Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and Responsibilities of APRN Prescribers

Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and Responsibilities of APRN Prescribers

 

  • Advanced practice: Engages in a high level of autonomy in clinical decision-making.
  • Final decision for medications: Responsible for the choice and management of medication therapy.
  • Degree of authority and autonomy decided state by state: Varies depending on state laws and regulations.
  • Annual updates on titling, roles, and prescriptive authority: APRNs must stay informed of any changes.
  • Scope of practice determined by NP license and licensing jurisdiction: Defined by legal and regulatory frameworks.
    • Employment sites may restrict this legal scope but cannot extend it: The scope of practice at a job may be more limited than the legal scope.

Clinical Judgement in Prescribing

  • Clinical judgement: Involves assessing the best therapeutic approach considering multiple factors.
    • Best therapy should be least invasive, least expensive, least likely to cause abuse: Prioritize safety, efficacy, and cost-effectiveness.
    • Prefer lifestyle modifications, non-pharmacological, and pharmacological therapies: Consider all treatment options.
  • Clear indication for drug therapy?
    • Before beginning, ask if necessary: Ensure there is a valid reason for starting medication.
  • Effectiveness of drugs in treating the disorder
    • Choose the best one: Select medications based on efficacy and patient-specific factors.
  • Goal of therapy with this drug
    • Cure disease, improve lifestyle, consider adverse effects: Define and monitor treatment objectives.
  • Not meeting goals?
    • Consult a therapist when needed: Seek collaboration if treatment is not effective.
  • Avoid unnecessary duplication with other drugs already taken: Prevent polypharmacy.
  • Consider over-the-counter drugs: Evaluate the suitability of OTC options.
  • Cost considerations
    • Will the patient pay out of pocket?: Assess the financial impact on the patient.
  • Sources of information to answer questions
    • Journals, FDA, evaluate reliable drug information: Utilize credible sources for decision-making.

Collaboration with Other Providers

  • Physicians, pharmacists, ARNPs, PAs, nurses: Engage in interdisciplinary collaboration to optimize patient care.

Autonomy and Prescriptive Authority

  • Varies by state: Each state has different laws regarding the scope of practice and prescriptive authority of APRNs.

Chapter 2: Review of Basic Principles of Pharmacology

Metabolism and Half-Life

  • Metabolism affects onset, duration of action, and toxicity of medications
    • Converts one chemical into another: Drug metabolism transforms active drugs into metabolites.
  • First-pass metabolism
    • Major organ for drug metabolism (liver): Liver is the primary site for drug metabolism.
    • Contains high amounts of drug metabolism enzymes: Enzymes in the liver metabolize drugs.
    • First organ encountered by the drug once absorbed by the GI tract: Drugs pass through the liver after absorption.
    • Determines if it can be given orally: First-pass effect influences oral bioavailability.
  • Rate of drug metabolism
    • Depends on drug blood levels, related to drug per hour: Influences pharmacokinetics.
    • First-order metabolism: time drug decreases by half
      • 50% at one half-life, 75% at two half-lives, 87.5% at three half-lives: Describes the drug elimination process.

Drug Responses

  • Receptors: agonists and antagonists
    • Agonists: drugs that produce receptor stimulation and change what they bind to
    • Antagonists: occupy receptor without stimulating them, prevent agonists from occupying them
  • Partial agonists: Produce a weaker, or less efficacious, response than an agonist.
  • Inverse agonists: Bind to the same receptor as an agonist but induce a pharmacological response opposite to that of the agonist.

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