As registered prescribers, Nurse Practitioners must stay on top of the latest news in the world of pharmacology. In this article, we answer some burning questions that cover today’s most widely discussed topics in the field. Today’s questions relate to the ongoing discussions around best practices for the pharmacologic management of Type II Diabetes and mitigating risks in opioid prescribing. Nurse Practitioners are also advised to stay on the lookout for impending changes in the world of medical marijuana.
What’s new in type II diabetes management?
Every year, the American Diabetes Association (ADA) publishes the Standards of Care in Diabetes. These contain updated research-based recommendations on diagnosis and treatment of Diabetes. This year, the Standards of Care included several important pharmacologic updates.
Related: RX Essentials |Diabetes Update: Focus on the Latest Recommendations
What are the new pharmacologic recommendations for diabetes management and weight loss?
The new guidance recommends that providers treat patients who have diabetes and obesity with a glucagon-like peptide 1 (GLP-1) receptor agonist or the dual-action GLP-1 and glucose-dependent insulinotropic polypeptide medication Tirzepatide.
Tirzepatide is the first drug in a new class known as “twincretins.” These are so-called for the double ability first to control blood glucose levels and second to promote weight loss. The Federal Drug Administration (FDA) approved this drug in November 2023. Healthcare professionals are hailing this as a potentially very powerful weapon in the fight against Type II Diabetes.
Consider other weight loss management drugs if this medication does not help the patient achieve their weight loss/management goals.
What are the new guidelines for managing diabetes and comorbidities?
Another key pharmacologic update for Nurse Practitioners in Diabetes management involves screening for and management of comorbidities. First, guidelines recommend the COVID-19 vaccine and boosters for all patients 6 years and older, including those with diabetes.
Second, recommendations call for an additional assessment of bone health for patients with diabetes-specific risk factors. Because diabetes may increase the risk of osteoporosis, patients with diabetes may be candidates for pharmacologic prevention of osteoporosis.
What is the new weight assessment recommendation for diabetes care?
The 2024 Standards of Care lists new recommendation for weight assessment. In the past, providers have relied on body mass index (BMI) to diagnose obesity. However, BMI can often be a misleading measurement for certain body types.
For this reason, assess patients with diabetes according to body fat distribution measurements. This may include waist circumference, waist-to-hip ratio, and weight-to-height ratio. Providers should assess patients with diabetes annually. Monitor these metrics over time as part of their diabetes management.
Opioid prescribing: What’s new in controlled substances?
From opioids to marijuana, there is always something new happening in the world of controlled substances. As authorized prescribers, Nurse Practitioners must stay up to date on changing regulations around controlled substances.
Related: 8-hour DEA Registration and Controlled Substance Prescribing Course
Is marijuana being rescheduled?
It is likely that marijuana will soon be rescheduled. This is in accordance with the scientific community’s consensus on the risks and benefits of marijuana use for medical purposes. In May 2024, the U.S. Department of Justice submitted a Proposed Rule to reschedule marijuana from Schedule I to Schedule III. This would move it from a category with “no accepted medical use” to arguably the most commonly prescribed drug category.
Schedule III substances include the five therapeutic categories of stimulants, opioids, depressants, hallucinogens, and corticosteroids. Many Nurse Practitioners in certain states might already be familiar with the process. Previously, they may have certified medical marijuana for patients with chronic pain, nausea caused by cancer treatment, and more.
What this rescheduling means for Nurse Practitioners’ Scope of Practice has yet to be determined. It will likely be a long process that differs from state to state.
What are the new opioid use disorder (OUD) prescription recommendations?
At the end of 2022, lawmakers passed two laws that affected opioid prescribing:
- The Mainstreaming Addiction Treatment (MAT) Act
- The Medication Access and Training Expansion (MATE) Act
These expanded buprenorphine prescribing authority to any prescriber registered with the Drug Enforcement Administration (DEA).
Experts recommend that all patients with OUD receive a 30-day prescription of buprenorphine. Also of note is that the law added the ability for prescribers to prescribe buprenorphine to patients treated via telemedicine. This is an essential step in managing the opioid epidemic. It is key for Nurse Practitioners who work in telemedicine.
In March of 2024, the DEA issued a letter to pharmaceutical companies asking them to reexamine thresholds for orders. This would ensure that pharmacies have enough supply to meet the demand of patients with OUD. Pharmacies will likely soon be able to handle larger dispensing demand for this life-saving medication. If you work with patients with opioid use disorder, this update comes as a welcome announcement.
What are the new exclusions to the opioid prescription guidelines?
In their 2022 update, the Centers for Disease Control and Prevention (CDC) released a list of exclusions. This came out alongside their updated guidelines for opioid prescribing. This list was long-awaited and necessary. The original guidelines left Nurse Practitioners unable to meet the long-term pain management needs of patients with chronic conditions or terminal illnesses.
The exclusions outlined in the 2022 update allow opioid prescription under a different level of scrutiny. This allows providers to better care for patients with unique circumstances and ensure quality of life. These circumstances are for pain management related to sickle cell disease, cancer, or cancer treatment. Providers may make exceptions for palliative and end-of-life care. If you are a Nurse Practitioner working with these patients, this exclusion is an important update in opioid prescribing. It will help you ensure your patients get the pain relief they need.
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