NURS 6521 Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs

NURS 6521 Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs

NURS 6521 Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position.

With this trust comes power, responsibility, and an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

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Scenario 1:

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Scenario 2:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Scenario 3:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Scenario 4:

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.

To prepare for NURS 6521 Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs:

Review Chapter 1 of the Arcangelo and Peterson text and articles from the American Nurses Association, Anderson and Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.

Select one of the four scenarios listed above.

Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

As an advanced practice nurse, think about two strategies you would use to guide your ethically and legally responsible decision-making in this scenario.

With these thoughts in mind:

By Day 3

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.

By Day 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different scenario than you did, in one or more of the following ways:

Suggest additional ethical and legal implications for all stakeholders in your colleagues’ scenarios.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders

As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This results from the extensive treatment and care often required for patients with these disorders.

While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors.

As an advanced practice nurse, you must recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Consider the following case studies:

Case Study 1:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

Atenolol 12.5 mg daily

Doxazosin 8 mg daily

Hydralazine 10 mg qid

Sertraline 25 mg daily

Simvastatin 80 mg daily

Case Study 2:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun

Aspirin 81 mg daily

Metformin 1000 mg po bid

Glyburide 10 mg bid

Atenolol 100 mg po daily

Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

Case Study 3:

Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

Glipizide 10 mg po daily

HCTZ 25 mg daily

Atenolol 25 mg po daily

Hydralazine 25 mg qid

Simvastatin 80 mg daily

Verapamil 180 mg CD daily

To prepare:

Review this week’s media presentation on hypertension and hyperlipidemia and Chapters 19 and 20 of the Arcangelo and Peterson text.

Select one of the three case studies, as well as one of the following factors: genetics, gender, ethnicity, age, or behavior factors.

Reflect on how your selected factor might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how pharmacokinetic and pharmacodynamic processes changes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

With these thoughts in mind:

By Day 3

Post an explanation of how the selected factor might influence the patient’s pharmacokinetic and pharmacodynamic processes from the case study you determined. Then, describe how process changes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.

By Day 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different case study than you did in one or more of the following ways:

Provide alternative recommendations for drug treatments.

Offer and support an alternative perspective using readings from the classroom or your research in the Walden Library.

Validate an idea with your own experience and additional research.