NR 565 PHARM MIDTERM EXAM

CHAPTER 1 THE ROLE OF THE NP AS THE PRESCRIBER Roles and responsibilities of APRN prescribers APRN- includes CNM, CRNA, NPs and APRNs The degree of autonomy and breadth of drugs that can be prescribed vary from state to state based on the Nurse practice act of the state. Nurse Practitioner Journal and American Journal for Nurse Practitioners present a legislative update once a year (January issue) providing a summary of each states practice as they relate to titling, roles, and prescriptive authority. The following were true of NP regulation of practice and prescribing authority as of 2015- *All states have title protection for NPs *Only Oregon has mandated third party reimbursement parity for NP services *In all but 5 states, the control of practice and licensure is within the sole authority of the states board of nursing. this 5 states have joint control in the board of nursing and the board of medicine *Scope of practice is determined by the individual NPs license under the nurse practice act of the licensing jurisdiction p *In 17 states and the District of Columbia, NPs have independent SOP and prescriptive authority without a requirement for physician collaboration, consultation, delegation, or supervision *6 states have full autonomous practice and prescriptive authority following a Period of post licensure/ post certification supervision and collaboration. IOM-called for removing scope of practice barriers and allowing NPs to practice to the full extent of their education and training. Clinical judgement in Prescribing Prescribing a drug results from clinical judgement based on a thorough assessment of the patient and the patients environment, the determination of medical and nursing diagnosis, a review of potential alternative therapies, and specific knowledge about the drug chosen and the disease process it is designed to treat. Best therapy- least expensive, least invasive, and least likely to cause adverse reaction. Best choice- to have lifestyle, non pharmacological and pharmacological therapies working together. Questions arises when the choice of treatment option is a drug Is there a clear indication for drug therapy? 1. Before drug therapy is chosen an indication and necessity of using a drug should be carefully considered. Example: In treating Otitis media, guidelines regarding the use of antibiotics have been evolving due to high percentage of OM infections resolves without intervention. Of concern is organism's resistance to antibiotics, with atbx over treatment. What drugs are effective in treating this disorder? 1. Consider the best and most effective class of drug 2. The agency for healthcare quality (AHCQ), National Institute of Health(NIH) and many specialty organizations publish disease specific treatment guidelines that include both pharmacological and non pharmacological therapy. What is the goal of therapy with this drug? 1. If cure is the goal (short term therapy ), troublesome adverse effects maybe better tolerated and cost maybe less of an issue 2. If the goal is long term treatment for chronic condition, adverse effects and cost take on a different level of importance, and how well the drug fits into the lifestyle of the patient. Under what conditions is it determined that a drug is not meeting the goal and a different therapy or drug should be tried? 1. The provider and patient should have a clear understanding of what outcome or goal is expected 2. Follow up and monitoring to see how well treatment with the drug is meeting the goal 3. Include questions when to consult with or refer to a specialist Are there unnecessary duplication with other drugs that the patient is already taking 1. Review patient medication history at each encounter to detect duplications or medications that maybe discontinued 2. Use of an integrated EHR can assist the provider in discovering the duplication of therapy and collaborating wi5 other providers to develop a simplified regimen. Would an OTC drug be just as useful as a prescription drug? 1. Increasing numbers of drugs are being moved from prescription to OTC, May lead to reduction in cost or increase patients cost due to insurance no longer paying for the medication. 2. Patient may not consider OTC as drugs because they are not prescribed therefore a careful history of medications would specifically ask about OTC medications. What about the cost? 1. Can the patient afford the drug? 2. Will the cost of medication affect adherence to the treatment regimen 3. Consideration of cost is a major factor in choosing between the newer drugs and ones that has been around long enough to be available in generic form Where is the information to answer this questions? 1. Sources of drug information includes the wide array of professional literature that ranges from journals to literatures from specialty and professional organizations and drug databases such as lexicomp and Epocrates 2. Reliable drug information - Current, unbiased information, relevant to specific patient for whom the drug will be prescribed, reliable and valid research, national and international guidelines were