How does limited prescriptive authority impact patients within the healthcare system?

Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible 

patient care. For example, restrictions on the distance of the APRN or PA from the physician 

providing supervision or collaboration may prevent outreach to areas of greatest need. A 

requirement to obtain the physician's cosignature on prescriptions can increase patient waits. 

Despite the use of terms such as collaborative arrangement, these relationships create a situation 

in which one partner holds the power. In the event of dissolution of the arrangement, the ultimate 

loss is commonly assumed by the advanced practice provider rather than the physician.

What are the key responsibilities of prescribing?

The best way to keep your patients (and yourself) safe is to be prudent and deliberate in your 

decision-making process. Have a documented provider-patient relationship with the person for 

whom you are prescribing. Do not prescribe medications for family or friends or for yourself. 

Document a thorough history and physical examination in your records. Include any discussions 

you have with the patient regarding risk factors, side effects, or therapy options. Have a 

documented plan regarding drug monitoring or titration, if applicable. If you consult additional 

providers, note that you did so. Finally, use the references provided in the following box to assist 

in safely and rationally choosing one medication over another.

What do CYP450 Inducers do?

Inducers act on the liver to stimulate enzyme synthesis. This process is known as induction. By 

increasing the rate of drug metabolism, the amount of active drug is decreased and plasma drug 

levels fall. If dosage adjustments are not made to accommodate for this, a drug may not achieve 

therapeutic levels.

Which schedule drugs can APRNs prescribe?

Schedule II-V

Who determines and regulates prescriptive authority?

Prescriptive authority is determined by state law. 

The regulation of prescriptive authority is under the jurisdiction of a health professional board. 

This may be the State Board of Nursing, the State Board of Medicine, or the State Board of 

Pharmacy, as determined by each state. Although the federal government controls drug 

regulation, it has no control over prescriptive authority.

What should be used to make prescribing decisions? (9)

The best way to keep your patients (and yourself) safe is to be prudent and deliberate in your 

decision-making process. Cost, availability, current practice guidelines, medication interactions 

including interactions with food, side effects, need for monitoring, how drug is metabolized 

(hepatic or renal), special populations (pregnancy, nursing, older adults)

What is pharmacokinetics?

The study of what happens to a drug from the time of administration until the parent drug and all 

metabolites leave the body. This process includes absorption, distribution, metabolism, and 

excretion -- What the body does to a drug

Pharmacokinetics photo

What is distribution?

The dispersion or dissemination of substances throughout the fluids and tissues of the body

The process whereby a substance is irreversibly transformed into metabolites

Metabolism

The elimination of the substance from the body. *In rare cases some substances accumulate in a 

tissue in the body

Excretion