Week 1: Midterm study guide
Tuesday, April 29, 2025 1:14 AM
Week 1:
Chapter 1: Prescriptive Authority
• State laws impact on prescriptive authority
○ Prescriptive authority is primarily governed by state laws.
○ Laws determine whether an APRN or a PN can prescribe medications independently or must
do so under physician supervision.
○ Some states have full prescriptive authority, allowing them to prescribe medications,
including controlled substances, without physician oversight.
○ Some states may require collaborative agreements with physicians, limiting scope of
prescriptive authority.
• Full Practice Authority
○ "Full Practice Authority" refers to the legal rights of an APRN and PA to prescribe
medications independently and without limitations imposed by physician oversight.
○ The autonomy encompasses the ability to assess patients, diagnosis conditions, interpret
diagnostic tests, and initiate and manage treatments, including prescribing medications.
○ Full prescriptive authority enables APRNs and PAs to provide comprehensive care in
underserved areas where access to physicians may be limited.
○ Full practice authority is supported by the advanced clinical education, national certification,
and licensure standards that ensure these providers are qualified to deliver safe and
effective care.
• Role: Prescriptive Authority
○ The legal right to prescribe drugs.
Chapter 2: Rational Drug Selection and Prescription Writing
• Assessing drug interactions
○ Polypharmacy increases risk of interactions.
○ Crucial importance: ask the pt about all current drugs, including OTC meds and herbal
preparations.
○ Always check for interactions; low risk medications may be acceptable, discuss with pt,
document conversation, then prescribe medication. If there is relative or absolute
contraindication, choose an alternative.
• Prescriptions
○ Necessities
Prescriber name, license number, contact info
Prescriber US DEA number
Patient name & DOB
Pt allergies
Name of medication
Indication of medication (ex: labetalol for HTN)
Medication strength (ex: 25 mg, 500mg/mL)
, Dose and frequency (ex: 12.5mg once daily)
Number of tablets or capsules to dispense
Number of refills
○ If using EMR, many elements are mandatory for provider, but many already completed by
the EMR. Important to note indication.
• Role of Formularies
○ Every facility/pharmacy provides drugs according to a formulary.
○ Formulary is selected by a panel of pharmacists and providers and may be subject to
guidelines created by regulatory agencies.
○ May also depend on regional/national drug suppliers, cost, available rebates, and presence
of generic medications on the market.
○ Formulary can affect your choice in medications you can order in place of what you
originally intended.
• Impact of drug selectivity on side effects
○ Assess risk to benefit ratio and severity of side effects
○ One patient may experience side effects, whereas another patient may not.
○ Be sure to monitor and ask about symptoms after initiating, stopping, or changing a dose.
○ Ex: patient is started on antihypertensive medication, blood pressure decreases
(improvement for HTN), but pt experiences syncope. A decrease in dose or a different
medication should be considered.
Chapter 3: Promoting positive outcomes of drug therapy
• Generic vs Brand name: Value of knowing
○ Sometimes patient will refer to medication by the brand name instead of generic or vice
versa.
○ Important to now all names of medication to ensure proper medication is prescribed and
taken and not a look-alike/sound-alike
• Duration of therapy
○ Important to notify pt of duration of therapy (i.e. short term for ABX, long term for thyroid
hormone therapy for hypothyroidism)
○ Failure to recognize prolonged therapy is why pts stop medications prematurely when rx
runs out.
○ Accompany all verbal education with written instructions
Chapter 4: Pharmacokinetics, pharmacodynamics, and drug interactions
• Excretion Process
○ The movement of drugs and their metabolites out of the body.
○ The combination of metabolism and excretion is called elimination.
• Metabolism Process
○ Also called biotransformation
○ The enzymatically mediated alteration of drug structure
• Distribution Process
○ The drug's movement from the blood to the interstitial space of tissues and from
there into the cells.
• Passage Across Membranes
○ To move throughout the body, drugs must cross membranes.
○ Three ways to cross a cell membrane:
Tuesday, April 29, 2025 1:14 AM
Week 1:
Chapter 1: Prescriptive Authority
• State laws impact on prescriptive authority
○ Prescriptive authority is primarily governed by state laws.
○ Laws determine whether an APRN or a PN can prescribe medications independently or must
do so under physician supervision.
○ Some states have full prescriptive authority, allowing them to prescribe medications,
including controlled substances, without physician oversight.
○ Some states may require collaborative agreements with physicians, limiting scope of
prescriptive authority.
• Full Practice Authority
○ "Full Practice Authority" refers to the legal rights of an APRN and PA to prescribe
medications independently and without limitations imposed by physician oversight.
○ The autonomy encompasses the ability to assess patients, diagnosis conditions, interpret
diagnostic tests, and initiate and manage treatments, including prescribing medications.
○ Full prescriptive authority enables APRNs and PAs to provide comprehensive care in
underserved areas where access to physicians may be limited.
○ Full practice authority is supported by the advanced clinical education, national certification,
and licensure standards that ensure these providers are qualified to deliver safe and
effective care.
• Role: Prescriptive Authority
○ The legal right to prescribe drugs.
Chapter 2: Rational Drug Selection and Prescription Writing
• Assessing drug interactions
○ Polypharmacy increases risk of interactions.
○ Crucial importance: ask the pt about all current drugs, including OTC meds and herbal
preparations.
○ Always check for interactions; low risk medications may be acceptable, discuss with pt,
document conversation, then prescribe medication. If there is relative or absolute
contraindication, choose an alternative.
• Prescriptions
○ Necessities
Prescriber name, license number, contact info
Prescriber US DEA number
Patient name & DOB
Pt allergies
Name of medication
Indication of medication (ex: labetalol for HTN)
Medication strength (ex: 25 mg, 500mg/mL)
, Dose and frequency (ex: 12.5mg once daily)
Number of tablets or capsules to dispense
Number of refills
○ If using EMR, many elements are mandatory for provider, but many already completed by
the EMR. Important to note indication.
• Role of Formularies
○ Every facility/pharmacy provides drugs according to a formulary.
○ Formulary is selected by a panel of pharmacists and providers and may be subject to
guidelines created by regulatory agencies.
○ May also depend on regional/national drug suppliers, cost, available rebates, and presence
of generic medications on the market.
○ Formulary can affect your choice in medications you can order in place of what you
originally intended.
• Impact of drug selectivity on side effects
○ Assess risk to benefit ratio and severity of side effects
○ One patient may experience side effects, whereas another patient may not.
○ Be sure to monitor and ask about symptoms after initiating, stopping, or changing a dose.
○ Ex: patient is started on antihypertensive medication, blood pressure decreases
(improvement for HTN), but pt experiences syncope. A decrease in dose or a different
medication should be considered.
Chapter 3: Promoting positive outcomes of drug therapy
• Generic vs Brand name: Value of knowing
○ Sometimes patient will refer to medication by the brand name instead of generic or vice
versa.
○ Important to now all names of medication to ensure proper medication is prescribed and
taken and not a look-alike/sound-alike
• Duration of therapy
○ Important to notify pt of duration of therapy (i.e. short term for ABX, long term for thyroid
hormone therapy for hypothyroidism)
○ Failure to recognize prolonged therapy is why pts stop medications prematurely when rx
runs out.
○ Accompany all verbal education with written instructions
Chapter 4: Pharmacokinetics, pharmacodynamics, and drug interactions
• Excretion Process
○ The movement of drugs and their metabolites out of the body.
○ The combination of metabolism and excretion is called elimination.
• Metabolism Process
○ Also called biotransformation
○ The enzymatically mediated alteration of drug structure
• Distribution Process
○ The drug's movement from the blood to the interstitial space of tissues and from
there into the cells.
• Passage Across Membranes
○ To move throughout the body, drugs must cross membranes.
○ Three ways to cross a cell membrane:
