Test 1 Flashcards
Prescriptive authority is
the legal right to prescribe independently and without limitation (full)
What is restrictive prescriptive authority?
limitations with oversight by MD or DO
Provider who prescribes without limitation may prescribe
any drugs, including controlled drugs with the exception of schedule 1 drugs (which have no current medical use)
Prescriptive authority is determined by
state law
The regulation of prescriptive authority is under the jurisdiction of
a health professional board including - the state board of nursing, the state board of medicine, or the state board of pharmacy
What does limited prescriptive authority cause
barriers to quality including affordable accessible patient care
Responsibility at prescribing rational drug selection in writing prescriptions -
keep yourself and your patients safe - be proven and deliberate in your decision making process
Prescribing rules:
- 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
Electronic apps for assistance are needed in practice including -
Lexicomp
UpToDate
Epocrates
List the things to think about when prescribing a drug (8)
- cost
- guidelines
- liability interactions
- side effects
- allergies
- liver and renal function
- need for monitoring
- special populations
What is the biggest factor to consider when prescribing medication
cost
Why is cost the biggest factor to consider
Cost is the number 1 reason for non-adherence with patients taking their prescribed medications
Availability of medications includes: (4)
- the facilities formularies
- insurance coverage and what they cover
- the $4 meds and pharmacies
- generic medications
What increases the risk for interactions
polypharmacy
Patients med list should be updated/reconciled including
- all current drugs
- OTC drugs
- herbal meds
Side effects things to consider
- some drugs have adverse effects
- risk to benefit ratio
- consider severity of side effects
New medication needs
- follow-up to evaluate any adverse effects from the drug
allergies
determine the type of reaction and document in the chart to prove why an alternative medication was chosen
liver and renal function
must be assessed because many drugs are metabolized in the liver and eliminated in the kidneys
what can happen if liver or renal function is impaired
- increase adverse effects
- possible medication overdose
how to prescribe with liver or renal impairment
- drugs have lower doses known as hepatic and renal dosing
some drugs require frequent monitoring at initiation or throughout the duration of treatment. Examples:
lithium, warfarin, opioids, immunosuppressive therapies (monitor these patients closely)
special populations to consider when prescribing
pregnant, nursing mothers, older adults
Key elements that must be included on a RX
- 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
What does SIG stand for on a prescription
this is the instructions how to take the medication
Telephone refills by phone to the pharmacy
must include all the required information
What medications cannot be called into the pharmacy
Schedule 2 drugs
Ways to prescribe meds
telephone, written, e-prescribing
Some pharmacies have auto refill or they will call for a refill request
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
Examples of other disciplines to have a good relationship with to assist with prescribing include:
supervising MD/DO
infectious disease
pharmacist
Ensuring positive patient outcomes requires establishing:
- a medication education plan
- monitoring positive and negative patient responses
- identifying and addressing issues of nonadherence
- managing the pts complete medication regimen
Probably no other provider action influences the patient’s commitment to carry out a medication plan more than
medication education
Medication education components (9)
- medication name
- purpose
- dosing regimen
- administration
- adverse effects
- any special storage needs
- associated laboratory testing
- food or drug interactions
- duration of therapy
It is important to teach patients adverse effects. Patients may not know that, for most drugs, most adverse effects occur less than
1-2% of those taking the drug
Drugs that need to be stored in their original containers to not lose potency are
- SL NTG
- dabigatran (Pradaxa)
Patients taking metronidazole (Flagyl) must avoid what for the entire duration of therapy.
alcohol
Make sure to discuss duration of therapy with patients especially ones that are for lifetime. Common problem -
Failure to recognize the need for prolonged therapy is a common reason why patients stop medications prematurely when a prescription runs out.
Three primary reasons for drug monitoring:
- determine therapeutic dosage
- evaluate medication adequacy
- identifying adverse effects
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.
- carbamazepine
- digoxin
- lithium
- phenytoin
- theophylline
