NR565 ADVANCE
PHARMACOLOGY MIDTERM
STUDY GUIDE
Weekly
Week 1
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.
1. Some physicians limit the types of drugs that the APRN can prescribe.
2. 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.
1. 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.
2. State Board of Nursing
3. The State Board of Medicine
4. 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 does limited prescriptive authority impact patients within the healthcare system?
o Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient
care.
1. Restrictions on the distance of the APRN or PA from the physician providing
supervision or collaboration may prevent outreach to areas of greatest need.
2. 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 As the Affordable Care Act is fully implemented, the demand for provider coverage will increase.
1. Full utilization of nurse practitioners and Pas can reduce the physician shortage.
2. To adequately meet the demands for future health care needs, APRNs and Pas
will need broader practice privileges than some states currently allow.
• This includes 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 guidelines to ensure that patients are safeguarded from harm.
1. Ethical prescribing starts with being well-informed about medications.
2. Mechanisms of action, effic
o Prescription writing requires prudent and deliberate decision-making process to maintain patient
safety and reduce liability.
1. Documentation of provider-patient relationship for the recipient of the
prescribed medications.
, 2. Documentation of a thorough history and physical examination for the
recipient.
3. Documentation of discussions regarding risk factors, side effects, or therapy
options.
4. Documentation of drug monitoring or titration plan, if applicable.
5. Documentation of consultations, if any.
6. Avoidance of prescribing medications for self, family, or friends.
What should be used to make prescribing decisions?
o Rational drug selection requires a logical approach that includes the formulation of a diagnosis based on
clinical reasoning and the selection and monitoring of the most appropriate pharmacological
treatment.
1.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.
2. Guidelines
• When in doubt, follow current guidelines for the treatment of a particular
disease of symptom.
• Keep abreast of new recommendations or changes in guidelines and
incorporate these into prescribing practices.
o We must always take into account that our patients may not fit into
these guidelines and that individualized care is always best.
It is important to document the rationale for deviating from
standard of care.
3. 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.
4. Interactions
• There are very few medications that do not interact with either another
medication of a food.
• Polypharmacy greatly increases the 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.
5. Side Effects
• All drugs have side effects.
o Some are adverse and some may be beneficial.
• It is important 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.
6. 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 chart.
1. Hepatic and Renal Function
• Many drugs are metabolized and eliminated by the liver and kidneys.
o If these systems are impaired, this can lead to increased adverse
effects and possible medication overdose.
• Frequently, drugs have special decreased doses or different dosing schedules
for patients with hepatic or renal impairment.
o Hepatic or renal dosing.
• Although some drugs are safe to give or can be used with caution in patients
with hepatic or renal dysfunction, other drugs are contraindicated in these
patients and must be avoided at all costs.
2. Need for Monitoring
Some drugs require frequent monitoring at initiation or throughout the duration of
treatment.
o If a patient does not have the ability to attend frequent laboratory
appointments, cannot take their medications reliably, or is not easily
reachable by phone or electronically, it may be best to try and avoid
these medications if possible.
3. Special Populations
• Populations that deserve special mention when thinking about medications include pregnant
or nursing mothers, and older adults.
• Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how
that would translate to baseline information needed to prescribe.
o Pharmacokinetic changes
1. Absorption
• The percentage of an oral dose that becomes absorbed does not usually
change with age.
• The rate of absorption may be slowed.
o Delayed gastric emptying and reduced splanchnic blood flow.
o Drug responses may be somewhat delayed.
• Gastric acidity is reduced in older adults and may alter the absorption of
certain drugs.
2. Distribution
• Increased percentage of body fat o The increase in body fat seen in older
adults provides storage depot for lipid-soluble drugs plasma levels of these
drugs are reduced, causing a reduction in responses.
• Decreased percentage of lean body mass and total body water.
o Because of the decline in lean body mass and total body water,
watersoluble drugs become distributed in smaller volume than in
younger adults the concentration of these drugs is increased, causing
the effects to be more intense.
• Reduced concentration of serum albumin.
PHARMACOLOGY MIDTERM
STUDY GUIDE
Weekly
Week 1
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.
1. Some physicians limit the types of drugs that the APRN can prescribe.
2. 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.
1. 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.
2. State Board of Nursing
3. The State Board of Medicine
4. 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 does limited prescriptive authority impact patients within the healthcare system?
o Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient
care.
1. Restrictions on the distance of the APRN or PA from the physician providing
supervision or collaboration may prevent outreach to areas of greatest need.
2. 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 As the Affordable Care Act is fully implemented, the demand for provider coverage will increase.
1. Full utilization of nurse practitioners and Pas can reduce the physician shortage.
2. To adequately meet the demands for future health care needs, APRNs and Pas
will need broader practice privileges than some states currently allow.
• This includes 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 guidelines to ensure that patients are safeguarded from harm.
1. Ethical prescribing starts with being well-informed about medications.
2. Mechanisms of action, effic
o Prescription writing requires prudent and deliberate decision-making process to maintain patient
safety and reduce liability.
1. Documentation of provider-patient relationship for the recipient of the
prescribed medications.
, 2. Documentation of a thorough history and physical examination for the
recipient.
3. Documentation of discussions regarding risk factors, side effects, or therapy
options.
4. Documentation of drug monitoring or titration plan, if applicable.
5. Documentation of consultations, if any.
6. Avoidance of prescribing medications for self, family, or friends.
What should be used to make prescribing decisions?
o Rational drug selection requires a logical approach that includes the formulation of a diagnosis based on
clinical reasoning and the selection and monitoring of the most appropriate pharmacological
treatment.
1.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.
2. Guidelines
• When in doubt, follow current guidelines for the treatment of a particular
disease of symptom.
• Keep abreast of new recommendations or changes in guidelines and
incorporate these into prescribing practices.
o We must always take into account that our patients may not fit into
these guidelines and that individualized care is always best.
It is important to document the rationale for deviating from
standard of care.
3. 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.
4. Interactions
• There are very few medications that do not interact with either another
medication of a food.
• Polypharmacy greatly increases the 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.
5. Side Effects
• All drugs have side effects.
o Some are adverse and some may be beneficial.
• It is important 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.
6. 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 chart.
1. Hepatic and Renal Function
• Many drugs are metabolized and eliminated by the liver and kidneys.
o If these systems are impaired, this can lead to increased adverse
effects and possible medication overdose.
• Frequently, drugs have special decreased doses or different dosing schedules
for patients with hepatic or renal impairment.
o Hepatic or renal dosing.
• Although some drugs are safe to give or can be used with caution in patients
with hepatic or renal dysfunction, other drugs are contraindicated in these
patients and must be avoided at all costs.
2. Need for Monitoring
Some drugs require frequent monitoring at initiation or throughout the duration of
treatment.
o If a patient does not have the ability to attend frequent laboratory
appointments, cannot take their medications reliably, or is not easily
reachable by phone or electronically, it may be best to try and avoid
these medications if possible.
3. Special Populations
• Populations that deserve special mention when thinking about medications include pregnant
or nursing mothers, and older adults.
• Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how
that would translate to baseline information needed to prescribe.
o Pharmacokinetic changes
1. Absorption
• The percentage of an oral dose that becomes absorbed does not usually
change with age.
• The rate of absorption may be slowed.
o Delayed gastric emptying and reduced splanchnic blood flow.
o Drug responses may be somewhat delayed.
• Gastric acidity is reduced in older adults and may alter the absorption of
certain drugs.
2. Distribution
• Increased percentage of body fat o The increase in body fat seen in older
adults provides storage depot for lipid-soluble drugs plasma levels of these
drugs are reduced, causing a reduction in responses.
• Decreased percentage of lean body mass and total body water.
o Because of the decline in lean body mass and total body water,
watersoluble drugs become distributed in smaller volume than in
younger adults the concentration of these drugs is increased, causing
the effects to be more intense.
• Reduced concentration of serum albumin.
