• Drug Schedules and Descriptions of each
Schedule Description Example
I Absolutely not. Highly addictive Heroin, LSD, Ecstasy
II Highly addictive,
... [Show More] but can be used Opiates, Marijuana
III Still addictive, but used in lesser quantities <90mg of codeine, steroids, ketamine
IV Less addictive Benzos
V Least addictive Robutussin, etc
• Which ones can and cannot be prescribed by nurse practitioners:
• safe side III-V
• What is prescriptive authority?
• Prescriptive authority is legal right to prescribe drugs. Full PA is the legal right to prescribe independently and without limitation.
• Who mandates is?
• Prescription authority is mandated by state law. For nurse practitioners, it’s the State Board of Nursing
• What problems arise when prescriptive authority is limited?
• Problems that arise when prescriptive authority is limited are decrease quality of care, affordability and accessible patient care.
• Know the responsibilities of prescribing
• The responsibility of prescribing include the safe and competent practice of prescribing and managing medications. The nurse practitioner should have a documented relationship with the person, document a history and physical, discuss the drug implications, have a plan about monitoring and use resources effectively.
• Know patient reasons for non-adherence
• There are many reasons for non-adherence including: forgetfulness, lack of planning, cost, dissatisfaction and altered dosing
• Know how what type of evidence prescribers should use to make treatment recommendations
• Prescribers should make treatment recommendations based on level A evidence, such as randomized controlled trials and based on genetic factors, risk factors, etc
• Be familiar with physiological changes of aging that impact pharmacological treatment
• Some physiological changes of aging that impact pharmacological treatment include:
• Absorption: rate may be slowed because of delayed gastric emptying
• Distribution: body, fat, mass, body water, decreased concentration of serum albumin
• Metabolism: hepatic drug decline with age
• Ecreation renal function decreases, always assess creatinine levels
Table 10.1 Physiolgic Changes that Can Affect Pharmacokinetics in Older Adults
Absopriton of Drugs:
Increased gastric pH
Decreased absorptive surface area Decreased splanchnic blood flow Decrease GI motiliti
Delayed gastric emptying
Distribution of Drugs: Incrased body fat Decreased lean body mass Decreased total body water Decreased serum albumin Decreased cardiac ouput
Metabolism of Drugs Decreased hepatic blood flow Decreased hepatic mass
Decreased activity of hepatic enzymes
Excretion of Drugs Decreased renal blood flow
Decreased glomerular filtration rate Decreased tubular secretion Decreased number of nephrons
• Be familiar with Beer’s Criteria [Show Less]