NR552A- ADVANCED PHARMACOLOGY
In the U.S., States vary in the regulations related to Advanced Practice Prescribing. Post the regulations in your home state discussing the following:
Who is the regulatory agency?
The State of California Board of Nursing which operates under the State of California Department of Consumer Affairs.
What is the scope of practice related to prescribing?
Under Governor Gavin Newsome, California at last joined other states in attaining Full Practice Authority (FPA). The bill AB-890 was approved September 29th and goes into effect January 2023 (just in time for my graduation!)
What schedules of controlled dangerous substances can be written by the Advanced Practice Nurse?
ACPs in California may prescribe Schdules III-V and can obtain Schedule II by taking a continuing education course for Controlled Substances (CS) II approved by the Board of Registered Nursing.
1. What are thee] Drug Enforcement Administration (DEA) categories of scheduled drugs
There are five categories of drug’s based on their acceptable medical use, abuse or potential for addiction. The rate of abuse is a qualifier in the scheduling of the drug; Schedule I drugs can create severe psychological and/or physical dependence. The other schedules also have abuse potential but as the numbers increase the potential decreases, with Schedule V presenting the least potential for abuse.
Schedule I drugs are can lead to cause for criminal prosecution as there are no currently accepted medical use with high abuse potential. Examples are heroin, lysergic acid (LSD), methamphetamine/ecstasy. One drug I also saw listed on the DEA website as Schedule I is marijuana/cannabis, which I find surprising as it is legal and sold in specialty dispensaries. The use is not just medicinal but also sold as recreational, so I find this to be very interesting. I am wondering whether because the reference came from the DEA and marijuana is illegal in other states if it is considered a Schedule I in California – will report back!!!
Examples of Schedule II are combination drugs such as those with less than 15 mg of hydrocodone per dosage unit (Vicodin), cocaine, methadone, hydromorphone, oxycodone, fentanyl and adderall and ritalin.
Schedule III are moderate to low risk and include drugs with less than 90 mg of codeine per dosage unit such as Tylenol with Codeine, ketamine, testoterone and anabolic steroids.
Schedule IV I disagree that have low potential for abuse or dependence, and thought they would be at least under Schedule III: benzodiazepines such as Xanax, Valium, Ativan and sleep aids such as Ambien, or pain relievers such as Tramadol
Finally, Schedule V drugs are generally used for diarrhea, cough, or mild analgesia like Imodium, Robitussin, Lyrica.
References:
DEA. 10 July, 2018. Drug Scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling on 6 June, 2022
https://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf
In the U.S., States vary in the regulations related to Advanced Practice Prescribing. Post the regulations in your home state discussing the following:
· Who is the regulatory agency?
1. I currently reside in Kansas and the nursing board regulates nurse practitioner’s.
· What is the scope of practice related to prescribing?
1. In 2022 nurse practitioner’s were granted full practice authority. Nurse practitioner’s have full capabilities as a medical doctor to prescribe medications and procedures.
· What schedules of controlled dangerous substances can be written by the Advanced Practice Nurse?
1. The same as what a medical doctor can prescribe without restrictions.
· Is there any additional education needed to prescribe?
1. In Kansas nurse practitioners have to be nationally certified by an organization recognized by the nursing board.
Advanced practice registered nurses; senate sub. for hb 2279. (2022). Kansas State Legislature. Retrieved June 6, 2022, from https://www.kslegislature.org/li/b2021_22/measures/documents/summary_hb_2279_2022
Please describe the term pharmacokinetic process (in your terms)
According to Whalen, (2018) “Pharmacokinetics refers to what the body does to a drug.” (p. 1)
Woo and Robinson (2019) states, “Pharmacokinetics is the branch of pharmacology dealing with the absorption, distribution through the body metabolism, and excretion of drugs.” (p. 24)
The pharmacokinetic process how the medication works in the body. How the body metabolizes the medication. How much is metabolized. How and when it is eliminated from the body. Where the medication is most concentrated. Which organs are the most impacted.
Overall, this term means what the medication and the body do together. The most important consideration when creating a medication is if the pharmacokinetic process is the same in every body that is metabolizing it, if each body is not doing it properly than it may not have the same or best outcomes for the patient.
Whalen, K. (2018). Lippincott illustrated reviews: Pharmacology (7th ed.).
Woo, T. M., & Robinson, M. V. (2019). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.).
Advanced practice registered nurse (APRN) means a licensed registered nurse authorized to practice in the State of Vermont who, because of specialized education and experience, is licensed and authorized to perform acts of medical diagnosis and to prescribe medical, therapeutic, or corrective measures under administrative rules adopted by the Board (Vermont General Assembly, 2022).
Within the state of Vermont, the regulatory agency is the Vermont State Board of Nursing (American Association of Nurse Practitioners, 2022). Vermont is a full authority state when it comes to the scope of practice. This means that, the state practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing (American Association of Nurse Practitioners, 2022). In the state of Vermont, APNP have authority to prescribe schedule II-V controlled substances (American Medical Association, 2017). Schedule II controlled substances consists of medications that have a high potential for abuse. Where level V substances have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of medications containing limited quantities of certain narcotics (U.S. Department of Justice Diversion Control Division, 2022).
The only educational requirements for prescriptive authority in Vermont is the completion of coursework including advanced pathophysiology, advanced assessment, and pharmacotheraputics for NP licensure (American Medical Association, 2017).
What are three Drug Enforcement Administration (DEA) category’s of scheduled drugs?
Schedule I: drugs, substances or chemicals are defined as drugs with no current acceptable medical use and a high potential for abuse. Examples are: heroin, LSD, marijuana, ecstasy, methaqualone and peyote (DEA, n.d).
Schedule II: drugs, substances or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Examples include: Vicodin, cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin (DEA, n.d).
Schedule III: drugs, substances or chemicals defined as drugs with a moderate too low potential for physical and psychological dependence. Examples are: Tylenol with codeine, ketamine, anabolic steroids and testosterone (DEA, n.d).
American Association of Nurse Practitioners. (2022). Vermont. https://www.aanp.org/advocacy/vermont
American Medical Association. (2017). State law chart: Nurse Practitioner Prescriptive Authority. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf
DEA. (n.d.). Drug scheduling. https://www.dea.gov/drug-information/drug-scheduling
U.S. Department of Justice Diversion Control Division. (2022). Controlled Substances Schedules. https://www.deadiversion.usdoj.gov/schedules/
Vermont General Assembly. (2022). Vermont Statues Outline. https://legislature.vermont.gov/statutes/fullchapter/26/028
