NR 508 Week 6: Open Forum Discussion

NR 508 Week 6: Open Forum Discussion

This is a required, but not graded open forum. Please feel free to post questions related to content or assignments.

One of the most challenging aspects of prescribing medications is the possibility of dangerous interactions with those patients on multi-drug therapies. According to Woo & Robinson, 2016, Colchicine, probenecid, and sulfinpyrazone are all used cautiously in the presence of peptic ulcer disease or spastic colon. Gastrointestinal (GI) adverse reactions from these drugs are likely to make these disorders worse. When it comes to prescriptive authority, precise critical thinking in decision making is crucial.  Medications can and do alter people’s lives, and the ability to prescribe them is an awesome responsibility. Some of the antigout medication that is being utilized such as allopurinol and febuxostat has hepatoxicity side effects. Liver function test should be performed on a regular basis. During my career as a nurse I have given patients colchicine and allopurinol numerous times, but I wasn’t aware of the dangerous side effects of these drugs.  The mechanism of action is quite impressive, allopurinol and febuxostat inhibit xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine and xanthine to uric acid. Allopurinol has a metabolite (alloxanthine) that is also an inhibitor of xanthine oxidase. Allopurinol acts directly on purine metabolism, reducing the production of uric acid, without disrupting the biosynthesis of vital purines. (Woo & Robinson, 2016). Part of the fear of having this responsibility lies in the fact that many times, as providers, we do not always know what medications a patient is already taking. Many of the antigout medicines excreted via the renal system, so it is essen

NR 508 Week 6 Open Forum Discussion

tial to know what other medication the patient is taking. Indeed, patients do their best in relaying their medical history and providing up-to-date lists of their current medications; however, we know that information is often forgotten or omitted from our conversations with them. Febuxostat, a xanthine oxidase inhibitor, is contraindicated in patients treated with drugs requiring xanthine oxidase for metabolism (azathioprine, mercaptopurine, or theophylline) because of increased risk for toxicity. (Woo & Robinson, 2016). The risk causes concern when prescribing new medications, as there may be harmful drug-drug interactions that we are not able to avoid without all the pertinent information from the patient.

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Reference

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advance Practice Nurse prescribers (4th ed.). Retrieved from http://bookshelf.vitalsource.com

NR 508Wk 6 Open Forum

Professor and Class,

In reviewing this week’s lesson on pain management. The current opioid crisis and changes to interventions and pain management. More specifically interventions mid-level providers must take into consideration in regards to effective pain management. As we have learned throughout this course, a significant number of states have prescriptive authority restrictions for schedule 2 through 5 dependent substances (“SOP Policy,” 2018). However, the lesson on pain management really put into perspective what considerations to assess prior to prescribing opioids such as the levels of pain. In which as nurses we either assess the patient’s pain employing descriptive factors and numerical scales or for the non-verbal pain the Wong-Baker assessment chart. What I found interesting is the recommendation for limited use of Demerol (Meperidine) related to the increased risk of adverse outcomes from “degradation to neurotoxic metabolites and association with tremors, delirium and seizures” (Woo & Robinson, 2016, p. 1363). More importantly, when managing pain the provider should also educate the patient on both pharmacological and non-pharmacological therapies such as emotional support, guided imagery and complement therapies such as acupuncture. Which has proven to help alleviate pain with both medication and behavior modification therapy.

Thanks,

References

Georgia scope of practice policy: State profile. (2018). Retrieved from http://scopeofpracticepolicy.org/states/ga/

Woo, T. M., & Robinson, M. V. (2016). The role of the advanced practice nurse as a prescriber. In Pharmacotherapeutics for advanced practice nurse prescribers (4th ed. (pp. 1-1373). Retrieved from https://online.vitalsource.com/#/books/9780803658110/cfi/6/2!/4/16/32@0:0