Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and Responsibilities of APRN Prescribers

Advanced practice: Engages in a high level of autonomy in clinical decision-making.
Final decision for medications: Responsible for the choice and management of medication therapy.
Degree of authority and autonomy decided state by state: Varies depending on state laws and regulations.
Annual updates on titling, roles, and prescriptive authority: APRNs must stay informed of any changes.
Scope of practice determined by NP license and licensing jurisdiction: Defined by legal and regulatory frameworks.
- Employment sites may restrict this legal scope but cannot extend it: The scope of practice at a job may be more limited than the legal scope.

Clinical judgement: Involves assessing the best therapeutic approach considering multiple factors.
- Best therapy should be least invasive, least expensive, least likely to cause abuse: Prioritize safety, efficacy, and cost-effectiveness.
- Prefer lifestyle modifications, non-pharmacological, and pharmacological therapies: Consider all treatment options.
Clear indication for drug therapy?
- Before beginning, ask if necessary: Ensure there is a valid reason for starting medication.
Effectiveness of drugs in treating the disorder
- Choose the best one: Select medications based on efficacy and patient-specific factors.
Goal of therapy with this drug
- Cure disease, improve lifestyle, consider adverse effects: Define and monitor treatment objectives.
Not meeting goals?
- Consult a therapist when needed: Seek collaboration if treatment is not effective.
Avoid unnecessary duplication with other drugs already taken: Prevent polypharmacy.
Consider over-the-counter drugs: Evaluate the suitability of OTC options.
Cost considerations
- Will the patient pay out of pocket?: Assess the financial impact on the patient.
Sources of information to answer questions
- Journals, FDA, evaluate reliable drug information: Utilize credible sources for decision-making.

Physicians, pharmacists, ARNPs, PAs, nurses: Engage in interdisciplinary collaboration to optimize patient care.

Varies by state: Each state has different laws regarding the scope of practice and prescriptive authority of APRNs.

Metabolism affects onset, duration of action, and toxicity of medications
- Converts one chemical into another: Drug metabolism transforms active drugs into metabolites.
First-pass metabolism
- Major organ for drug metabolism (liver): Liver is the primary site for drug metabolism.
- Contains high amounts of drug metabolism enzymes: Enzymes in the liver metabolize drugs.
- First organ encountered by the drug once absorbed by the GI tract: Drugs pass through the liver after absorption.
- Determines if it can be given orally: First-pass effect influences oral bioavailability.
Rate of drug metabolism
- Depends on drug blood levels, related to drug per hour: Influences pharmacokinetics.
- First-order metabolism: time drug decreases by half
  - 50% at one half-life, 75% at two half-lives, 87.5% at three half-lives: Describes the drug elimination process.

Receptors: agonists and antagonists
- Agonists: drugs that produce receptor stimulation and change what they bind to
- Antagonists: occupy receptor without stimulating them, prevent agonists from occupying them
Partial agonists: Produce a weaker, or less efficacious, response than an agonist.
Inverse agonists: Bind to the same receptor as an agonist but induce a pharmacological response opposite to that of the agonist.