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1. ·· Which schedule
Schedule II-V
drugs can APRNs
prescribe?
Nurse practitioner scope of practice is determined by state
2. · Who determines and
practice and licensure laws.
reg-ulates prescriptive
author-ity?
limited authority creates problems for the patient. The patient
3. · How does limited pre-
is not able to get the care they need
scriptive authority
impact patients within
the health-care
system? 1. Be prudent and deliberate in your decision-making
process
4. · What are the key 2. Have a documented provider-patient relationship
respon-sibilities of with the per-son for whom you are prescribing
prescribing? 3. Do not prescribe medications for family or friends or
for yourself
4. Document a thorough history and physical
examination in your records
5. Include any discussions you have with the patient
regarding risk factors, side ettects, or therapy options
6. Have a documented plan regarding drug monitoring
or titration, if applicable
5. · What should be used
to make prescribing
deci-sions?
drug accumulation secondary to reduced renal
6. Pharmakinetiscs and function polypharmacy (the use of five or more
Phar-modynamics of medications daily) greater severity of illness
older adults presence of comorbidities
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use of drugs that have a low
therapeutic index (e.g., digoxin)
increased individual variation secondary
to altered pharmacokinet-
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ics
inadequate supervision of long-term
therapy poor patient adherence
7.
8. · Beer's Criteria •potentially Inappropriate Medication (PIM) use in older
adults
• PIM use in older adults due to medication-disease or
medica-tion-syndrome interactions that may exacerbate the
disease or syn-drome
• medications to be used cautiously in older adults
• clinically significant drug interactions that should be
avoided in older adults
• medications to be avoided or dosage decreased in the
presence of impaired kidney function in older adults
(American Geriatric Society Beers Criteria Update Expert
Panel, 2019)
9. CYP450 Many medications are metabolized through the liver
enzyme sys-tem called cytochrome P450 (CYP450).
Metabolization can be in-hibited or induced by drugs
and once this happens drug-drug interactions can
occur.
10. VISA credit card dept Valproat
In-hibits Spending on e I-
CK and GQ soniazid
S-ulfamids
A-miodarone
C-hloramphenical
Ketoconazole
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