Deborah Robertson

First Pass Metabolism

In this article in the series of ‘bite sized’ pharmacology, we will look at the concept of first pass metabolism. All drugs given by the oral route undergo a degree of first pass metabolism either in the gut or the liver, with some drugs being destroyed before they reach the systemic circulation. This pharmacokinetic process affects the bioavailability of drugs administered by this route and is an important consideration for the prescriber. Knowledge of first pass metabolism can assist the prescriber when deciding on doses and dose schedules to ensure that patients receive their medications at the correct dosing, by the correct route for optimum therapeutic effect. It also helps the prescriber understand why dose adjustments are made for some drugs when switching the route of administration from oral and why some drugs cannot be given by the oral route.

Drug action: The therapeutic effect

In this article in the series of ‘bite sized’ pharmacology, we will look at the concept of drug action—the therapeutic effect of the medications we give. It is important that prescribers are aware of factors that can affect drug action and the time-to-onset, and subsequent duration of, the desired therapeutic effect. This article will look at factors that affect these two important areas of drug action. Knowledge of these factors can assist the prescriber when deciding on doses and dose schedules to ensure that patients receive their medications at the correct dosing, by the correct route and in the right formulation to ensure optimum therapeutic effect. It also helps the prescriber understand why dose adjustments are made or some drugs are avoided in patients with hepatic or renal impairment.

Time for an election for health

Consultant Editor Deborah Robertson Editor Abigail James np@markallengroup.com Commercial Manager James Demery james.demery@markallengroup.com Classified Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher Associate Publisher Sophie Gardner Publisher Chloe Benson Managing Director Jon Benson Chief Executive Officer Ben Allen Editorial Board Omar Ali Formulary Development Pharmacist, Surrey and Sussex Healthcare NHS Trust Maggi Banning Senior Lecturer in Advanced Clinical Practice, Brunel University Dianne Bowskill Health Lecturer, Adult Nursing, University of Nottingham Jane Camp Non-Medical Prescribing Lead, NHS Greater Glasgow and Clyde Nicola Carey Lecturer in Health and Social Care, University of Surrey Georgina Cox Programme Leader in Adult Health, Middlesex University Richard Griffith Lecturer in Health Law, University of Swansea Sandra Hall Head of Pharmacy Practice, De Montfort University, Leicester Barbara Novak Senior Lecturer and Education Lead for Non-Medical Prescribing, City University, London Christine Otway Supervisor, Family Nurse Partnership, Leicestershire NHS Partnership Trust Fiona Peniston-Bird Consultant for the Development of Non-Medical Prescribing, West Sussex Liz Plastow Children’s Commissioner NHS South West Essex Lynne Roberts Nurse Consultant in Serious Mental Illness and Honorary Lecturer, University of Glamorgan Deborah Robertson Senior Lecturer and Programme Leader Non-Medical Prescribing, University of Chester Austyn Snowden Lecturer in Mental Health Nursing, University of West of Scotland Karen Stenner Lecturer in Health and Social Care, University of Surrey Barbara Stuttle, CBE Chair, Association for Nurse Prescribing Marea Brennan Thorns Independent Nurse Prescriber, Aesthetic Nursing

Prescribe, reflect, revalidate

Consultant Editor Deborah Robertson Editor Abigail James np@markallengroup.com Commercial Manager James Demery james.demery@markallengroup.com Classified Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher Associate Publisher Sophie Gardner Publisher Chloe Benson Managing Director Jon Benson Chief Executive Officer Ben Allen Editorial Board Omar Ali Formulary Development Pharmacist, Surrey and Sussex Healthcare NHS Trust Maggi Banning Senior Lecturer in Advanced Clinical Practice, Brunel University Dianne Bowskill Health Lecturer, Adult Nursing, University of Nottingham Jane Camp Non-Medical Prescribing Lead, NHS Greater Glasgow and Clyde Nicola Carey Lecturer in Health and Social Care, University of Surrey Georgina Cox Programme Leader in Adult Health, Middlesex University Richard Griffith Lecturer in Health Law, University of Swansea Sandra Hall Head of Pharmacy Practice, De Montfort University, Leicester Barbara Novak Senior Lecturer and Education Lead for Non-Medical Prescribing, City University, London Christine Otway Supervisor, Family Nurse Partnership, Leicestershire NHS Partnership Trust Fiona Peniston-Bird Consultant for the Development of Non-Medical Prescribing, West Sussex Liz Plastow Children’s Commissioner NHS South West Essex Lynne Roberts Nurse Consultant in Serious Mental Illness and Honorary Lecturer, University of Glamorgan Deborah Robertson Senior Lecturer and Programme Leader Non-Medical Prescribing, University of Chester Austyn Snowden Lecturer in Mental Health Nursing, University of West of Scotland Karen Stenner Lecturer in Health and Social Care, University of Surrey Barbara Stuttle, CBE Chair, Association for Nurse Prescribing Marea Brennan Thorns Independent Nurse Prescriber, Aesthetic Nursing

Real nurses for a real world

Consultant Editor Deborah Robertson Editor Abigail James np@markallengroup.com Commercial Manager James Demery james.demery@markallengroup.com Classified Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher Associate Publisher Sophie Gardner Publisher Chloe Benson Managing Director Jon Benson Chief Executive Officer Ben Allen Editorial Board Omar Ali Formulary Development Pharmacist, Surrey and Sussex Healthcare NHS Trust Maggi Banning Senior Lecturer in Advanced Clinical Practice, Brunel University Dianne Bowskill Health Lecturer, Adult Nursing, University of Nottingham Jane Camp Non-Medical Prescribing Lead, NHS Greater Glasgow and Clyde Nicola Carey Lecturer in Health and Social Care, University of Surrey Georgina Cox Programme Leader in Adult Health, Middlesex University Richard Griffith Lecturer in Health Law, University of Swansea Sandra Hall Head of Pharmacy Practice, De Montfort University, Leicester Barbara Novak Senior Lecturer and Education Lead for Non-Medical Prescribing, City University, London Christine Otway Supervisor, Family Nurse Partnership, Leicestershire NHS Partnership Trust Fiona Peniston-Bird Consultant for the Development of Non-Medical Prescribing, West Sussex Liz Plastow Children’s Commissioner NHS South West Essex Lynne Roberts Nurse Consultant in Serious Mental Illness and Honorary Lecturer, University of Glamorgan Deborah Robertson Senior Lecturer and Programme Leader Non-Medical Prescribing, University of Chester Austyn Snowden Lecturer in Mental Health Nursing, University of West of Scotland Karen Stenner Lecturer in Health and Social Care, University of Surrey Barbara Stuttle, CBE Chair, Association for Nurse Prescribing Marea Brennan Thorns Independent Nurse Prescriber, Aesthetic Nursing

Changes will come, but we are strong

Consultant Editor Deborah Robertson Editor Abigail James np@markallengroup.com Commercial Manager James Demery james.demery@markallengroup.com Classified Director Rachel McElhinney rachel.mcelhinney@markallengroup.com Circulation Director Sally Boettcher Associate Publisher Sophie Gardner Publisher Chloe Benson Managing Director Jon Benson Chief Executive Officer Ben Allen Editorial Board Omar Ali Formulary Development Pharmacist, Surrey and Sussex Healthcare NHS Trust Maggi Banning Senior Lecturer in Advanced Clinical Practice, Brunel University Dianne Bowskill Health Lecturer, Adult Nursing, University of Nottingham Jane Camp Non-Medical Prescribing Lead, NHS Greater Glasgow and Clyde Nicola Carey Lecturer in Health and Social Care, University of Surrey Georgina Cox Programme Leader in Adult Health, Middlesex University Richard Griffith Lecturer in Health Law, University of Swansea Sandra Hall Head of Pharmacy Practice, De Montfort University, Leicester Barbara Novak Senior Lecturer and Education Lead for Non-Medical Prescribing, City University, London Christine Otway Supervisor, Family Nurse Partnership, Leicestershire NHS Partnership Trust Fiona Peniston-Bird Consultant for the Development of Non-Medical Prescribing, West Sussex Liz Plastow Children’s Commissioner NHS South West Essex Lynne Roberts Nurse Consultant in Serious Mental Illness and Honorary Lecturer, University of Glamorgan Deborah Robertson Senior Lecturer and Programme Leader Non-Medical Prescribing, University of Chester Austyn Snowden Lecturer in Mental Health Nursing, University of West of Scotland Karen Stenner Lecturer in Health and Social Care, University of Surrey Barbara Stuttle, CBE Chair, Association for Nurse Prescribing Marea Brennan Thorns Independent Nurse Prescriber, Aesthetic Nursing

Have you heard the news

Then came the high-point of the evening—the proclamation of the 2010 Barbershopper of the Year. The 2008 recipient and this year’s presenter, Peter Jarnberg, led the audience in a merry chase replete with Ole and Lena jokes, Ole and Sven jokes, musical jokes, baritone jokes, and even a story that was a little risque, culminating in the announcement that David P. Speidel was the Minneapolis Chapter’s 2010 Barbershopper of the year.