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Vicente GutierrezYesterdaySep 4 at 8:56pm

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How do variations in prescriptive authority across different states impact the practice of advanced practice nurses and physician assistants, and what strategies can be used to navigate these variations while ensuring patient safety and adherence to legal and regulatory requirements? Use your state as an example.

Prescriptive Authority

Prescriptive authority is known as the legal right to prescribe drugs (Rosenthal & Burchum, 2021). One of the main issues surrounding prescriptive authority and how those issue affect this fundamental aspect of comprehensive patient care is the limitations of prescriptive authority (Burchum & Rosenthal, 2021). The two main components of prescriptive authority are the right to prescribe independently and the right to prescribe without limitation (Burchum & Rosenthal, 2021). The limitations between physician assistants (PAs) and advanced practice nurses vary (APRNs). A PA must have an affiliation or partnership with a physician who serves as a supervisor or partner for the PA to be able to prescribe medications (Burchum & Rosenthal, 2021). APRNs have full prescriptive authority, but some states may regulate their ability to practice on their own even though they are trained to independently prescribe without supervision (Burchum & Rosenthal, 2021). The state of California requires physician collaboration to prescribe scheduled II and V drugs for CNM, and CNP (Burchum & Rosenthal, 2021).These regulations fall under the jurisdiction of health professional board. Many advanced practice providers are pushing to have full prescriptive authority since the education they receive an extensive education from accredited programs that meet national standards to be able to prescribe medications (Burchum & Rosenthal, 2021). This is a strategy that can be used to ensure the patient’s safety while also ensuring the advanced practice provider will have the knowledge to prescribe, assess, and adequately diagnose the patient. If the regulations are set by the federal government instead of states, the advanced practice providers will have more autonomy to practice.

References

Burchum, J., & Rosenthal, L. D. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier Health Sciences (US). 

Summer RomeroYesterdaySep 4 at 8:03am

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How can healthcare providers account for the age-related changes in pharmacokinetics and pharmacodynamics that impact medication absorption, distribution, metabolism, and excretion,

Age-related changes are inevitable, so healthcare providers should anticipate a potential reduction in efficiency in the typical process of absorption, distribution, metabolism, and excretion. For example, if a patient has issues with their liver or resections to their intestines, they may not be capable of metabolizing medications for optimal therapeutic response as desired. Therefore, this patient could benefit from a different treatment route that can take effect more efficiently, such as intravenously. Patients with renal organ failure may not be capable of excreting medications, which could be harmful concerning the build-up of renal-harming medications such as vancomycin. Other contributing factors weigh into patients with renal failure, such as muscle wasting, paraplegia, and extreme elderly (Shukle, n.d.)

and what strategies can be used to adjust medication regimens for older adult patients to minimize the risk of adverse drug reactions and medication errors?

Laboratory monitoring for those patients on harmful medications that monitor the efficiency of clearance of medications such as vancomycin is standard, as well as calculating safe dosages as indicated based on a patient’s ability to clear creatinine from the kidney. Considering older adults may have a more challenging time clearing medications from the body, understanding the half-life of medicines is essential to ensure you do not harm the patient by prescribing them medications at unrealistic doses to excrete timely (Shukle, n.d.). If unfamiliar with the patient’s elimination ability, review medical diagnoses that influence the ability to absorb, distribute, metabolize, and excrete. Also, run laboratory work to understand the patient’s state, such as CBC, CMP, TSH, ESR, LDH, and UA. The risk of drug reactions is also more prevalent in the older population. It should be prescribed with precaution as harmful effects are likely to occur, such as the consumption of antipsychotics, glyburide, benzodiazepines, sedatives, and anticholinergic drugs. All of these medications should be a red flag and pose for increased monitoring in the population, as the potential for falls, fractures, increased confusion, orthostasis, and other harmful side effects, including mortality, can be anticipated. Medication errors are also more common in the population due to issues such as polypharmacy, cognitive decline, dexterity, and vision issues. Early identification from healthcare providers and families would aid in correcting these issues (Vega, n.d.).

References

Shukle, P. (n.d.). Pharmacology Elimination Kinetics [PowerPoint slides]. Lecturio. course/c/84556Links to an external site.“>https://westcoastuniversity-aprn.lecturio.com/#/course/c/84556Links to an external site.

Vega, C. (n.d.). Caring for Older Adults [PowerPoint slides]. Lecturio. course/c/84556Links to an external site.“>https://westcoastuniversity-aprn.lecturio.com/#/course/c/84556Links to an external site.