Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172

Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172Pharmacology 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