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Advanced Pharmacology > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Prescriptive authority is

A

the legal right to prescribe independently and without limitation (full)

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2
Q

What is restrictive prescriptive authority?

A

limitations with oversight by MD or DO

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3
Q

Provider who prescribes without limitation may prescribe

A

any drugs, including controlled drugs with the exception of schedule 1 drugs (which have no current medical use)

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4
Q

Prescriptive authority is determined by

A

state law

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5
Q

The regulation of prescriptive authority is under the jurisdiction of

A

a health professional board including - the state board of nursing, the state board of medicine, or the state board of pharmacy

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6
Q

What does limited prescriptive authority cause

A

barriers to quality including affordable accessible patient care

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7
Q

Responsibility at prescribing rational drug selection in writing prescriptions -

A

keep yourself and your patients safe - be proven and deliberate in your decision making process

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8
Q

Prescribing rules:

A
  • pt/provider relationship documented
  • do not prescribe to family/friends/yourself
  • doc. a thorough hx/physical exam in your records
  • include risk factors, side effects, therapy options, doc.
  • also doc. pt plan/drug monitoring/or titration
  • consult additional providers if needed
  • use references available to help
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9
Q

Electronic apps for assistance are needed in practice including -

A

Lexicomp
UpToDate
Epocrates

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10
Q

List the things to think about when prescribing a drug (8)

A
  • cost
  • guidelines
  • liability interactions
  • side effects
  • allergies
  • liver and renal function
  • need for monitoring
  • special populations
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11
Q

What is the biggest factor to consider when prescribing medication

A

cost

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12
Q

Why is cost the biggest factor to consider

A

Cost is the number 1 reason for non-adherence with patients taking their prescribed medications

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13
Q

Availability of medications includes: (4)

A
  • the facilities formularies
  • insurance coverage and what they cover
  • the $4 meds and pharmacies
  • generic medications
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14
Q

What increases the risk for interactions

A

polypharmacy

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15
Q

Patients med list should be updated/reconciled including

A
  • all current drugs
  • OTC drugs
  • herbal meds
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16
Q

Side effects things to consider

A
  • some drugs have adverse effects
  • risk to benefit ratio
  • consider severity of side effects
17
Q

New medication needs

A
  • follow-up to evaluate any adverse effects from the drug
18
Q

allergies

A

determine the type of reaction and document in the chart to prove why an alternative medication was chosen

19
Q

liver and renal function

A

must be assessed because many drugs are metabolized in the liver and eliminated in the kidneys

20
Q

what can happen if liver or renal function is impaired

A
  • increase adverse effects

- possible medication overdose

21
Q

how to prescribe with liver or renal impairment

A
  • drugs have lower doses known as hepatic and renal dosing
22
Q

some drugs require frequent monitoring at initiation or throughout the duration of treatment. Examples:

A

lithium, warfarin, opioids, immunosuppressive therapies (monitor these patients closely)

23
Q

special populations to consider when prescribing

A

pregnant, nursing mothers, older adults

24
Q

Key elements that must be included on a RX

A
  • prescriber name
  • license #
  • contact information
  • DEA #’s of you and your supervising physician
  • patient name
  • patient date of birth
  • allergies
  • medication
  • indication for medication
  • strength
  • dosing frequency (all spelled out)
  • # of tablets
  • # of refills
  • your signature
  • SIG
25
Q

What does SIG stand for on a prescription

A

this is the instructions how to take the medication

26
Q

Telephone refills by phone to the pharmacy

A

must include all the required information

27
Q

What medications cannot be called into the pharmacy

A

Schedule 2 drugs

28
Q

Ways to prescribe meds

A

telephone, written, e-prescribing

29
Q

Some pharmacies have auto refill or they will call for a refill request

A

you have to ensure all the essentials are asked such as:

  • new med for patient
  • change the dose or frequency
  • add a new medication to the regimen
  • any side effects experienced by the patient
  • when did I see pt. last
  • when is patients follow-up appointment
  • do they need appt. before the refill
  • is this a schedule 2 drug
30
Q

Examples of other disciplines to have a good relationship with to assist with prescribing include:

A

supervising MD/DO
infectious disease
pharmacist

31
Q

Ensuring positive patient outcomes requires establishing:

A
  • a medication education plan
  • monitoring positive and negative patient responses
  • identifying and addressing issues of nonadherence
  • managing the pts complete medication regimen
32
Q

Probably no other provider action influences the patient’s commitment to carry out a medication plan more than

A

medication education

33
Q

Medication education components (9)

A
  • medication name
  • purpose
  • dosing regimen
  • administration
  • adverse effects
  • any special storage needs
  • associated laboratory testing
  • food or drug interactions
  • duration of therapy
34
Q

It is important to teach patients adverse effects. Patients may not know that, for most drugs, most adverse effects occur less than

A

1-2% of those taking the drug

35
Q

Drugs that need to be stored in their original containers to not lose potency are

A
  • SL NTG

- dabigatran (Pradaxa)

36
Q

Patients taking metronidazole (Flagyl) must avoid what for the entire duration of therapy.

A

alcohol

37
Q

Make sure to discuss duration of therapy with patients especially ones that are for lifetime. Common problem -

A

Failure to recognize the need for prolonged therapy is a common reason why patients stop medications prematurely when a prescription runs out.

38
Q

Three primary reasons for drug monitoring:

A
  • determine therapeutic dosage
  • evaluate medication adequacy
  • identifying adverse effects
39
Q

Examples of drugs that have narrow therapeutic indexes and have to be frequently monitored are:
The difference between an effective dose and a lethal dose is small.

A
  • carbamazepine
  • digoxin
  • lithium
  • phenytoin
  • theophylline

Advanced Pharmacology (2 decks)

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