#1 - Polypharmacy and Drug Interactions

I. Polypharmacy – Contributing Factors and Recognition

II. “At risk” populations – the older patient, the infant, the parturient

III. Consequences of polypharmacy – Adverse Drug Interactions

IV. Patient Risk Factors for Adverse Drug Interactions

V. Common Drug-Drug and Drug-Disease Interactions

VI. Strategies for avoiding polypharmacy and adverse drug interactions

Behavioral/Learning Objectives:

1. Identify operant factors leading to polypharmacy situations and describe the clinicians’ responsibility in recognition of potentially dangerous situations.
2. Describe the processes in pharmacokinetics and pharmacodynamics related to “at risk” populations across the lifespan that can contribute to differences in drug activity and interactions.
3. Explain age-related physiological changes in the older adult that may be operant in untoward/unexpected drug responses or interactions.
4. Describe the maturational issues present in infants less than 2 years of age that may be operant in untoward/unexpected drug responses or interactions.
5. Briefly outline the physiological changes in the parturient that may result in altered/untoward drug responses or interactions.
6. List three strategies for avoiding interactions due to polypharmacy.

#2 - Mood Stabilizing Drugs and Interactions

I. Mood Disorders – Increased Incidence and diagnostic classification

II. Recognition of Bipolar Disorder versus Major Depressive Disorder

III. Caring for patients with medical/surgical disorders who are concurrently being treated for mood disorders

IV. Potential Drug interactions in non-psychiatric clinical situations with drugs used in the treatment of Mood Disorders

A. Lithium
B. Anticonvulsant Drugs
C. Antipsychotic medications
D. Antidepressant agents
E. Benzodiazepine drugs

Behavioral/Learning Objectives:

1. Describe the current incidence and diagnosis of mood disorders in the United States.
2. Describe risk factors for untoward interactions between mood stabilizing drugs and other medications in both in-patient and out-patient populations.
3. List and discuss recognition/prevention of two important untoward drug interactions that are associated with lithium, valproate, or carbamazepine.
4. Describe the effect of two additional mood stabilizing drugs on the metabolic activity of Cytochrome P450 enzymes in the liver. Discuss how these effects could potentially change the activity of other drugs in the patient’s system.
5. Outline strategies for risk assessment and early recognition of interaction potential with mood stabilizing drugs in adult populations.

#3 - Nonsteroidal anti-inflammatory Drugs (NSAIDS) and Interactions

I. Development and Trends in the Current Use of NSAIDs

II. Classification of NSAID compounds by structure and mechanism of action

III. Activity, benefits, and concerns with specific NSAID agents.

IV. Specific population related NSAID drug interactions of clinical importance

V. Strategies for risk reduction and reduction of untoward interactions with NSAIDs.

Behavioral/Learning Objectives:

1. Describe the two dominant classifications of NSAIDs based on chemical structure.
2. Outline the mechanism of NSAIDs that produces inhibition of prostaglandin development and subsequent inflammatory response in the body.
3. In addition to anti-inflammatory characteristics, describe two additional physiological activities ascribed to NSAIDS.
4. Define the risk factors for two disease populations that are at high risk for untoward drug interactions between NSAIDs and other therapeutic agents.
5. Describe patient education strategies that the nurse can use to teach patients about common NSAID interactions.

#4 - Anticoagulant and Antithrombotic Drugs and Interactions

I. Review of hemostasis and the clotting cascade- understanding the mechanisms of action

II. Anticoagulant/thrombolytic agents

A. Clinical considerations with drugs of interest: warfarin, unfractionated heparin, Low Molecular Weight heparin, fondaparindux,dabigatran
B. Clinically significant drug/herbal/food interactions

III. Antiplatelet Drugs

A. Clinical considerations with drugs of interest: aspirin, clopidogrel, glycoprotein receptor blockers
B. Clinically significant drug/herbal/food interactions

IV. Assessment, risk identification, and education of patients receiving drug affecting coagulation.

Behavioral/Learning Objectives:

1. Describe the events of the clotting cascade and identify the points at which various anticoagulant medication inhibit coagulation.
2. Identify the factors that often complicate clinical Coumadin management and predispose the patient to untoward interactions and responses. Discuss the advantages of other newer medications that may be advantageous in avoiding some of these difficulties.
3. Describe the differences between unfractionated and low molecular weight heparin in terms of management and relative risk for untoward interactions.
4. List five clinically important drug interactions with agents that inhibit coagulation.
5. Describe three clinically important herbal/drug interactions with agents that inhibit coagulation.
6. Develop a strategy for education of the patient about the risks of interactions when being prescribed agents that inhibit coagulation.

Accreditation Information

Nurses – Academy Medical Systems is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

Academy Medical Systems (AMS) is also a provider approved by the California Board of Registered Nursing, provider #CEP14413.

AMS is also a provider approved by the Florida Board of Nursing, provider #50-19.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

8.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR.) Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 8.0 continuing professional education units (CPEUs) for completion of this program/material.

Occupational Therapist - Occupational Therapist will receive 8, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470. This course is an advanced education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Cardiovascular Techs – Cardiovascular Credentialing International recognizes our approved provider status with the ANCC for continuing education courses for CCTs.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs and PTAs in the following states will receive 8 contact hours for completion of all 4 courses: AK, AL, AZ, CA, CO, CT, GA (Class 1), HI, IA, ID, IN, KS (Cat 2), KY, MA, ME, MI, MN (Cat 2), MO, MS, MT, NE, NM, ND, OK (Cat 2), OR, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WI, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10. The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, NV, OK (Cat 2), WI.

This course has been approved by the Nevada State Board of Physical Therapy Examiners for 0.8 CE Units (8 hours) of continuing education.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.  See The Federation of State Boards of Physical Therapy website for more information.

Respiratory Therapists – This course meets the requirements for continuing education for Respiratory Care Professionals in AL, CA, CT, DE, FL, ID, IL, IN, IA, KS, LA, ME, MA, MN, MS, MT, NE, NV, NY, OH, OK, OR, RI, SC, TN, TX, WA, WV, WY.

Because each state’s continuing education requirements for respiratory therapists is subject to change, please verify this information with your state board. Thank you.

Social Workers - This course meets the qualifications for 8 hours of continuing education credit for MFCCs and/or LCSWs as required by the California Board of Behavioral Sciences, provider #PCE 4947. Please check with your state board’s requirements to determine if this program meets your continuing education requirements or call us at 866-414-3500 to assist you.

Academy Medical Systems has been approved by the TX State Board of Social Workers Examiners to provide continuing education activities for social workers, Provider # 5998.

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