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Pharm 5018 ETSU NP

Ch 3 Drug Prescribing

The Process of Rational Drug Prescribing Define the patient’s problem/Specify the therapeutic objective/Collaborate with the patient/Choose the treatment/Educate the pt/Monitor effectiveness.
Define the Patient’s Problem Assess patient. Develop working and differential diagnosis. Use diagnostic tests to confirm.
Specify the Therapeutic Objective Goal of treatment: Cure the disease? Relieve symptoms of disease? Replacing deficiencies (e.g., insulin)? Long-term prevention?
Collaborate With the Patient The World Health Organization recommends including patient in developing therapeutic objective of drug therapy.
Choose the Treatment Use evidence-based guidelines/Individualize for each patient/Novice providers use analytic, step-by-step decision making/Experienced providers use exp & pattern recognition/Use more systematic approach with complex patients.
The I Can PresCribE A Drug Mnemonic    Indication - Contraindications - Precautions - Cost/Compliance - Efficacy - Adverse effects - Dose/Duration/Direction
Start Treatment Patient usually fills prescription at pharmacy. When writing prescription, discuss whether pt has ability to pay for prescrip Insurance copays/Generics often less expensive $4 retail lists
Educate the Patient Poor adherence contributes to worsening disease, hospital admissions, and death. Pt ed at the 5th or 6th gr level/Include in ed purpose of medication/Instructions for administration Adverse drug reactions (ADRs)
Monitor Effectiveness Passive monitoring: Pt is ed on expected outcome and instructed to contact provider. Active monitoring: f/u lab tests or monitoring to measure therapeutic effectiveness
Drug Factors Influencing Drug Selection Pharmacokinetic factors/Pharmacodynamic factors Therapeutic factors/Safety /Cost (to patient and to society)/Patient factors/Provider factors
Pharmacokinetic Factors Bioavailability /CYP 450 metabolism/Renal /elimination/Dose-concentration curve /Half-life
Therapeutic Factors Evidence for therapeutic impact: Clinical trials/Clinical practice guidelines/Systematic reviews Randomized controlled trials: Extrapolate with caution
Safety Safety profile is taken into consideration/ varies by population: Teratogens/Liver or renal disease/Drug allergy MedWatch report U.S. Food and Drug Administration advisories
Cost Cost to patient: High drug cost outlay by patient may decrease adherence/Ask about prescription drug coverage/Consider $4 retail pharmacy lists. Cost to society: Thoughtful prescribing considers cost to health system.
Patient Factors Previous ADRs/Health beliefs Current drug therapy: Drug interactions/Consult PharmD regarding complex drug regimens. Patient age/Pregnancy
Provider Factors Ease of prescribing or monitoring Formularies: Nurse practitioners need to be familiar with the formulary they are allowed to prescribe. Personal formulary: Each provider develops a small list of drugs they are comfortable prescribing.
Influences on Rational Prescribing Pharmaceutical promotion: May influence prescribing When prescribing recom change: When guidelines change, providers may need to be coached or reeducated regarding appropriate prescribing.
Created by: palmerag