NR 565 Advanced Pharmacology Fundamentals Exam

• Which schedule drugs can APRNs prescribe?
o APRNs can prescribe Schedule II-V drugs, but whether APRNs possess full prescriptive authority
depends on their legal right to prescribe without supervisory or collaborative requirements.
o Some state laws require that they practice in collaboration with or under supervision of a
physician.
▪ Some physicians limit the types of drugs that the APRN can prescribe.
▪ State laws may place additional restrictions with regard to controlled drugs.
• Who determines and regulates prescriptive authority?
o Prescriptive authority is determined by state law.
▪ Advanced practice providers may have full prescriptive authority in some states yet face
significant restrictions in other states.
o The regulation of prescriptive authority is under the jurisdiction of a health professional board.
▪ State Board of Nursing
▪ The State Board of Medicine
▪ The State Board of Pharmacy
• As determined by each state.
o Although the federal government controls drug regulation, it has no control over prescriptive
authority.
• How doeslimited prescriptive authority impact patients within the healthcare system?
o Limited prescriptive authority creates numerous barriersto quality, affordable, and accessible
patient care.
▪ Restrictions on the distance of the APRN or PA from the physician providing supervision
or collaboration may prevent outreach to areas of greatest need.
▪ A requirement to obtain the physician’s co-signature on prescriptions can increase
patient waits.
o By 2025, the shortage of physicians will range between 46,100 and 90,400. In primary care alone,
a 12,500 to 31,100 physician shortage is anticipated.
o Asthe Affordable Care Act is fully implemented, the demand for provider coverage will increase.
▪ Full utilization of nurse practitioners and Pas can reduce the physician shortage.
▪ To adequately meet the demands for future health care needs, APRNs and Pas will need
broader practice privileges than some states currently allow.
• Thisincludes an imperative to afford full prescriptive authority.
• What are the key responsibilities of prescribing?
o The ability to prescribe medications is both a privilege and a burden.
o It requires adherence to ethical guidelinesto ensure that patients are safeguarded from harm.
▪ Ethical prescribing starts with being well-informed about medications.
• Mechanisms of action, effic
o Prescription writing requires prudent and deliberate decision-making processto maintain patient
safety and reduce liability.
▪ Documentation of provider-patient relationship for the recipient of the prescribed
medications.
▪ Documentation of a thorough history and physical examination for the recipient.
▪ Documentation of discussionsregarding risk factors, side effects, or therapy options.
▪ Documentation of drug monitoring or titration plan, if applicable.
▪ Documentation of consultations, if any.
▪ Avoidance of prescribing medicationsforself, family, or friends.
• What should be used to make prescribing decisions?
o Rational drug selection requires a logical approach that includesthe formulation of a diagnosis
based on clinical reasoning and the selection and monitoring of the most appropriate
pharmacological treatment.
▪ Cost
• Ask patients if they have difficulty obtaining their medication because it is costprohibitive.
o Consider changing pharmacies or drug regimens.
o Be familiar with the local resources for medication assistance and lowcost medications.
▪ Guidelines
• When in doubt, follow current guidelines for the treatment of a particular
disease of symptom.
• Keep abreast of new recommendations or changesin guidelines and
incorporate these into prescribing practices.
o We must alwaystake into account that our patients may not fit into
these guidelines and that individualized care is always best.
▪ It isimportant to document the rationale for deviating from
standard of care.
▪ Availability
• The drug you want may not be available in your facility or at a specific
pharmacy.
o This can affect your choice in medication.
• Become familiar with the formulary where you are employed and know that it
can change over time.
o Often there are substitutes or similar medications you can order in
place of what you originally intended.
▪ Interactions
• There are very few medications that do not interact with either another
medication of a food.
• Polypharmacy greatly increasesthe risk for interactions.
• It is of crucial importance to ask the patient about all current drugs, including
OTC medications and other herbal preparations.
o When adding a new medication to a patient regimen, check for
significant interactions.
▪ Side Effects
• All drugs have side effects.
o Some are adverse and some may be beneficial.
• It isimportant to note the pertinent side effects for each medication and to ask
patients about presence of symptoms after initiating, stopping, or changing a
medication dose.
o When assessing a risk-to-benefit ratio of a medication, one must
consider the severity of the side effects.
▪ Allergies
• Unfortunately, your patient may have an allergy to that medication or class of
drug.
• It is of critical importance to determine the type of reaction and to document in
the patient’s char