Roles and Responsibilities: NPs as Prescribers - ANSAll states have title protection for NPs.
The Board of Nursing regulates practice.
Five states have joint oversight with the Medical Board.
Scope of Practice is determined by NP license. In 26 states NPs are totally autonomous.
Twenty-one states have independent prescribing.
Clinical Judgment in Prescribing - ANSIs a prescription the right treatment?
What are the effective drugs for the disease?
Goals of therapy?
Monitoring to see if drug it meeting goals?
Duplications in medications patient is taking?
OTC vs prescription drugs
Cost?
Sources of information
The Process of Rational Drug Prescribing - ANSDefine the patient's problem.
Specify the therapeutic objective.
Collaborate with the patient.
Choose the treatment.
Educate the patient.
Monitor effectiveness.
Define the Patient's Problem - ANSAssess patient.
Early screening of high-risk patients maximizes the benefit of pharmacological treatment
Develop working and differential diagnosis.
Use diagnostic tests to confirm.
Specify the Therapeutic Objective - ANSGoal of treatment
Cure the disease?
Relieve symptoms of disease?
Replacing deficiencies (e.g., insulin)?
Long-term prevention?
Choose the Treatment - ANSUse evidence-based guidelines.
Individualize for each patient.
, Novice providers use analytic, step-by-step decision making.
Experienced providers use experience and pattern recognition.
Use more systematic approach with complex patients.
The I Can PresCribE A Drug Mnemonic - ANSIndication
Contraindications
Precautions
Cost/Compliance
Efficacy
Adverse effects
Dose/Duration/Direction
Educate the Patient - ANSPoor adherence contributes to worsening disease, hospital
admissions, and death.
Patient education should be at the 5th or 6th grade level.
Include in education
Purpose of medication
Instructions for administration
Adverse drug reactions (ADRs)
Monitor Effectiveness - ANSPassive monitoring: Patient is educated on expected outcome and
instructed to contact provider.
Active monitoring: follow-up laboratory tests or monitoring to measure therapeutic effectiveness
Drug Factors Influencing Drug Selection - ANSPharmacokinetic factors
Pharmacodynamic factors
Therapeutic factors
Safety
Cost (to patient and to society)
Patient factors
Provider factor
Pharmacodynamic Factors - ANSEase of titration
Therapeutic index - the relationship between the drugs desired therapeutic effects and its
adverse effects
A narrow therapeutic index is more difficult to manage - require close monitoring for toxicity.
A wider therapeutic index is safer and requires less monitoring.
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