Posted: August 25th, 2021

Describe the method used to determine what drug therapy to prescribe?

Describe the roles and responsibilities of the APRN when prescribing medication.

The role of an Advanced Practice Registered Nurse (APRN) when prescribing medication involves numerous responsibilities. As a licensed healthcare provider with prescriptive authority, the APRN must ensure safe and effective use of medications. APRNs must monitor and follow up with patients to see if the medication is working for the patient as well as ensuring proper adherence is happening. Recent studies have shown that nurse practitioners prescribe as safely as primary care physicians, particularly when caring for older adults (Stanford Medicine, 2023). The first thing that has to happen before an APRN prescribes a medication is assess and diagnose the patient. This helps the APRN establish a baseline for the patient to figure out what medication would best benefit the patient. Before prescribing therapy, the APRN has a responsibility to gather data by taking a thorough history and performing a physical examination (Arcangelo et al., 2017). A risk-benefit analysis is then analyzed to see if this patient would even need medication. Regardless of a specific prescribing pattern of different providers, all providers must focus on patient-centered care (Zhang & Patel, 2023). Patient education is a huge aspect of healthcare for everyone, not just an APRN. Patient education is a major responsibility that involves interprofessional collaboration within a healthcare system. A responsibility that some providers have to worry about are certain state regulations and statutes. Some providers attend school in a different state than they will be practicing in so they have to take into consideration what will be different from the state they are learning in. Although NPs provide services across the country, their ability to do so is not equal in all areas due to state scope-of-practice laws that limit the services (Milbank Quarterly, 2021). It’s worth noting that the APRN profession has seen significant growth, with the number of licensed NPs increasing from 355,000 in 2022 to 385,000 in 2023, indicating a growing demand for their services and expanding responsibilities in healthcare delivery (American Association of Nurse Practitioners, 2023).

Describe the method used to determine what drug therapy to prescribe?

As stated above, a risk-benefit analysis, evaluating the therapeutic value versus the risk associated with each drug to be prescribed (Arcangelo et al., 2017). Factors that get taken into consideration are the drug action, side effects, interactions, convenience, storage needs, route of administration, efficacy, and cost (Arcangelo et al., 2017). A recent study by Tzeng et al. (2022) highlighted the impact of state nurse practitioner regulations on prescribing practices, emphasizing the need for APRNs to consider regulatory environments when determining drug therapies. Rational prescribers should attempt to maximize clinical effectiveness, minimize harm, avoid wasting healthcare resources, and respect patient wishes (Maxwell, 2016). In addition to these considerations, APRNs must stay updated on the latest clinical guidelines and evidence-based practices to ensure they’re prescribing the most appropriate and effective treatments for their patients. This ongoing education is crucial in maintaining high standards of care and adapting to evolving medical knowledge and pharmaceutical advancements.

Discuss responsibilities for patient education and teaching based on the prescribed therapy.

Patient education is an integral part of an APRNs role and responsibility. Education should include the intended therapeutic effect, potential side effects, and strategies for dealing with possible adverse drug reactions. When I was younger, I had a provider print out easy to understand drug info that I really enjoyed as this was the only prescriber to ever do that for me. I think having that handout readily available can help patients identify what to expect if an adverse reaction is present. A study by Chapman et al. (2024) emphasized the importance of APRN education and training in specific areas like opioid use disorder treatment, highlighting the need for comprehensive patient education in complex therapeutic areas. APRNs should also consider cultural and linguistic factors when providing patient education, ensuring that information is accessible and understandable to diverse patient populations. This may involve using interpreters, providing materials in multiple languages, or utilizing visual aids to enhance comprehension. Additionally, APRNs should encourage patients to ask questions and actively participate in their treatment plans, fostering a collaborative approach to healthcare.

Discuss Schedule drugs and prescribing restrictions for each scheduled drug.

The FDA’s Controlled Substances Act of 1970 established the schedule of ranking drugs that have the highest potential for abuse (Arcangelo et al., 2017). Schedule 1 drugs have a high potential for abuse. These drugs are not available for everyday use. Examples are heroin and LSD. Schedule 2 can be prescribed but are not available for refill and must have a new prescription each time. Examples include fentanyl and morphine. Schedule 3 drugs can be refilled up to five times within 6 months. Examples include ketamine and testosterone. Schedule 4 drugs have a low potential for abuse, such as Ativan. Schedule 5 drugs have the least potential for abuse and an example is an antidiarrheal. Providers can only prescribe these medications if they are approved by the Drug Enforcement Agency (DEA). Zhang and Patel (2023) noted that prescriptive authority, including for controlled substances, varies by state and requires APRNs to maintain specific certifications and adhere to strict regulations. It’s crucial for APRNs to stay informed about changes in controlled substance regulations, as these can impact prescribing practices. Additionally, APRNs should be aware of potential drug interactions, especially when prescribing controlled substances alongside other medications, and should implement safeguards to prevent misuse or diversion of these drugs.

References
Stanford Medicine. (2023). Nurse practitioners prescribe as safely as primary care physicians, study finds. [This reference was used in the first paragraph]

American Association of Nurse Practitioners. (2023). NP Fact Sheet. [This reference was used at the end of the first paragraph]

Tzeng, H. M., Feng, H. P., Raji, M. A., Kuo, Y. F., & Goodwin, J. S. (2022). Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: A retrospective study. BMC Health Services Research, 22(1), 1-10. [This reference was used in the second paragraph]

Chapman, S. A., Coffman, J., McConville, S., & Phoenix, B. J. (2024). Expanding access to buprenorphine treatment: Lessons from nurse practitioners and physician assistants in California. Substance Abuse Treatment, Prevention, and Policy, 19(1), 1-12. [This reference was used in the third paragraph]

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Tags: APRN prescribing responsibilities, controlled substance regulations, Evidence-Based Prescribing Practices, Patient-Centered Medication Management