NR 565 Midterm Study Guide Sept 2023

Which schedule drugs can APRNs prescribe?  DEA license will allow for prescribing of Schedules 2-5. There can be restrictions as noted in collaborative agreement. May be facility/state dependent. • Who determines and regulates prescriptive authority?  Determines: Also known as independent prescribing. APRNS can prescribe without limitation and is state dependent. Includes "legend" (prescription) and controlled drugs, health/medical services, DME, etc. Regulates: regulated by health professional board, state board of nursing or the State Board of Medicine, or the State Board of Pharmacy, as determined by each state. Federal government controls drug regulations but has no control over prescriptive authority.  Prescriptive authority is the legal right to prescribe drugs. • How does limited prescriptive authority impact patients within the healthcare system?  Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care. For example, restrictions on the distance of the APRN or PA from the physician providing supervision or collaboration may prevent outreach to area of greatest need. An increase in patient waits. • What are the key responsibilities of prescribing? The ability to prescribe medications is both a privilege and a burden. Have a documented provider-patient relationship, do not prescribe medications to family or friends or yourself, Document a thorough history and physical examination, include any discussions you have with the patient about risk factors, side effects, or therapy options, have documented plan regarding drug monitoring or titration, if you consult additional providers not that you did so. Use the references provided in the following boxes to assist in safely and rationally choosing one medication over another. Be sensible, accept responsibility, do not fear it, know constraints and limitations, always learn and update, keep Rx pads in safe place, confirm allergies, verify medication list with patient, do not let insurance dictate quantity of Rx, Charting is key (particularly with off label use), Provide use and rationale. • What should be used to make prescribing decisions?  The best way to keep your patients (and yourself) safe is to be prudent and deliberate in your decision-making process. Cost, availability, current practice guidelines, medication interactions including interactions with food, side effects, need for monitoring, how drug is metabolized (hepatic or renal), special populations (pregnancy, nursing, older adults) Cost: It is of critical importance that providers ask patients if they have difficulty obtaining their medication because it is cost-prohibitive.