Ethical and Legal Implication of Prescribing Drugs PDF

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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.

Give examples. For example, say it was dilaudid (hydromorphone) tablets....

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Running Head: ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS

Ethical and Legal Implication of Prescribing Drugs (Author’s Name) (Course) (Instructor Name) (Assignment Due Date)

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ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS

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Ethical and Legal Implication of Prescribing Drugs Pharmacology The prescription of a drug involves a set of stakeholders, such as the prescriber, pharmacist, patient, and patient’s family that ought to adhere to the ethical and legal implications of the drug. These individuals are accountable for the lives of a many individuals that require medication therapy to regains their normal physiological function. Medical practitioners are, therefore liable for the mistakes they make while prescribing medication to their patients. As such, the prescriber (Nurse/ doctor) should make the right prescription of a drug only after conducting necessary examination of their patient, and carrying out proper test to certain their condition. A pharmacist is liable, on the same note for failing to do disclose full information of the proposed medication, such as the side effects associated with the medication. However, it is in violation of Good Medical Practice for a nurse practitioner to prescribe a drug to a friend, especially narcotics, such as dilaudid (hydromorphone) without conducting proper test and assessment as observed in the scenario 2 selected. Nonetheless, if the patient family arrests any prescription error, they have a legal obligation of reporting it to the legal justice system and notifying the administration of the health care system of the mistake. All the same, the patient has a legal and ethical obligation of attesting to the legal justice system of the error made by medical provider in their prescription during their treatment process. Doctors and nurses should only prescribe or repeat prescriptions if it only benefit needs of the patient and their health. Otherwise, it also vital to understand the medical history of the family before making a prescription a friend or family as observed in scenario 2, which can only be done in emergency situation.

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Disclosure and Non-disclosure Virginia Medical Practice Act prohibits family members practicing medicine to prescribe narcotics to their relatives, which can spark legal actions. Family Nursing Practitioners (FNPs) in the state of Virginia have legal obligation when found prescribing drugs to a family or friend as observed in the scenario 2. The administrative code in Virginia mandates health care providers to prescribe medication to a patient only in an authentic practitioners-patient relationship only by adhering to the appropriate code in Virginia in relations to self or family. Nursing practitioners are only allowed to prescribe schedule VI drugs to their family members as established in § 54.1-3455, both in advance and emergency situation that requires their immediate attention. They are also required to keep a record of the compliance detailing relevant statutory procedures for a bona fide practitioner- patient relationship, particularly pertaining to the family and self. However, in the state of Virginia, Nurses are not allowed to make prescription for themselves or family members, but can only do so in critical emergencies out of reach of other medical practitioners. Consequence of Dilaudid (Hydromorphone) Hydromorphone is a narcotic drug with long-term pharmacodynamic effects similar to morphine, such as nausea, vomiting, cough suppression, sedation, constipation, and cough suppression (Halo Pharmaceutical, Inc., 2016: Rosenthal & Burchum, 2017). During pharmacokinetics process, the drug binds itself on several opioid receptors, especially mu-opioid receptors that triggers side effects associated with morphine. The opioid receptors- the drug binds itself to, are connected with a G-protein that triggers guanosine triphosphate (GTP) to substitute guanosine diphosphate, which reacts with the adenylate cyclase contained in the plasma membrane

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National Center for Biotechnology Information). The impact of the latter process cause neuronal reactivity to diminish as well as hyperpolarization through stimulation of potassium channels. Hydromorphone can be administered orally, or through injections in targeted areas through subcutaneous, intravenous, and intramuscular routes. It effects become noticeable between 15 to 30 minutes of administration and prolongs up to 3 to 4 hours from the initial consumption (Halo Pharmaceutical, Inc., 2016). The metabolism processes of the drug take place in the liver, where glucoronidation changes it to hydromorphone-3-glucoronide. The drug also affects central nervous system, endocrine system, cardiovascular systems, and gastrointestinal tract. It also prevents the secretion of luteinizing hormone (LH), cortisol, and adrenocorticotropic hormone (ACTH). Abuse of opioid is associated with diminished libido from lack of androgen that is initiated due to its impact on the hypothalamic pituitary gonadal axis, subsequently contributing to erectile dysfunction, infertility, and impotence. Most of the drug ingested is absorbed in the body, with only a smaller percentage excreted through urine. Nearly 95 percent of the drug is metabolized to it active form in the liver and a smaller amount excreted out ( Halo Pharmaceutical, Inc., 2016). It is noteworthy to mention that hydromorphone should not be given to patients who

have allergic reaction to it or sulfites. More importantly, clinicians should avoid prescribing the drug to bronchial asthmatic patients because it can trigger respiratory arrest. Hydromorphone is also a serotonergic drug that triggers serotonin syndrome. Strategy for Decision-Making Study shows that hydromorphone users are prone to misuse, abuse, and addiction. Patients using the drug should be under constant supervision with a clear care plan to monitor their response before weaned off the drug slowly to prevent them from experiencing withdrawal

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effects. Based on the following information alone, as practicing nurse I would approach the nurse who gave her husband hydromorphone to discontinue supplying medications she is not allowed to prescribe to a family member or friend. Also, I will seek to find the circumstance under she has given the husband the medication and his medical history. If it not under an emergency, but for personal use- knowing the effects associated with abuse, I will recommend the nurse to put his husband under monitored care plan to wean him off the drug gradually. Secondly, based on the Virginia Medical Practices Act, I will report the nurse to the hospital administration since nurse practitioners are not recommended to make prescription in such situation, where there are other more qualified clinicians. She is only allowed under the Act to make prescriptions of substance VI drugs, but in emergency and situations where other medical practitioners are not easily accessible. Nurses are required to stick to the fidelity of their practices. The act of the nurse is also in violation of the hospital administration practice, which does not meet the criteria set forth in administrative code of Virginia. In both scenario, I will disclose the error to the nursing practitioner to help her avoid punishment or omission by the legal justice system. Process of writing prescription and strategies to minimize medication errors Before writing a prescription there are numerous issues that needs to be acknowledged, such as side effects, cost, current practice guideline, interactions of the medicine, and if the medication require monitoring (Duquesne University., 2020). It is also vital to select suitable therapy during the prescription process to minimize medical error ( Rosenthal & Burchum, 2017). However, there are specific ways of writing a prescription, such as writing the prescriber’s names, license number, contact information, and USA Drug Enforcement Administration (DEA) number.

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Besides, the clinicians are required to write the patient names, and date of birth during the prescription process. It is also essential to take note of any allergies reported with the patients that might interfere with their physiological processes (Rosenthal & Burchum, 2017). In addition to that, the clinician should also write the correct name of the drug/medication the patient should be taking and disease being treated. It is critical to write down the strength of the medication and frequency of the consumptions on a daily basis. Lastly, the number of capsules to be given is also essential, and number of refill before medication is discontinued. When writing a prescription, the clinician should avoid using decimals points, particularly when writing the strength of the drug, such as 5 mg, or 200 micrograms not 5.0 mg or 0.2 mg (National Center for Biotechnology Information). On top of that, specify write generics, and schedule written in English including the strength of the drug. Likewise, avoid using abbreviations for drugs, and minimum dosage per interval. Using the strategy above, a clinician can minimize error during prescription of drug in addition to giving the correct dosage. Using computer for prescription reduces the margin by 50 percent. In summary, it is illegal and unethical for a nurse in Virginia State to give a family or friend prescription of a narcotic. The act itself can lead to omission and revoking of nursing practice license. Hydromorphone is an opioid with similar side effects like morphine. It has high addiction rate in use, subject to it abuse and misuse. The drug can be administered orally or through injection to their patients. Abi-Aad KR (2019) states among serotonergic drugs, that contributes to serotonin syndromes due to their prolonged use.

ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS

References Abi-Aad KR, Derian A. (2019). Hydromorphone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470393/ Duquesne University. (2020). APRN’s Role in Ethical Prescribing | Duquesne University. Duquesne University School of Nursing. Retrieved 6 June 2020, from https://onlinenursing.duq.edu/blog/aprns-roleresponsibility-ethical-prescribing/. Halo Pharmaceutical, Inc. (2016). Highlights of Prescribing Information. Accessdata.fda.gov. Retrieved 6 June 2020, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019891s024,019892s029lbl.pdf.

National Center for Biotechnology Information. PubChem Database. Hydromorphone, CID=5284570, https://pubchem.ncbi.nlm.nih.gov/compound/Hydromorphone#section=2D-Structure (accessed on June 6, 2020) Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences. pp 4- 36

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