Test 1

Question 1

Prescriptive authority is

Answer 1

the legal right to prescribe independently and without limitation (full)

Question 2

What is restrictive prescriptive authority?

Answer 2

limitations with oversight by MD or DO

Question 3

Provider who prescribes without limitation may prescribe

Answer 3

any drugs, including controlled drugs with the exception of schedule 1 drugs (which have no current medical use)

Question 4

Prescriptive authority is determined by

Answer 4

state law

Question 5

The regulation of prescriptive authority is under the jurisdiction of

Answer 5

a health professional board including - the state board of nursing, the state board of medicine, or the state board of pharmacy

Question 6

What does limited prescriptive authority cause

Answer 6

barriers to quality including affordable accessible patient care

Question 7

Responsibility at prescribing rational drug selection in writing prescriptions -

Answer 7

keep yourself and your patients safe - be proven and deliberate in your decision making process

Question 8

Prescribing rules:

Answer 8

• pt/provider relationship documented
• do not prescribe to family/friends/yourself
• doc. a thorough hx/physical exam in your records
• include risk factors, side effects, therapy options, doc.
• also doc. pt plan/drug monitoring/or titration
• consult additional providers if needed
• use references available to help

Question 9

Electronic apps for assistance are needed in practice including -

Answer 9

Lexicomp
UpToDate
Epocrates

Question 10

List the things to think about when prescribing a drug (8)

Answer 10

• cost
• guidelines
• liability interactions
• side effects
• allergies
• liver and renal function
• need for monitoring
• special populations

Question 11

What is the biggest factor to consider when prescribing medication

Answer 11

cost

Question 12

Why is cost the biggest factor to consider

Answer 12

Cost is the number 1 reason for non-adherence with patients taking their prescribed medications

Question 13

Availability of medications includes: (4)

Answer 13

• the facilities formularies
• insurance coverage and what they cover
• the $4 meds and pharmacies
• generic medications

Question 14

What increases the risk for interactions

Answer 14

polypharmacy

Question 15

Patients med list should be updated/reconciled including

Answer 15

• all current drugs
• OTC drugs
• herbal meds

Question 16

Side effects things to consider

Answer 16

• some drugs have adverse effects
• risk to benefit ratio
• consider severity of side effects

Question 17

New medication needs

Answer 17

• follow-up to evaluate any adverse effects from the drug

Question 18

allergies

Answer 18

determine the type of reaction and document in the chart to prove why an alternative medication was chosen

Question 19

liver and renal function

Answer 19

must be assessed because many drugs are metabolized in the liver and eliminated in the kidneys

Question 20

what can happen if liver or renal function is impaired

Answer 20

• increase adverse effects

- possible medication overdose

Question 21

how to prescribe with liver or renal impairment

Answer 21

• drugs have lower doses known as hepatic and renal dosing

Question 22

some drugs require frequent monitoring at initiation or throughout the duration of treatment. Examples:

Answer 22

lithium, warfarin, opioids, immunosuppressive therapies (monitor these patients closely)

Question 23

special populations to consider when prescribing

Answer 23

pregnant, nursing mothers, older adults

Question 24

Key elements that must be included on a RX

Answer 24

• prescriber name
• license #
• contact information
• DEA #’s of you and your supervising physician
• patient name
• patient date of birth
• allergies
• medication
• indication for medication
• strength
• dosing frequency (all spelled out)
• # of tablets
• # of refills
• your signature
• SIG

Question 25

What does SIG stand for on a prescription

Answer 25

this is the instructions how to take the medication

Question 26

Telephone refills by phone to the pharmacy

Answer 26

must include all the required information

Question 27

What medications cannot be called into the pharmacy

Answer 27

Schedule 2 drugs

Question 28

Ways to prescribe meds

Answer 28

telephone, written, e-prescribing

Question 29

Some pharmacies have auto refill or they will call for a refill request

Answer 29

you have to ensure all the essentials are asked such as: - new med for patient - change the dose or frequency - add a new medication to the regimen - any side effects experienced by the patient - when did I see pt. last - when is patients follow-up appointment - do they need appt. before the refill - is this a schedule 2 drug

Question 30

Examples of other disciplines to have a good relationship with to assist with prescribing include:

Answer 30

supervising MD/DO infectious disease pharmacist

Question 31

Ensuring positive patient outcomes requires establishing:

Answer 31

- a medication education plan - monitoring positive and negative patient responses - identifying and addressing issues of nonadherence - managing the pts complete medication regimen

Question 32

Probably no other provider action influences the patient's commitment to carry out a medication plan more than

Answer 32

medication education

Question 33

Medication education components (9)

Answer 33

- medication name - purpose - dosing regimen - administration - adverse effects - any special storage needs - associated laboratory testing - food or drug interactions - duration of therapy

Question 34

It is important to teach patients adverse effects. Patients may not know that, for most drugs, most adverse effects occur less than

Answer 34

1-2% of those taking the drug

Question 35

Drugs that need to be stored in their original containers to not lose potency are

Answer 35

- SL NTG | - dabigatran (Pradaxa)

Question 36

Patients taking metronidazole (Flagyl) must avoid what for the entire duration of therapy.

Answer 36

alcohol

Question 37

Make sure to discuss duration of therapy with patients especially ones that are for lifetime. Common problem -

Answer 37

Failure to recognize the need for prolonged therapy is a common reason why patients stop medications prematurely when a prescription runs out.

Question 38

Three primary reasons for drug monitoring:

Answer 38

- determine therapeutic dosage - evaluate medication adequacy - identifying adverse effects

Question 39

Examples of drugs that have narrow therapeutic indexes and have to be frequently monitored are: The difference between an effective dose and a lethal dose is small.

Answer 39

- carbamazepine - digoxin - lithium - phenytoin - theophylline