Pharmacology for the Primary Care Provider: Test-Bank Solutions

Pharmacology for the Primary Care Provider: Test-Bank Solutions 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 Chapter 9: Establishing the Therapeutic Relationship • "How scientific principles are introduced in the relationship with the patient has everything to do with therapeutic success." The balance of art and science in healthcare. • "A continuing relationship with the healthcare provider is essential in making adjustments to discover the proper therapy for the individual." o Identify a problem, assess it adequately, identify various potential solutions, examine he variables needed to judge the risk/benefit ratio of the solutions, choose the most appropriate solution, and identify the effects (beneficial and adverse) that may result from implementation of the chosen solution. • Factors of a Therapeutic Relationship o Time--investment--particularly with the elderly--initial investment to obtain thorough H&P--cost-effective--follow up call strengthen the relationship o Attitude--how time is spent and what is said--"Who owns the problem?" o Information--it may take several visits to obtain a full history o Communication--effective two-way communication between patient and provider requires consistent commitment to respect the others' role in the relationship. • Transference • Focus on patient, environment, and lastly, self. • Find a balance between creating uncontrolled and unfounded anxieties vs creating a false sense of equally grounding security and reassurance. • It is implicitly understood that once a problem is presented, the provider will do their utmost to provide the best therapy. • The therapeutic objective must be clearly stated--1) must be realistic and attainable, 2) clearly related to the problem as defined and assessed, 3) measurable. • Be flexible, accept occasional lapses in compliance, attempt to understand the patient's point of view. o Therapeutic Relationship Fails • Skepticism in the medical profession. ▪ Provider main goal is pharmacoadherence. ▪ Over or under utilization. ▪ Therapeutic failure and increase in disease severity. ▪ Gender, race, education, occupation, income, marital status--are not factors in compliance. • Blame the economy! • Compliance vs adherence--both suggest patient fault • Concordance--suggests a therapeutic alliance between prescriber and patient--a negotiated agreement that may even be an agreement to disagree. ▪ Patient--actively participates in consultation process regarding treatment, risk, and benefit. ▪ Provider--communicates evidence to enable the patient to make informed choices, accepts patient's choices regarding their care, continues to negotiate treatment and part of the ongoing process. ▪ Risk Factors • Increases with preventive care • Increases with duration of therapy • Greatest for regimens with significant behavioral change • Poor understanding of instructions • Complex treatment regimen • Unpleasant side effects • Increases in drug costs Chapter 10: Practical Tips on Writing Prescriptions • DEA--state-controlled substance license--federally issued DEA# o Drugs are scheduled by potential for abuse.