• Which schedule drugs can APRNs prescribe? Scheduled II- V
• Who determines and regulates prescriptive authority? Federal government controls drugs
... [Show More] regulation. State law
• How does limited prescriptive authority impact patients within the healthcare system?
Limited prescriptive authority creates numerous barriers to quality, affordable,
and accessible patient care. For example, a requirement to obtain the physician’s cosignature on prescription can increase patient waits. Increases patient wait time.
• What are the key responsibilities of prescribing? The ability to prescribe medications is both a Privilege and a burden. The best way to keep your patients and yourself safe is to be
prudent and deliberate in your decision making process. Have a documented provider- patient relationship with the person for whom you are prescribing. Do not prescribe for family or friends or for yourself. Document a thorough history and physical examination in your records.
• What should be used to make prescribing decisions? Cost, availability, drug guidelines, interactions, side effects, allergies, hepatic and renal function, monitoring, special
populations.
• Be familiar with pharmacokinetic and pharmacodynamic changes of older adults and how that would translate to baseline information needed to prescribe.
• Beer’s Criteria
potentially Inappropriate Medication (PIM) use in older adults
potentially Inappropriate Medication (PIM) use in older adults due to medication-disease or medication-syndrome interactions that may exacerbate the disease or syndrome medications to be used cautiously in older adults
clinically significant drug interactions that should be avoided in older adults
medications to be avoided or dosage decreased in the presence of impaired kidney function in older adults
o What is it? guidelines addressing inappropriate prescribing practices for adults, aged 65 and older.
o Why is it important? These guidelines include a safety component aimed to protect older adults by helping prescribers avoid medications that are or can be harmful to older adults.
• Impacts/outcomes of polypharmacy
• CYP450 inhibitors
o Examples: valproate, Isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole, grapefruit, Quinidine. Sertraline, erythromycin, terbinafine.
o What do they do? Inhibitors are medications that inhibit the metabolic activity of one or more of the CYP450 enzymes.
o What do they cause if not used correctly? (aka: What would the patient [Show Less]