids, marijuana o Appropriate use of reversal agents for digoxin, opioids, etc.
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