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All replies must be constructive and use literature where possible.

Reply to Ivonne

• 1. Prescribing medication is one of the most critical duties of advanced practice registered nurses (APRNs). According to Arcangelo et al (2021), before prescribing therapy, the practitioner must gather data by taking a thorough history and performing a physical examination. An ARNP must formulate a diagnosis and care plan. Furthermore, healthcare professionals must be aware of the responsibility that comes with providing a medical prescription and identifying which one is best for that particular patient. ARNPs are responsible for doing medication reconciliation to prevent medical errors that may cause harm to patients. When prescribing any drug therapy, the practitioner must have a solid knowledge and background in the pathophysiology of disease, pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and any interactions (Arcangelo et al., 2021).

2. In order to determine what drug therapy to prescribe, the practitioner conducts a risk–benefit analysis, evaluating the therapeutic value versus the risk associated with each drug to be prescribed (Arcangelo et al., 2021). Clinicians face ongoing challenges of prescribing evidence-based therapy, while also trying to avoid unnecessary polypharmacy and under-prescribing in the same patient (Ailabouni et al., 2021). Based on the patient’s diagnosis, practitioners obtain a list of possible medication treatments. Using the risk-benefit analysis which is pros and cons they are able to jot down the best medical treatment. Factors to consider are variations in cost, efficacy, storage requirements, interactions, convenience, side effects, and administration route. In addition, another factor is patients asking to be prescribed a specific medication.

• 3. ARNPs have the responsibility of educating the patient about drug therapy and the intended therapeutic effect, potential side effects, and strategies for dealing with possible adverse drug reactions (Arcangelo et al., 2021). Patients need to have adequate knowledge and skills to follow their medication regimen and compliance to avoid medication errors, hospitalization, and fatality. According to Marks et al (2022), individuals’ health literacy, which is the ability to obtain, process, and understand health information and services needed to make appropriate health decisions and follow instructions for treatment, influences self-management. One effective teaching strategy is the teach-back method. The teach-back- method helps medical providers teach patients and get feedback on what they understand. In addition to the teach-back- method, it is imperative for written teaching as well. Some older adults don’t have the capacity to recollect information therefore they rely on written instructions. Furthermore, education on lifestyle changes is important.

4. Schedule drugs pertain to controlled substances. In the United States, controlled substances are under strict regulation by both federal and state laws that guide their manufacture and distribution (Preuss et al., 2023). The medications indicated in each category have a decreasing propensity to lead to a substance use or addiction issue as the schedules go down, I through V.

Schedule I: Schedule I drugs are considered the most dangerous and have a high potential for abuse. They have no accepted medical use in the United States or a lack of accepted safety for use under medical supervision. Examples include heroin, lysergic acid diethylamide, mescaline, methylenedioxymethamphetamine (MDMA), methaqualone, and marijuana.

Prescribing Restrictions: It is against the law to administer these medications, and they are typically not allowed for medical usage.

Schedule II:  Schedule II drugs have a high potential for abuse, but they also have recognized medical uses. Examples include fentanyl, hydromorphone, meperidine, methadone, morphine, oxycodone, fentanyl, dextroamphetamine, methylphenidate, methamphetamine, pentobarbital, and secobarbital.

Prescribing Restrictions: Prescriptions for Schedule II drugs are highly regulated. They can’t be faxed or called in, and they usually need a documented prescription with no refills. Oral emergency prescriptions are sometimes permitted, but they must be followed by a written prescription.

Schedule III: Schedule III drugs have a lower potential for abuse than Schedule I and II drugs and have accepted medical uses. Examples include benzphetamine, ketamine, phendimetrazine, and anabolic steroids.. Prescribing Restrictions: Schedule III drugs are often prescribed with a written or verbal prescription, and they may allow for a limited number of refills.

Schedule IV: Schedule IV drugs have a lower potential for abuse than Schedule III drugs and have recognized medical uses. Examples include alprazolam, carisoprodol, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, tramadol, and triazolam.

Prescribing Restrictions: Compared to Schedule III medicines, Schedule IV drugs are typically administered more liberally and frequently permit multiple refills.

Schedule V: Schedule V drugs have the lowest potential for abuse and have accepted medical uses. These substances include cough medicines with codeine, antidiarrheal medications that contain atropine/diphenoxylate, pregabalin, and ezogabine.

Prescribing Restrictions: In most cases, schedule V medications can be purchased over-the-counter (OTC) or with a prescription, depending on the particular substance and state laws.

References

Ailabouni, N. J., Marcum, Z. A., Schmader, K. E., & Gray, S. L. (2021). Medication Use Quality and Safety in Older Adults: 2019 Update. Journal of the American Geriatrics Society, 69(2), 336–341. https://doi.org/10.1111/jgs.17018

Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2021). Pharmacotherapeutics for advanced practice: a practical approach (5th Ed.)

Marks, L., O’Sullivan, L., Pytel, K., & Parkosewich, J. A. (2022). Using a teach?back intervention significantly improves knowledge, perceptions, and satisfaction of patients with Nurses’ discharge medication education. Worldviews on Evidence-Based Nursing, 19(6), 458–466. https://doi.org/10.1111/wvn.12612

Preuss, C. V., Kalava, A., & King, K. C. (2023). Prescription of Controlled Substances: Benefits and Risks. In StatPearls. StatPearls Publishing.

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