NR 508 Week 4 Midterm Exam Study guide
NR 508: ADVANCED PHARMACOLOGY
, 1
Chapter 1: The Role of the Advanced Practice Nurse as 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.
, 2
Questions arises when the choice of treatment option is a drug
Is there a clear indication for drug therapy?
● 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?
● Consider the best and most effective class of drug
● 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?
● If cure is the goal (short term therapy ), troublesome adverse effects maybe
better tolerated and cost maybe less of an issue
● 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?
● The provider and patient should have a clear understanding of what outcome or
goal is expected
● Follow up and monitoring to see how well treatment with the drug is meeting the
goal
● Include questions when to consult with or refer to a specialist
Are there unnecessary duplication with other drugs that the patient is already taking
● Review patient medication history at each encounter to detect duplications or
medications that maybe discontinued
● 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.
, 3
Would an OTC drug be just as useful as a prescription drug?
● 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.
● 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?
● Can the patient afford the drug?
● Will the cost of medication affect adherence to the treatment regimen
● 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?
● 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
● 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 used
Collaboration with other providers
● Physicians- expertise related to pharmacology is based on understanding
biochemistry and prescribing for a given pathophysiology- emphasis is on the
disease and the drug with less emphasis on the impact on the patient.
● Pharmacist- extensive knowledge about pathophysiology and best drug to
prescribe. Can assist APRNs and physicians by offering expertise on the clinical
management of the patients including available dosage forms, potential adverse
reactions and drug interactions.
● other APRNs- one to one basis dealing with individual patient issues. Share
knowledge base and collaborate to improve the care of the patient. Collaboration
on issues related to SOP and prescriptive privilege at the state and national level
is critical to obtaining and maintaining the autonomy of practice needed to
provide optimal patient care.
NR 508: ADVANCED PHARMACOLOGY
, 1
Chapter 1: The Role of the Advanced Practice Nurse as 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.
, 2
Questions arises when the choice of treatment option is a drug
Is there a clear indication for drug therapy?
● 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?
● Consider the best and most effective class of drug
● 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?
● If cure is the goal (short term therapy ), troublesome adverse effects maybe
better tolerated and cost maybe less of an issue
● 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?
● The provider and patient should have a clear understanding of what outcome or
goal is expected
● Follow up and monitoring to see how well treatment with the drug is meeting the
goal
● Include questions when to consult with or refer to a specialist
Are there unnecessary duplication with other drugs that the patient is already taking
● Review patient medication history at each encounter to detect duplications or
medications that maybe discontinued
● 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.
, 3
Would an OTC drug be just as useful as a prescription drug?
● 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.
● 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?
● Can the patient afford the drug?
● Will the cost of medication affect adherence to the treatment regimen
● 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?
● 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
● 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 used
Collaboration with other providers
● Physicians- expertise related to pharmacology is based on understanding
biochemistry and prescribing for a given pathophysiology- emphasis is on the
disease and the drug with less emphasis on the impact on the patient.
● Pharmacist- extensive knowledge about pathophysiology and best drug to
prescribe. Can assist APRNs and physicians by offering expertise on the clinical
management of the patients including available dosage forms, potential adverse
reactions and drug interactions.
● other APRNs- one to one basis dealing with individual patient issues. Share
knowledge base and collaborate to improve the care of the patient. Collaboration
on issues related to SOP and prescriptive privilege at the state and national level
is critical to obtaining and maintaining the autonomy of practice needed to
provide optimal patient care.
