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.