RX test Flashcards
What is a prescription?
A written, verbal or electronic order from a licensed health care provider to a pharmacisy for a specific medication for a specific pt
When does a drug require a prescription?
When it is considered potential harmful if not used under the supervision of a license practitioner
How are scheduled drugs determined?
Scheduled drugs II-V are determined by the controlled substance Act. (Schedule I are not for medicinal purpose)
What is a Dangerous Drug? Or a Legend drug?
A device or drug that is considered unsafe for self-medication, but is not in included in Scheduled I- V bears the ‘legend’ Caution: federal law prohibits from dispensing without prescription or ‘ RX only”
Any non-scheduled drug requiring a Rx – Antibiotic, antihypertensives etc
Who regulates prescriptive authority?
Each state regulates prescriptive authority
What is Off label and example of a med, also what NP must tell pt
Using a med for something outside its main purpose
Propranolol beta blocker but can be used ‘off label’ for performance anxiety
Pt must be aware that they are being prescribed a drug that is being used off label and be OK with this
Who can NPs write Rx for?
Can only write prescriptions for patients who are established in your clinic
MDs can write Rxs for whomever
Under state law all prescriptions should have what elements included?
Date of the prescription
Patient name, address and birthdate
Inscription (Rx) – name of drug (Rx) strength
Vehicle for drug – cap or tab, liquid susp or inhaler (pharmacist will assume pill form unless otherwise specified)
Quantity of the drug – number of pills, cc of liquid, gms of ointment
Transcription (Signature): dose, frequency, route of administration, duration of therapy, indications for medication
Intended use of the drug (unless practitioner feels indication is not in the best interest of the pt – EX- antidepressants for ‘mood’ or zovirax for ‘suppressive therapy’ or ‘tx dose’
Practitioner Name, Clinic contact info, collaborating MD
Must include license number /NPI (of both NP and MD)
• DEA ONLY if SCHEDULED DRUG
Why is the date important on the Prescription?
Shows when the Rx was issued or written
Establishes the life of the Rx and validity of refills
When do Legend drug Rxs expire?
ONE YEAR from date of Rx
When do Controlled Drugs expire?
30 days from the time it is prescribed
Specific exp dates for certain drugs, name one
Accutane only has 7 days, for pregnancy monitoring. Its X for pregnancy
Why are Rxs dates sometimes modified?
Rxs can be written for 1 month or 3 months to encourage pt follow up
How are patient weights used when determining dosage?
Pt weight is ALWAYS converted into Kgs
Hoq mNY MEDICATIONS PER PRESCRIPTION?
Technically only supposed to have 1 med per prescription
Should one write brand or generic names?
Generic names should typically be written
Only write brand name when
EX: birth control pill ..Sprinta (brand) but write ‘generis allowed’ or ‘substition allowed’ (so that pharmacists can substitute if needed)
How should instructions for Rx be written
Write out in full English- avoid abbreviations
Provide clear, consice , specific direction
Avoid ‘take as directed’
Risk Evaluation and Mitigation Strategy (REMS) drug that has it’s own rules for Rx expiration dates. REMS are addressed in the text when it’s pertinent for a drug (like Accutane). Knowing there are REMS drugs and what that means is what will be addressed in the text.
Drug Scheduling at DEA.gov would be the best resources for scheduled drugs. The correct term would be “schedule I” or “schedule II”, etc. Schedule I drugs are drugs like LSD, Ecstasy. Cannabis is also listed as schedule I. The DEA is always the best resource for this kind of information, but it is generally only schedule IV drugs that may be different between states.
egally in Texas, APRNs must work under the ‘supervision’ of a physician. Part of that supervision is having a collaborative prescriptive agreement. These restrictions are determined at the state level and is the reason we must advocate for full practice authority with our Texas legislators. The terms supervision and collaboration are often used interchangeably. I use the term collaboration because all health care providers should collaborate in their practice and the legalities of “supervision” rankles me. Collaboration is what describes my practice even thought the law says I am being supervised. It’s political.
There are situations when an APRN can prescribe some schedule II drugs in Texas, but these circumstances are limited.
Texas FAQ for APRNs prescribing Schedule II
What is prescriptive authority?
the legal right to prescribe drugs
What is full prescriptive authority?
The legal right to prescribe drugs independently and without limitation – Physician’s have this
Who decides of the prescritptive authority of APRNs?
State laws- state board of nursing (for APRNs)
What are some considerations with drug selection?
- Cost
- Guidelines
- Availability
- Interactions
- Side Effects
- Allergies
- Hepatic and Renal Function
- Need for monitoring
- Special Populations
How are formularies for drugs selected?
selected by a panel of pharmacists and providers and may be subject to guidelines by (CMS) Centers for Medicare and Medicaid Services
What is important about interactions of meds?
When adding a new med to a pts regimen important to check for interactions with all meds, OTC herbals etc that the pt is taking.
If low risk interaction is found, discuss risks w/ pt and document the conversation prior to prescribing.
What is significant about Side Effects?
All drugs have side effects- some good, some bad, some fatal
Important to assess R/B ratio and discuss w/ pt
Also provide pt with list of more likely and important possible SEs and provide direction w/ how to respond…
what is hepatic dosing or renal dosing?
special decreased doses d/t pt impaired renal or hepatic functioning.
sometimes alt drug substituted (EX morphine not good for renal impaired pts as has highly metabolized by the kidneys- better choice fentnyl)
