NURS 5334 ADV PHARM FOR ANP - MODULE 1
LECTURES Questions And Answers With
Verified Solutions 100% Correct.
When writing any prescription, there are key elements that must be on the prescription
including prescriber name, license number, and contact information; DEA number of both the
supervising physician and the prescriber if applicable; patient name and date of birth; patient
allergies; the name of the medication; the indication of the medication; the strength of the
medication; the dosing frequency; number of tablets/capsules to dispense; and the number of
refills. Abbreviations are no longer acceptable. Everything should be written out. Example: 25
milligrams once daily by mouth for hypertension. And If you are using an electronic medical
record for prescriptions, these are going to automatically be on there in some instances, but
other instances you may need to add them. You will have assignments in this course involving
writing prescriptions. Students get confused when it comes to the SIG on the prescription. Sig st
- ANSWER
What is prescriptive authority? - ANSWER The ability and extent of NP's ability to
prescribe medication to patient is dependent on state nurse practice act
Wall EE EA has ruled that nurses in advanced practice roles may obtain registered members,
state practice acts dictate the level of prescriptive authority allowed
Components of prescriptive authority - ANSWER are the right to prescribe
independently, and the right to prescribe without limitation. The prescriber who prescribes
independently is not subject to rules requiring physician supervision or collaboration. The
provider who prescribes without limitation may prescribe any drugs, including controlled drugs,
with the exception of Schedule 1 drugs, which have no current medical use.
Prescriptive authority is determined by state law. As a result - - ANSWER of difference
from state to state advanced practice providers may have full prescriptive authority in some
states, yet face a lot of restrictions in other states. Texas, unfortunately, is a state where we are
restricted. The differences particularly affect providers who serve in locum tenems staffing
positions, or who have practices in two contiguous states. The regulation of prescriptive
authority is under the jurisdiction of a health professional board. This may be the state board of
nursing, state board of medicine, or the state board of pharmacy as determined by each state.
Although the federal government controls drug regulation, it has no control over prescriptive
authority.
,What is the argument for full prescriptive authority? - ANSWER Advanced practice
providers complete rigorous programs of study largely in accredited programs that meet
stringent national standards. Although there are differences in each program, they all include
common components. For example, they require extensive education focused on assessment,
diagnosis, and management of health problems. Diagnostic reasoning, critical thinking and
procedural skills are evaluated in both didactic and clinical courses. National examinations
validate the ability to provide safe and competent care, and licensure ensures that providers
comply with standards of practice that promote public health and safety. Advanced practice
providers are prepared to fully implement the advanced practice role in their profession.
Limited prescriptive authority creates a number of barriers. What are some of those barriers? -
ANSWER It creates barriers to quality, affordable and accessible patient care. An example is
restrictions on the distance of the APRN from the physician providing supervision or
collaboration may prevent outreach to areas that have the greatest need. A requirement to
obtain the physician's co-signature on prescriptions can increase patient waits. Despite the use
of terms such as collaborative arrangements. These relationships create a situation in which one
partner holds all the power. It is estimated that by the year 2025, the physician shortage will be
between 46,100 to 90,400. In primary care alone a 12,500 to 31,100 physician shortage is
anticipated. APRN's with full prescriptive authority would help offset the shortage and meet the
future needs of healthcare demands.
Many factors are involved when considering drug selection. Some include - - ANSWER
cost, guidelines, liability interactions, side effects, allergies, liver and renal function, need for
monitoring, and special populations.
If you find that your patient is having difficulty purchasing the prescribed medications, what
should you do? - ANSWER consider changing pharmacies or drug regimens. The cost of
a drug can vary widely between pharmacies, even within the same city. Many corporations have
created generic $4 lists or special prescription programs that allow patients to fill their
medications for a reasonable cost. When in doubt, follow current guidelines for the treatment
of a particular disease or symptom. Almost all medical and nursing societies have published
guidelines, including the American Heart Association, the American College of Cardiology, the
Infectious Diseases Society of America, and the American Diabetes Association. It is the
provider's responsibility to keep abreast of new recommendations or changes in guidelines and
to incorporate these into their prescribing practices. Although closely following the guidelines is
desirable, we must always take into account that our patients may not fit well into these
guidelines and that individualized care is always best. In these cases, it is important to
document the rationale for deviating from standard of care. Every facility and pharmacy provide
drugs according to a formulary. This formulary is selected by a panel of pharmacists and
providers and may be subject to following guidelines created by regulatory agencies, such as the
,Centers for Medicare and Medicaid Services (CMS). The formulary may also depend on regional
and national drug supplies, drug costs and available rebates, and the presence of generic
medications on the market. In short, the drug you want may not be available in your facility or
at a specific pharmacy. This can affect your choice in medications. Become familiar with the
formulary where you are employed and know that it can change over time. Often there are
substitutes or similar medications you can order in place of what you originally intended.
Polypharmacy - ANSWER Polypharmacy greatly increases the risk for interactions.
Some of these interactions are negligible, but some can have life-threatening consequences. It is
of crucial importance to ask the patient about all current drugs, including over-the-counter
(OTC) medications and other herbal preparations. Many patients do not consider OTC or
alternative pharmaceuticals as "medications" and may not mention them unless you ask
specifically. When adding a new medication to a patient regimen, check for significant
interactions. All drugs have side effects. Some are adverse, and some may be beneficial. In
addition, one patient may experience adverse effects to a medication, whereas another patient
may not. It is important to note the pertinent side effects for each medication and to ask your
patients about presence of symptoms after initiating, stopping, or changing a medication dose.
When assessing the risk-to-benefit ratio of a medication, one must consider the severity of the
side effects. At times, guidelines may suggest a particular drug for a specific ailment.
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.
Then, selection of an appropriate drug may begin. Many drugs are metabolized and eliminated
by the liver and kidneys. 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. This is known as hepatic dosing
or renal dosing.
Some drugs require frequent monitoring at initiation or throughout the duration of treatment.
Examples of these medications include - - ANSWER warfarin, lithium, opioids, and
immunosuppressive therapies (tacrolimus, sirolimus). When levels of these drugs are not within
therapeutic range, serious patient harm can occur. Populations that deserve special mention
when thinking about medications include pregnant or nursing mothers, and older adults. We
will cover special populations in the next module with drugs across the lifespan.
Types of prescriptions - ANSWER include telephone prescriptions, written, E-
prescribing, and refills. Telephone rxs are convenient. Schedule II medications cannot be
prescribed or refilled by phone. Written rxs must contain all the necessary elements. Never
write rxs on presigned scripts or presign blank scripts for other providers or staff. Many facilities
provide tamper resistant scripts, and some states require their use. Many pharmacies have
capabilities to accept electronic prescriptions. These allow the provider to select a specific,
, patient selected pharmacy and the rx is automatically sent to the selected pharmacy. Direct
transmission of information makes errors less likely. The rx will be ready sooner. Some
organizations do not have a functional EMR and some pharmacies do not have software
capabilities to process these requests. In these instances, paper rxs are still required. When
giving refills ask yourself: Is this a newer medication for this patient: Am I changing dose or
frequency of the medication? Am I adding a new medication to the regimen? Is the patient
having undesired side effects? When do I expect to follow with this patient? Do I need to see
the patient prior to the refill? Is this a schedule II medication?
Education not only provides an opportunity to explain the importance of the medication, but
also allows the provider to dispel rumors about medications that often lead to therapy failures.
Education reduces medication errors by empowering the patients with accurate information
and clear guidelines. - ANSWER
There are basic components of education, and they need to be included when teaching about
any new medication including medication name generic vs trade name; purpose: reason for
taking the medication and desired effect; dosing regimen: how much, how often, and time of
day; administration: preparation for taking, with or without food; side effects: all risks and how
to manage them; special storage needs: refrigeration, original container; associated lab testing:
need for regular appointments; food or drug interactions: what to avoid; and duration of
therapy: length of administration. - ANSWER
Medication information is notoriously easy to forget, especially for patients taking numerous
medications. We recommend accompanying all verbal education with written instructions. For
those who are unable to read due to literacy or vision problems, video or audio instructions can
be used. The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy
as "the degree to which an individual has the capacity to obtain, communicate, process, and
understand basic health information and services to make appropriate health decisions." Low
levels of health literacy can impair a patient's ability to understand medication instructions. Best
practices in developing written patient education materials are abundant in the literature. Best
practices in developing written patient education includes: limit content, important information
first, write in active voice, white space, include illustrations, use c - ANSWER
Monitoring is an important consideration in medication therapy. Monitor positive and negative
patient responses, and act on findings in ways that increase or decrease risk. This is essential to
have optimal outcomes. There are three primary reasons for drug monitoring. The first is to
determine therapeutic dosage; evaluating medication adequacy: desired effect achieved; and
identifying adverse effects: presence of patient harm. - ANSWER
Medication adherence costs the United States about 290 billion a year. It is often directly
responsible for disease exacerbations, hospitalizations, transitioning to long-term care, and
LECTURES Questions And Answers With
Verified Solutions 100% Correct.
When writing any prescription, there are key elements that must be on the prescription
including prescriber name, license number, and contact information; DEA number of both the
supervising physician and the prescriber if applicable; patient name and date of birth; patient
allergies; the name of the medication; the indication of the medication; the strength of the
medication; the dosing frequency; number of tablets/capsules to dispense; and the number of
refills. Abbreviations are no longer acceptable. Everything should be written out. Example: 25
milligrams once daily by mouth for hypertension. And If you are using an electronic medical
record for prescriptions, these are going to automatically be on there in some instances, but
other instances you may need to add them. You will have assignments in this course involving
writing prescriptions. Students get confused when it comes to the SIG on the prescription. Sig st
- ANSWER
What is prescriptive authority? - ANSWER The ability and extent of NP's ability to
prescribe medication to patient is dependent on state nurse practice act
Wall EE EA has ruled that nurses in advanced practice roles may obtain registered members,
state practice acts dictate the level of prescriptive authority allowed
Components of prescriptive authority - ANSWER are the right to prescribe
independently, and the right to prescribe without limitation. The prescriber who prescribes
independently is not subject to rules requiring physician supervision or collaboration. The
provider who prescribes without limitation may prescribe any drugs, including controlled drugs,
with the exception of Schedule 1 drugs, which have no current medical use.
Prescriptive authority is determined by state law. As a result - - ANSWER of difference
from state to state advanced practice providers may have full prescriptive authority in some
states, yet face a lot of restrictions in other states. Texas, unfortunately, is a state where we are
restricted. The differences particularly affect providers who serve in locum tenems staffing
positions, or who have practices in two contiguous states. The regulation of prescriptive
authority is under the jurisdiction of a health professional board. This may be the state board of
nursing, state board of medicine, or the state board of pharmacy as determined by each state.
Although the federal government controls drug regulation, it has no control over prescriptive
authority.
,What is the argument for full prescriptive authority? - ANSWER Advanced practice
providers complete rigorous programs of study largely in accredited programs that meet
stringent national standards. Although there are differences in each program, they all include
common components. For example, they require extensive education focused on assessment,
diagnosis, and management of health problems. Diagnostic reasoning, critical thinking and
procedural skills are evaluated in both didactic and clinical courses. National examinations
validate the ability to provide safe and competent care, and licensure ensures that providers
comply with standards of practice that promote public health and safety. Advanced practice
providers are prepared to fully implement the advanced practice role in their profession.
Limited prescriptive authority creates a number of barriers. What are some of those barriers? -
ANSWER It creates barriers to quality, affordable and accessible patient care. An example is
restrictions on the distance of the APRN from the physician providing supervision or
collaboration may prevent outreach to areas that have the greatest need. A requirement to
obtain the physician's co-signature on prescriptions can increase patient waits. Despite the use
of terms such as collaborative arrangements. These relationships create a situation in which one
partner holds all the power. It is estimated that by the year 2025, the physician shortage will be
between 46,100 to 90,400. In primary care alone a 12,500 to 31,100 physician shortage is
anticipated. APRN's with full prescriptive authority would help offset the shortage and meet the
future needs of healthcare demands.
Many factors are involved when considering drug selection. Some include - - ANSWER
cost, guidelines, liability interactions, side effects, allergies, liver and renal function, need for
monitoring, and special populations.
If you find that your patient is having difficulty purchasing the prescribed medications, what
should you do? - ANSWER consider changing pharmacies or drug regimens. The cost of
a drug can vary widely between pharmacies, even within the same city. Many corporations have
created generic $4 lists or special prescription programs that allow patients to fill their
medications for a reasonable cost. When in doubt, follow current guidelines for the treatment
of a particular disease or symptom. Almost all medical and nursing societies have published
guidelines, including the American Heart Association, the American College of Cardiology, the
Infectious Diseases Society of America, and the American Diabetes Association. It is the
provider's responsibility to keep abreast of new recommendations or changes in guidelines and
to incorporate these into their prescribing practices. Although closely following the guidelines is
desirable, we must always take into account that our patients may not fit well into these
guidelines and that individualized care is always best. In these cases, it is important to
document the rationale for deviating from standard of care. Every facility and pharmacy provide
drugs according to a formulary. This formulary is selected by a panel of pharmacists and
providers and may be subject to following guidelines created by regulatory agencies, such as the
,Centers for Medicare and Medicaid Services (CMS). The formulary may also depend on regional
and national drug supplies, drug costs and available rebates, and the presence of generic
medications on the market. In short, the drug you want may not be available in your facility or
at a specific pharmacy. This can affect your choice in medications. Become familiar with the
formulary where you are employed and know that it can change over time. Often there are
substitutes or similar medications you can order in place of what you originally intended.
Polypharmacy - ANSWER Polypharmacy greatly increases the risk for interactions.
Some of these interactions are negligible, but some can have life-threatening consequences. It is
of crucial importance to ask the patient about all current drugs, including over-the-counter
(OTC) medications and other herbal preparations. Many patients do not consider OTC or
alternative pharmaceuticals as "medications" and may not mention them unless you ask
specifically. When adding a new medication to a patient regimen, check for significant
interactions. All drugs have side effects. Some are adverse, and some may be beneficial. In
addition, one patient may experience adverse effects to a medication, whereas another patient
may not. It is important to note the pertinent side effects for each medication and to ask your
patients about presence of symptoms after initiating, stopping, or changing a medication dose.
When assessing the risk-to-benefit ratio of a medication, one must consider the severity of the
side effects. At times, guidelines may suggest a particular drug for a specific ailment.
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.
Then, selection of an appropriate drug may begin. Many drugs are metabolized and eliminated
by the liver and kidneys. 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. This is known as hepatic dosing
or renal dosing.
Some drugs require frequent monitoring at initiation or throughout the duration of treatment.
Examples of these medications include - - ANSWER warfarin, lithium, opioids, and
immunosuppressive therapies (tacrolimus, sirolimus). When levels of these drugs are not within
therapeutic range, serious patient harm can occur. Populations that deserve special mention
when thinking about medications include pregnant or nursing mothers, and older adults. We
will cover special populations in the next module with drugs across the lifespan.
Types of prescriptions - ANSWER include telephone prescriptions, written, E-
prescribing, and refills. Telephone rxs are convenient. Schedule II medications cannot be
prescribed or refilled by phone. Written rxs must contain all the necessary elements. Never
write rxs on presigned scripts or presign blank scripts for other providers or staff. Many facilities
provide tamper resistant scripts, and some states require their use. Many pharmacies have
capabilities to accept electronic prescriptions. These allow the provider to select a specific,
, patient selected pharmacy and the rx is automatically sent to the selected pharmacy. Direct
transmission of information makes errors less likely. The rx will be ready sooner. Some
organizations do not have a functional EMR and some pharmacies do not have software
capabilities to process these requests. In these instances, paper rxs are still required. When
giving refills ask yourself: Is this a newer medication for this patient: Am I changing dose or
frequency of the medication? Am I adding a new medication to the regimen? Is the patient
having undesired side effects? When do I expect to follow with this patient? Do I need to see
the patient prior to the refill? Is this a schedule II medication?
Education not only provides an opportunity to explain the importance of the medication, but
also allows the provider to dispel rumors about medications that often lead to therapy failures.
Education reduces medication errors by empowering the patients with accurate information
and clear guidelines. - ANSWER
There are basic components of education, and they need to be included when teaching about
any new medication including medication name generic vs trade name; purpose: reason for
taking the medication and desired effect; dosing regimen: how much, how often, and time of
day; administration: preparation for taking, with or without food; side effects: all risks and how
to manage them; special storage needs: refrigeration, original container; associated lab testing:
need for regular appointments; food or drug interactions: what to avoid; and duration of
therapy: length of administration. - ANSWER
Medication information is notoriously easy to forget, especially for patients taking numerous
medications. We recommend accompanying all verbal education with written instructions. For
those who are unable to read due to literacy or vision problems, video or audio instructions can
be used. The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy
as "the degree to which an individual has the capacity to obtain, communicate, process, and
understand basic health information and services to make appropriate health decisions." Low
levels of health literacy can impair a patient's ability to understand medication instructions. Best
practices in developing written patient education materials are abundant in the literature. Best
practices in developing written patient education includes: limit content, important information
first, write in active voice, white space, include illustrations, use c - ANSWER
Monitoring is an important consideration in medication therapy. Monitor positive and negative
patient responses, and act on findings in ways that increase or decrease risk. This is essential to
have optimal outcomes. There are three primary reasons for drug monitoring. The first is to
determine therapeutic dosage; evaluating medication adequacy: desired effect achieved; and
identifying adverse effects: presence of patient harm. - ANSWER
Medication adherence costs the United States about 290 billion a year. It is often directly
responsible for disease exacerbations, hospitalizations, transitioning to long-term care, and
