Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172

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Pharmacology and Pharmacotherapeutics in Advanced Nursing Practice NGR6172 Chapter 1: Prescriptive Authority and Role Implementation: Tradition vs Change o Primary Care is provided by clinicians wh... o 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 Registration of MLPs--can obtain DEA# beginning with M  NPs  DEA number and prescriptive authority differ by state.  May dispense pharmaceutical samples in all states.  Across-state-line prescribing  CNMs  CRNAs--do not "prescribe" under law.  CNSs o Barriers to Practice for Nurses in the Diagnosing and Prescribing Role  Regulatory irregularity among states  Increased antagonism from organized medical groups competing with APNs for patients  Growing number of NP graduates without prior nursing experience  Inequity in data collection on physician prescribing patterns among pharmaceutical companies  Difficulty in obtaining prescribing data from Prescription Drug Marketing Act Chapter 9: Establishing the Therapeutic Relationship  "How scientific principles are introduced in the relationship with the patient has everything to do with therapeutic success." The balance of art and science in healthcare.  "A continuing relationship with the healthcare provider is essential in making adjustments to discover the proper therapy for the individual." o Identify a problem, assess it adequately, identify various potential solutions, examine he variables needed to judge the risk/benefit ratio of the solutions, choose the most appropriate solution, and identify the effects (beneficial and adverse) that may result from implementation of the chosen solution.  Factors of a Therapeutic Relationship o Time--investment--particularly with the elderly--initial investment to obtain thorough H&P--cost-effective--follow up call strengthen the relationship o Attitude--how time is spent and what is said--"Who owns the problem?" o Information--it may take several visits to obtain a full history o Communication--effective two-way communication between patient and provider requires consistent commitment to respect the others' role in the relationship.  Transference  Focus on patient, environment, and lastly, self.  Find a balance between creating uncontrolled and unfounded anxieties vs creating a false sense of equally grounding security and reassurance.  It is implicitly understood that once a problem is presented, the provider will do their utmost to provide the best therapy.  The therapeutic objective must be clearly stated--1) must be realistic and attainable, 2) clearly related to the problem as defined and assessed, 3) measurable.  Be flexible, accept occasional lapses in compliance, attempt to understand the patient's point of view. o Therapeutic Relationship Fails  Skepticism in the medical profession.  Provider main goal is pharmacoadherence.  Over or under utilization.  Therapeutic failure and increase in disease severit [Show More]

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