How does limited prescriptive authority impact patients within the healthcare system? -
answers Creates numerous barriers to quality affordable and acessible patient care.
Key responsibilities to prescribing? - answers Do not prescribe to family/friends or
yourself. document a thorough history and physical examination. Include discussions
with patient about risk factors and side effects, medication monitoring or titration. if
additional consults are made, know limitations, keep rx pads in a safe place confirm
allergies verify medication list dont let insurance dictate quality of RN charting is key.
what should be used to make prescribing decisions? - answers Cost, availability,
current practice guidelines, medication interactions with food side effects need for
monitoring how drug is metabolized. special populations. ask if prescriptions are cost
prohibitive.
Pharmacokinetics - answers what the body does to the drug
Pharmacodynamics - answers what the drug does to the body
physilogic changes that can affect the pharmaconetics in older adults. - answers
absorption: inc gastric PH decreased absorptive surface area and dec splanchnic blood
flow. dec GI motility delayed gastric emptying distribution: inc body fat dec lean body
mass dec total body water serum albumin cardiac output. metabolism: dec hepatic
blood flow mass and activity of hepatic enzymes. excretion: decreased renal blood flow
GFR tubular secretion and number of nephrons.
reducing adverse drug reaction in older adults? - answers Thorough drug history go
low and slow with initiating drug therapy monitor clinical responses and plasma levels
use simple medication regimen, monitor drug interaction review drug therapy dispose
old medications promote adherence use beers criteria.
Beers Criteria - answers A list of medications that are generally considered
inappropriate when given to elderly people
impacts of polypharmacy - answers using 5 or more medications daily leads to
possible drug interactions.
Acute alcohol use
Valproate
Isoniazid
Grapefruit Juice
Sulfonamides
Which Drugs can APRNS perscribe - answers DEA license will allow for prescribing
schedules 2-5 there can be restrictions as noted in collaborative agreement. maybe
facility/state dependent.
Who determines and regulates prescriptive authority? - answers determines: APRNS
can prescribe without limitation and is state dependent. It is regulated by health
professional board state board of nursing or state board of medicine or pharmacy.
federal government controls regulation but no control over prescriptive authority.
CYP450 inhibitors function - answers slow down the metabolic activity of specific
enzymes, causing a decrease in the rate/extent of metabolism of other drugs that are
substrates for those same enzymes this can cause drug toxicity.
CYP450 inducers - answers barbituates, griseofulvin, carbamazepine, rifampin, st.
john wart, chronic alcoholism, phenytoin (CRAP GPS)
CYP450 inducers function - answers increase medication metabolism. act on the liver
to stimulate enzyme synthesis
If CYP450 is induced, what is the effect on medication metabolism? - answers drug
may not achieve therapeutic effects
When patients have a poor metabolism phenotype? - answers slows or increases
absorption ex; plavix clots and inc platelets pregnancy hepatic metabolism increases
and dec bowel motility increases absorption of the drug. newborns the drug
metabolizing capacity is low, children by the age of 1 are similar to adults but they can
be metabolized quickly an increase or reduction in dosing may be needed. geriatric
rates of hepatic drug metabolism tend to decline with age half life of drugs maybe
increased and prolong responses.
What does the FDA regulate when it comes to medication? - answers what
pharmacies can sell, requires special alerts and management guidelines ensures
pharmaceutical companies test and ensure efficacy patient adherence to directions of
use for efficacy and patients need to know about potentially serious side effects and
which medications are safe for pregnant and breast feeding women to take.
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