https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\nRoles and responsibilities of the APRN prescribers
Role as prescriber requires additional knowledge beyond the nursing program. The willingness and ability to assume responsibility for medication prescription.<\/p>\n\n\n\n
Prescribing collaboration with a provider is valuable<\/p>\n\n\n\n
APRN’s have no need for protocols in ordering<\/p>\n\n\n\n
Clinical judgement in prescribing
Based on thorough assessment of patient and environment<\/p>\n\n\n\n
determination of medical and nursing DX, review of alternative therapies, and knowledge about drug choice.<\/p>\n\n\n\n
Best therapy considerations: least invasive, least expensive, and least likely to cause adverse reactions.<\/p>\n\n\n\n
Is there a clear indication for drug therapy? What drugs are effective? What is the goal of therapy? What conditions for drug failure? Are there unnecessary duplications with other drugs? Would an OTC med work? Cost?<\/p>\n\n\n\n
Collaboration with other providers
Collaboration includes working with other disciplines within the health care team, this includes physicians, pharmacist, other APRN’S, PA’s, Nurses. While collaboration can, at times be difficult, it is necessary.<\/p>\n\n\n\n
Autonomy and prescriptive authority
APRN’s have full autonomy in 21 states and prescriptive authority in all 50 states. Not all APRN’s can prescribe autonomously. Physician supervision remains a key concern for the AMA and fights to keep physician oversight in place.<\/p>\n\n\n\n
Drug Databases
Part of the prescription drug monitoring program, contains information on the last prescription filled, the name of the ordering prescriber and the name of the pharmacist who filled it.<\/p>\n\n\n\n
Medication adherence
Direct and indirect methods of assessing medication adherence can be utilized to identify elderly people having difficulty in adhering to prescribed regimens. Health care professionals can monitor blood levels and\/or urine assays for drug metabolites or marker compounds. Indirect methods of assessing adherence include patient interviews, pill counts, refill records, medication organizers, and measurement of health outcomes. Cost can affect adherence, poor education, previous reactions, health beliefs, all affect medication adherence.<\/p>\n\n\n\n
New drug approval process including clinical phases I-IV
U.S. is the most rigorous in the world for drug approval. cost is around 2.6 billion for each medication approved. Takes around 8.5 years to gain approval from the FDA.<\/p>\n\n\n\n
Process includes preclinical research: the process of identifying new compounds for medication research in non-human study.
Clinical studies: includes 3 phases to implement human studies.
phase I (healthy subjects) is clinical evaluation on humans to establish tolerance, pharmacological effects. Pharmacodynamics studied in this phase.<\/p>\n\n\n\n
Phase II (subjects with the target disease) to determine potential usefulness and short term risk.<\/p>\n\n\n\n
Phase III controlled and uncontrolled clinical trials for safety and efficacy to a larger study size.<\/p>\n\n\n\n
U.S. FDA regulatory jurisdiction: Official labeling vs off-label use of drugs
Drugs are labeled for specific uses and disease treatment however some drugs may exhibit desired effects outside of these parameters. prescription drugs have drug labeling inserts with pertinent information intended for clinical personnel. only if the drug information can be labeled for the lay person can it be over the counter. Official labeling applies to the FDA insert packaging with all information on the drug in question.
Off-labeling pertains to a drug, dose or route that is not approved by the FDA but is given for clinical indication.
Example: Diphenhydramine, Reglan, and Toradol cocktail for the treatment of migraines.<\/p>\n\n\n\n
Controlled substance laws
Controlled substance act of 1970, these laws are designed to regulate the manufacturing, distribution, and dispensing of identified drugs and limited to legitimate prescribers only for closed system communication. To “control” the flow and access to these medications.<\/p>\n\n\n\n
Controlled drug DEA schedules
5 schedules of controlled drugs
I – No excepted use, illicit drugs like heroine, lsd, peyote, marijuana
II – No refills permitted, no telephone orders outside of emergency and electronic prescribing allowed as of 2011 with appropriate software. examples: narcotics, stimulants, depressants
III – Prescription must be re-written after 6 months or 5 refills. examples certain narcotics like norco and codein combined with non-narcotics under 90mg, stimulants like benzphetamine, chlorpheniramine. Depressants like butabarbital. anabolic steroids like testosterone.
IV – same as schedule III but penalties for possession are different.
V – Same as all prescription drugs, may be dispensed without a prescription<\/p>\n\n\n\n
Controlled substance misuse: Prescriber education-behavioral red flags, pressure to prescribe, enabling
Education includes, chemical dependent screening skills, limit setting, careful documentation, practice with saying no to patients.
Behavioral red flags scams are intended to procure higher doses, more potent medications, and to illicit a discomfort to denying the request in the provider. Scammers generate pressure when resistance to the scam is present.
Pressure to prescribe arises from a perceived expectation that patient should “leave with something” leading to overuse of medications like antibiotics.
Enabling is a powerful instinct for providers to do anything to improve a patient disability or quality of life but disease and dependence have a bottomless appetite for enabling.<\/p>\n\n\n\n
Patient medication misuse: Communication, systemic solutions, prescribing tips, medication agreements, and prescription drug monitoring programs
already covered<\/p>\n\n\n\n
State Law
Jurisdiction: federal law dictates that a drug must be prescribed but state law dictates who can prescribe. NP’s are governed state by state.<\/p>\n\n\n\n
Writing and transmitting the prescription
prescription format includes name, date, dea# (if controlled), drug, route, dose, duration, frequency.<\/p>\n\n\n\n
Ethical aspects of prescribing
Informed consent, patients ability to agree to therapy and understand the risk\/benefit of therapy.<\/p>\n\n\n\n
OTC Medication characteristics and regulation
Characteristics: must be safe, low potential for abuse, can be labeled, patient must be able to self diagnose for the drug to be taken, and must be for a condition where the patient does not require supervision.<\/p>\n\n\n\n
OTC medication sales
CHPA (consumer healthcare products association) monitors physical complaints for self treatment with otc meds<\/p>\n\n\n\n
Hazards of OTC self-medication
overdose, toxic effects, misuse, lack of understanding of the drug all play a role.<\/p>\n\n\n\n
Drug interactions: Antacids, Anticholinergics, CNS depressants, NSAIDS, ans ASA
Antacids, contain metalic ions which interfere with most drugs through stomach acid alterations. seperate antacid use by 2 hours
Anticholinergics: adverse effects of benadryl and doxylamine causes dry mouth, difficulty urinating, hypertension, tachycardia, tinnitus, blurred vision, constipation.
CNS depressants: CNS sedation which can be additive with other forms of sedation meds
NSAIDS: GI bleeding from cox-2 (mucosal barrier breakdown) inhibition with increased risk when combined with anti platelet or anticoagulant therapy.<\/p>\n\n\n\n
Abuse of OTC medications: Combat methamphetamine epidemic act
otc antitussives can be used in the making of methamphetamine, this act combats this by regulating how much can be purchased and tracks those purchasing.<\/p>\n\n\n\n
Pt education regarding OTC medications
think adverse effects, what to look out for, when to use, etc<\/p>\n\n\n\n
NSAIDS: Pharmacodynamics including FDA black box warnings, pharmacotherapeutics, acetaminophen poisoning, drug interactions, clinical use, rational drug selection, monitoring and patient education.<\/p>\n\n\n\n
Aspirin Pharmacodynamics, pharmacotherapeutics including ADR’s and toxicity monitoring and patient education. Clinical use and dosing for fever, mild to moderate pain, RA, OA, MI prophylaxis TIA’s<\/p>\n\n\n\n
Overview of pain concepts: special populations, comorbid chronic illness, pregnancy substance abuse<\/p>\n\n\n\n
Acute pain: pharmacodynamics, anti-inflammatory drugs, goals of tx, addiction and dependency (redflags, pain management contracts, rational drug selection, monitoring, outcome evaluation, patient education<\/p>\n\n\n\n
Chronic pain: pharmacodynamics, goals of treatment, algorithm for rational drug selection: drug therapy: anti-inflammatories, adjuvants, opioids, monitoring, outcome, evaluation, patient education.<\/p>\n","protected":false},"excerpt":{"rendered":"
NR565 \/ NR 565 Week 2 Quiz (Latest 2024 \/ 2025): Advanced Pharmacology Fundamentals – Chamberlain NR-565 Advanced Pharmacology FundamentalsWeek 2 QuizWriting and transmitting the prescriptionCorrect Answer:prescription format includes name, date, dea# (if controlled), drug, route,dose, duration, frequency.Ethical aspects of prescribingCorrect Answer:Informed consent, patients ability to agree to therapy and understand therisk\/benefit of therapy.OTC Medication […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-131014","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131014","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=131014"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131014\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=131014"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=131014"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=131014"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}