Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172

Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172 Chapter 1: Prescriptive Authority and Role Implementation: Tradition vs Change o Primary Care is provided by clinicians who address "personal health care needs, developing a sustained partnership with patient, and practicing in the context of family and community."  Prevention, Diagnosis, Prescription, Treatment  Assess health status.  Promote healthy lifestyles.  Identifying/diagnosing normal/abnormal conditions.  Determining the causes of abnormal conditions, providing referral to health care specialists.  Selecting appropriate therapeutic measures.  Implementing treatment.  Supervising/monitoring the patient on an ongoing basis.  Traditional Primary Care--physicians as the only providers with diagnostic and treatment authority--an intention to protect the public.  Prescriptive practices should not be compared to those of physicians--all providers should be held to a standard of approved therapeutic practice.  Most Prescribed by PCP--antidepressants, NSAIDs, antihistamines/bronchodilators, antihypertensives, antilipidemic.  Rate of Adoption by Prescribers--innovators, early adopters, early majority, late majority, and laggards. o Problems in the Prescribing Practice of Physicians  Prescriptions are not the most up to date--"new research findings diffuse slowly into practice."  Pharmaceutical company influence--FDA intervention and PhRMA guidelines.  Lack of time--short consultation, incorrect H&P, problem is left undefined, over-reliance on drug therapy.  Consumers' pressure for prescribed medications--"Do something!"--lifetime of medications, overused antibiotics, and direct-to-consumer advertising.  Ineligible prescriptions -- Medication errors. Current federal mandate for e-prescribing. TJC Do Not Use Abbreviations.  Undetected/anticipating drug interactions--liver cytochrome P450 enzymes = drug-to-drug interactions may render medication ineffective--prescription warning system alerts. Rising use of OTC and herbal products. Chapter 2: Historical View of Prescriptive Authority (Nurses vs. PA) o Primary Care is provided by clinicians who address "personal health care needs, developing a sustained partnership with patient, and practicing in the context of family and community." o "Delegable authority -- "Delegable prescriptive authority" without it, an APN can only suggest OTC medications. o Nursing Legislation  Dependent authority--the physician retains ultimate authority through co-signature.  Independent authority--the APN prescribes alone--can still be restrictive.  1993--Definition and Registration of MLPs--can obtain DEA# beginning with M  NPs  DEA number and prescriptive authority differ by state.  May dispense pharmaceutical samples in all states.  Across-state-line prescribing  CNMs  CRNAs--do not "prescribe" under law.  CNSs o Barriers to Practice for Nurses in the Diagnosing and Prescribing Role  Regulatory irregularity among states  Increased antagonism from organized medical groups competing with APNs for patients  Growing number of NP graduates without prior nursing experience  Inequity in data collection on physician prescribing patterns among pharmaceutical companies  Difficulty in obtaining prescribing data from Prescription Drug Marketing Act