Pharmacology Unit 2 Prescribing Responsibility and Drug Selection
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Questions and Answers

What is one key responsibility of practitioners when prescribing medications?

  • Assuming that all patients are able to afford their medications.
  • Keeping a documented provider-patient relationship. (correct)
  • Prescribing medications to family members if they request it.
  • Relying solely on previous experience in medication administration.

Which factor is cited as a reason for poor adherence to prescribed medication regimens?

  • Patient forgetfulness about medication schedules.
  • Lack of understanding regarding medication purposes.
  • Miscommunication between providers.
  • Excessive cost of medications. (correct)

What should practitioners do if they find a patient is struggling to obtain their prescribed medication due to cost?

  • Refer the patient to a psychiatrist for medication management.
  • Change the patient's diagnosis to fit the medication needs.
  • Reassess the prescribed medication or consider alternative options. (correct)
  • Maintain the prescription and advise the patient to seek financial assistance.

What should be considered if the patient is experiencing undesired side effects?

<p>Schedule a follow-up within 1 to 3 months (A)</p> Signup and view all the answers

Why is it important for practitioners to document a thorough history and physical examination?

<p>To guide safe and appropriate prescribing decisions. (C)</p> Signup and view all the answers

What is a common misconception about prescribing medications?

<p>It is the same as administering medications. (A)</p> Signup and view all the answers

Which medications require a new prescription during each renewal period?

<p>Schedule II medications (C)</p> Signup and view all the answers

Which of the following should not be done in the context of prescribing medications?

<p>Prescribe medications for self-treatment. (B)</p> Signup and view all the answers

Which action is recommended when altering a patient's medication regimen?

<p>Follow up by phone or in person to assess changes (B)</p> Signup and view all the answers

What is an important factor to consider when selecting medications for patients?

<p>The financial status of the patient. (B)</p> Signup and view all the answers

What is generally acceptable for refilling medications if the patient has been stable on their current dose?

<p>Refill for 12 months (B)</p> Signup and view all the answers

What practice should be avoided when making prescription decisions?

<p>Prescribing without documented patient interactions. (A)</p> Signup and view all the answers

What is an important factor to consider when prescribing medications?

<p>The patient's insurance coverage (A)</p> Signup and view all the answers

Who can be a valuable resource for appropriate antimicrobial agent selection?

<p>Local infectious disease specialists (C)</p> Signup and view all the answers

What consequence may arise from overlooking a patient's financial situation during prescribing?

<p>Potential risk of treatment failure. (B)</p> Signup and view all the answers

Which is NOT a recommended action when prescribing medication?

<p>Selecting a medication based solely on personal experience. (D)</p> Signup and view all the answers

In what scenario should a shorter refill period be considered?

<p>If medication levels require frequent monitoring (B)</p> Signup and view all the answers

What resource should providers avoid using for decision-making?

<p>Experimental treatments with no validation (B)</p> Signup and view all the answers

What is a recommended practice when one is uncertain about medication dosing?

<p>Consult a pharmacist for their expertise (A)</p> Signup and view all the answers

What is the maximum interval for a medication refill for stable patients?

<p>12 months (D)</p> Signup and view all the answers

What is a key consideration when prescribing medications to patients who cannot reliably attend appointments or take medications?

<p>Avoid the medications if possible. (A)</p> Signup and view all the answers

What element is mandatory in a written prescription?

<p>Prescriber DEA number, if applicable (D)</p> Signup and view all the answers

Which population requires special consideration when prescribing medications?

<p>Pregnant or nursing mothers (B)</p> Signup and view all the answers

What is a limitation of telephone prescriptions for certain medications?

<p>They require written follow-up for scheduled medications. (B)</p> Signup and view all the answers

What should prescriptions avoid to decrease the risk of medication errors?

<p>Commonly used abbreviations (C)</p> Signup and view all the answers

What feature of tamper-resistant scripts helps prevent their unauthorized copying?

<p>Hidden Message Technology (B)</p> Signup and view all the answers

What is a benefit of using an electronic medical record (EMR) for e-prescribing?

<p>It ensures faster communication with pharmacies. (A)</p> Signup and view all the answers

When refilling a prescription, what is an important question to consider?

<p>Is this a newer medication for this patient? (D)</p> Signup and view all the answers

Which of the following is NOT a necessary element of a complete prescription?

<p>Patient address (D)</p> Signup and view all the answers

What does the program Meaningful Use relate to in healthcare?

<p>Incentives for using electronic medical records. (A)</p> Signup and view all the answers

What should a prescriber do if a patient does not fit well into standard treatment guidelines?

<p>Document the rationale for deviating from standard care. (A)</p> Signup and view all the answers

Why is it critical to ask patients about over-the-counter medications?

<p>Patients may not consider OTC medications as drugs. (B)</p> Signup and view all the answers

What are the primary responsibilities of the provider regarding prescription drug coverage?

<p>To keep informed about local resources for medication assistance. (A)</p> Signup and view all the answers

What is a potential consequence of polypharmacy?

<p>Higher risk for drug interactions. (C)</p> Signup and view all the answers

What should be done if a patient experiences adverse side effects from a new medication?

<p>Consider a dose reduction or changing the medication. (D)</p> Signup and view all the answers

How should a prescriber handle a severe allergy to a recommended medication?

<p>Document the allergy and avoid using the contraindicated medication. (D)</p> Signup and view all the answers

What is meant by 'renal dosing'?

<p>Adjusting medication doses based on renal function. (C)</p> Signup and view all the answers

What is the role of a formulary in medication prescribing?

<p>A selective list influenced by pharmacists and regulatory agencies. (D)</p> Signup and view all the answers

Which of the following is a key reason for frequent monitoring of certain medications?

<p>To maintain drug levels within a therapeutic range. (B)</p> Signup and view all the answers

Which of the following considerations is important when prescribing medications to patients with hepatic or renal function impairment?

<p>Alternative medications may have better safety profiles. (D)</p> Signup and view all the answers

Flashcards

Prescriptive Authority

The right to prescribe medications; it's a legal authorization granted to healthcare professionals.

Prescribing Assistance

Guidance and support provided to healthcare professionals on medication selection and use.

Prescribing

The act of recommending a specific medication to a patient for treatment.

Prescriptions

Detailed instructions for dispensing and using a medication, written by a healthcare provider.

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Nurse Practitioner

A healthcare professional licensed to diagnose and treat illnesses, with the ability to prescribe medications.

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Responsibility of Prescribing

The significant responsibility a healthcare provider carries when prescribing medication, involving considerations like safety, effectiveness, and patient welfare.

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Thorough history and Physical Examination

A crucial aspect of responsible prescribing, where a healthcare provider obtains a comprehensive understanding of a patient's medical history, physical condition, and potential risks before prescribing medication.

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Documented Provider-Patient Relationship

A key element in patient safety, ensuring a clear and documented relationship exists between a prescriber and the patient for whom medication is prescribed.

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Cost of Medications

The financial burden of medication, which can significantly affect patient adherence to treatment plans.

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Cost-Effective Prescribing

A critical step in cost-effective prescribing, where healthcare providers consider alternative medication choices or pharmacies to minimize financial burden on patients.

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Formulary

A list of medications covered by a health plan or pharmacy.

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Drug Interaction

When a medication's effectiveness is reduced or its side effects are increased when combined with another medication, food, or substance.

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Side Effects

The unwanted or unexpected effects of a medication.

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Drug Allergy

A patient's reaction to a specific medication or class of medications, ranging from mild to life-threatening severity.

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Drug Metabolism

The process of eliminating a medication from the body, primarily through the liver and kidneys.

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Hepatic/Renal Dosing

Adjusting medication dosage based on the patient's liver or kidney function.

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Drug Monitoring

Monitoring the levels of certain medications in the bloodstream to ensure they are within the therapeutic range.

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Polypharmacy

Using multiple medications simultaneously.

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Clinical Guidelines

Guidelines developed by medical and nursing societies to provide standardized recommendations for the treatment of specific diseases or symptoms.

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Individualized Care

Care that is tailored to the individual patient's needs and circumstances.

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Medication choice considering patient factors

When choosing a medication, it is important to consider the patient's ability to attend frequent appointments, take their medications reliably, and be reached easily by phone or electronically. Medications could be avoided if these factors present challenges.

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Special populations in medication

Pregnant or nursing mothers, along with older adults, require special considerations when prescribing medication due to their unique physiological and/or developmental stages.

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Components of a complete prescription

A complete written prescription must include essential information about the prescriber, patient, medication, and dosage.

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Telephone prescription

Telephone prescriptions often require a message with specific information to be left at the pharmacy.

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Schedule II medication prescription

Medications belonging to Schedule II (highly addictive and potentially dangerous) cannot be refilled or prescribed over the phone.

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Written prescription

Written prescriptions are still commonly used, and it is crucial to double-check the information (like provider name, contact details) before submitting it to the pharmacy.

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E-prescription

Electronic prescriptions can be sent directly to the pharmacy through an EMR, allowing for quick and accurate transmission of information.

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E-prescribing controlled medications

E-prescribing of controlled medications now possible through enhanced security measures like two-factor authentication, allowing for increased patient safety.

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Considerations for refilling prescriptions

When refilling a prescription, it is important to consider whether the medication is new to the patient, if the prescription is due for a refill, or if there are any changes in the patient's condition or medications.

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Using EMR for prescriptions

Many electronic medical record systems are capable of sending prescriptions electronically to pharmacies, making the process faster and minimizing errors.

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When to follow up with patients on medication changes?

When a patient is changing medications or adding new ones, it's essential to follow up with them to assess any changes, discuss new side effects, and review vital signs.

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Refill duration for stable patients:

For stable patients on medications, it's usually safe to refill prescriptions for a longer period, like 12 months.

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Patient requests refill by phone, what to ask?

When a patient requests a refill by phone, consider their last visit date. If it's been a while, consider seeing them in person before refilling.

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Schedule II medication refills:

Schedule II medications are controlled substances that cannot be refilled and require a new prescription every time.

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Refill frequency for medications requiring frequent monitoring:

If a medication requires frequent monitoring, like blood levels for warfarin, shorter refill periods are necessary.

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Factors that influence refill frequency?

When deciding refill frequency, consider the patient's individual circumstances, including any side effects, cost of medication, and their overall health.

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Prescribing aids and their role:

Prescribing aids, like mobile apps and websites, can assist prescribers with dosing and duration suggestions, but should always be used with caution and professional judgment.

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Why is collaboration with pharmacists important?

Pharmacists are valuable resources for prescribers, providing information on drug interactions, formulary, and medication dosing.

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Why is collaboration with infectious disease specialists helpful?

Infectious disease specialists can assist prescribers in choosing appropriate antimicrobial agents for specific infections, considering local resistance patterns and correct dosages.

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Overall benefits of collaboration in prescribing?

Collaborative relationships with colleagues and specialists can enhance prescribing practices and ensure safe and effective medication use for patients.

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Study Notes

Prescribing Responsibility

  • Prescribing medications is a privilege and a burden, demanding careful consideration.
  • Distinguish between giving medications and prescribing them.
  • Crucial for safe prescribing: a documented provider-patient relationship, thorough history and physical, patient discussion of risk factors, side effects, and treatment options, documented plan for drug monitoring, notes of any consultations with other providers, references to aid in medication selection.
  • Avoid prescribing for family, friends, or oneself.

Drug Selection

  • Medication costs in the US have risen significantly in recent years.
  • High costs can affect patient compliance and well-being.
  • Essential to inquire about affordability challenges.
  • Consider alternative pharmacies or drug regimens if cost is a barrier.
  • Drug costs can vary significantly between pharmacies.
  • Generic $4 lists and prescription programs, affordable prescription coverage (ACA), and local resources are important to consider.

Guidelines

  • Adhere to current guidelines for treatment of diseases/symptoms; consult societies like the American Heart Association, American College of Cardiology, Infectious Diseases Society of America, and the American Diabetes Association.
  • Keep informed about updates and changes; individualized care is paramount; document rationale for deviations from standard of care.

Availability

  • Facilities and pharmacies have formularies that impact medication choices.
  • Formularies consider guidelines, regions/national drug supplies, costs, rebates, and generic availability.
  • Familiarity with the local formulary is vital; formularies can change.
  • Substitutions/similar medications are often available.

Interactions

  • Most medications interact with other medications or foods.
  • Polypharmacy significantly increases interaction risk.
  • Inquire about all current medications (OTC, herbal).
  • Check for significant interactions when adding new medications.
  • If low-risk interactions are identified, discuss with patient, document, and then prescribe.
  • Avoid combinations with relative/absolute contraindications.

Side Effects

  • All drugs have side effects; some are adverse, some may be beneficial.
  • Side effect experiences vary between patients.
  • Note pertinent side effects for each medication.
  • Inquire about new symptoms after medication changes.
  • Consider risk-benefit ratio, carefully evaluate severity and patient response.

Allergies

  • Guidelines may suggest a drug for a condition, but a patient allergy exists.
  • Determine the type of reaction and document it.
  • Select an appropriate alternative.
  • Severe (anaphylaxis, swelling) allergies are contraindications; milder reactions might allow re-use.

Hepatic and Renal Function

  • Many drugs are metabolized/eliminated by liver/kidneys.
  • Impaired function leads to increased adverse effects; potential overdose.
  • Drugs have special decreased doses for patients with impairment.
  • Choose a different medication if possible; consider appropriate dosing for hepatic/renal impairment cases.

Monitoring Needs

  • Some drugs mandate frequent monitoring (warfarin, lithium, opioids, immunosuppressants).
  • Serious patient harm can occur if levels are outside therapeutic range.
  • Difficulty with follow-up or reliable medication taking could necessitate alternative treatment.

Special Populations

  • Pregnant/nursing mothers and older adults need special consideration -- addressed in Unit III, Drug Therapy Across the Life Span.
  • Consult Life Span Tables within chapters.

Prescriptions

  • Necessary components of a prescription:
    • Prescriber's name, license, contact; DEA number (if applicable)
    • Patient's name, date of birth, allergies
    • Medication name, indication, strength
    • Dose, frequency, quantity to dispense
    • Number of refills
  • EMRs automate many aspects of prescribing, but indication must still be clearly noted.

Types of Prescriptions

  • Telephone Prescriptions:

    • Convenient, use for refills, limited use for specific medications.

  • Written Prescriptions:

    • Traditional format, includes necessary information.
    • Use black ink or indelible pencil; avoid abbreviations.
    • Never write on pre-signed/blank scripts.
    • Facilities often use tamper-proof prescriptions

  • Electronic Prescriptions:

    • Increasing use with EMRs.
    • Direct transmission to pharmacy, reducing errors; medication readiness.
      • Two-factor authentication enhances security.

  • Availability depends on facilities/pharmacies' software capabilities.

Refills

  • Consider factors for refill requests:
    • New medication?
    • Changes to dosage, frequency, or regimen?
    • Side effects observed?
    • Follow-up schedule?
    • Schedule II medications do not allow refills without a new order.
  • Consider the need for adjust or monitoring on refills

Prescribing Assistance

  • Applications and websites assist with safe prescribing.
  • Collaboration with colleagues (pharmacists, infectious disease specialists) can assist.
    • Pharmacists provide knowledge of formulary; interactions and dosing strategies.
    • Specialists aid in selection of antimicrobials.

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Description

This quiz explores the essential principles of prescribing medications responsibly and the implications of drug selection. It emphasizes the importance of a strong provider-patient relationship and the cost considerations that affect patient compliance. Learn how to navigate the complexities of prescribing while prioritizing patient well-being.

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