PMHNP prescribing questions

[Joebird21]

So I am just curious if a PMHNP can ever prescribe any non psych medications in certain situations?

For example, an elderly patient has a ua done to r/o a uti due to a change in mental status. The ua comes back positive.... does the pmhnp go ahead and order an antibiotic? I know of psychiatrists that will.

If a patient is in pain are there any type of pain meds a pmhnp would be OK with ordering? Or medications that will alleviate side effects of a prescribed psychotropic (ie colace for constipation, etc?) Or what about refilling routine meds? (Simvastatin, etc?)

Lastly, are all abnormal labs referred to a pcp?

Sorry, probably dumb questions, but I am just curious.......

[ThePsychWhisperer, BSN, MSN, APRN, NP]

4 hours ago, TheNietzsche said:

I'm surprised to hear that. Perhaps its regional. Can you refer out to ECT if absolutely necessary or is it really that hard to find? I'm thinking of the very severe cases, e.g., catatonia, what do you do in those instances.

In cases of catatonia, I'm limited to hitting it hard and fast with antipsychotics/benzodiazepines if I'm having to provide care solely at my facility. We can refer out, but to my knowledge, we have one local OP provider of ECT, and Vanderbilt is the nearest IP facility to me, and I'm in Knoxville, TN. It may be there are others out there, and they're just not on my radar. In fact if that's the case, someone please correct me.

[Angeljho, MSN, NP]

I work in a psych clinic. I do prescribe docusate, glycopyrrolate, etc, especially for clozapine related side effects. I will also prescribe meds like propranolol if needed. I will NOT prescribe antibiotics or treat anything not psych related or psych side effect related. At my clinic, the psych director challenges all prescribing clinicians to think outside the box. For instance, studies have shown that low vit D is linked to worsening cognition in clients with psychosis. So, I will check vit D levels in respective clients (mostly AA) and prescribe accordingly.

[myoglobin, ASN, BSN, MSN]

I would also add that I read (just yesterday in reviewing Stahl/ and clozapine) that he advises that clinicians consider prophylactic metoprolol for patients on clozapine. Also, I was just listening to a podcast, psychotherapy and psychopharmacology with Dr. Puder and Dr. Cummings https://psychiatrypodcast.com/psychiatry-psychotherapy-podcast/2019/6/19/clozapine-and-schizophrenia-with-dr-cummings (free on Itunes) that their clozapine patients often need to be on two or three anti constipation medications. Thus, I would argue that not to at least consider these medications (in the setting of certain medications like clozapine) borders on malpractice.