Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice
NGR6172
Chapter 1: Prescriptive Authority and Role Implementation: Tradition vs
... [Show More] Change
o Primary Care is provided by clinicians who address "personal health care needs, developing a sustained partnership
with patient, and practicing in the context of family and community."
Prevention, Diagnosis, Prescription, Treatment
Assess health status.
Promote healthy lifestyles.
Identifying/diagnosing normal/abnormal conditions.
Determining the causes of abnormal conditions, providing referral to health care specialists.
Selecting appropriate therapeutic measures.
Implementing treatment.
Supervising/monitoring the patient on an ongoing basis.
Traditional Primary Care--physicians as the only providers with diagnostic and treatment authority--an intention to
protect the public.
Prescriptive practices should not be compared to those of physicians--all providers should be held to a
standard of approved therapeutic practice.
Most Prescribed by PCP--antidepressants, NSAIDs, antihistamines/bronchodilators, antihypertensives,
antilipidemic.
Rate of Adoption by Prescribers--innovators, early adopters, early majority, late majority, and laggards.
o Problems in the Prescribing Practice of Physicians
Prescriptions are not the most up to date--"new research findings diffuse slowly into practice."
Pharmaceutical company influence--FDA intervention and PhRMA guidelines.
Lack of time--short consultation, incorrect H&P, problem is left undefined, over-reliance on drug therapy.
Consumers' pressure for prescribed medications--"Do something!"--lifetime of medications, overused antibiotics,
and direct-to-consumer advertising.
Ineligible prescriptions --> Medication errors. Current federal mandate for e-prescribing. TJC Do Not Use
Abbreviations.
Undetected/anticipating drug interactions--liver cytochrome P450 enzymes = drug-to-drug interactions may render
medication ineffective--prescription warning system alerts. Rising use of OTC and herbal products.
Chapter 2: Historical View of Prescriptive Authority (Nurses vs. PA)
o Primary Care is provided by clinicians who address "personal health care needs, developing a sustained partnership
with patient, and practicing in the context of family and community."
o "Delegable authority --> "Delegable prescriptive authority" without it, an APN can only suggest OTC medications.
o Nursing Legislation
Dependent authority--the physician retains ultimate authority through co-signature.
Independent authority--the APN prescribes alone--can still be restrictive.
1993--Definition and R [Show Less]