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Fitzgerald Health Education Associates, Inc., January 2015 fhea.com
News Briefs
the action of orexin in the brain. It is a Schedule-IV
controlled drug because it can be abused or lead to
dependence.
To allow clinicians to find the best dose to treat
each individual patient's sleeplessness, suvorexant is
available in four different strengths (5 mg, 10 mg, 15
mg, and 20 mg). The drug is to be used at the lowest
effective dose to reduce the risk of side effects such
as next-morning drowsiness. The prescribing infor-
mation notes that suvorexant should be taken no
more than once per night, within 30 minutes of go-
ing to bed, with at least 7 hours remaining before
the planned waking time. Total dose should not ex-
ceed 20 mg once daily.
Three clinical trials of suvorexant in more than 500
participants demonstrated the new drug's effective-
ness. The most common adverse event reported by
participants taking suvorexant was drowsiness. Ac-
cording to the FDA, insomnia medications can cause
next-day drowsiness and impair driving and activities
requiring alertness, and people can be impaired even
when they feel fully awake. Patients should be cau-
tioned against next-day driving or activities requiring
full mental alertness after taking the 20-mg strength.
As is the case with other sleep medications, there
is a risk with suvorexant of sleep-driving and other
complex behaviors while not being fully awake. The
drug will be dispensed with an FDA-approved pa-
tient Medication Guide that provides instructions for
At the same time, solid evidence shows that NPs
who follow the traditional path of completion of a
formal NP program, certification, and licensure pro-
vide safe and effective care with excellent out-
comes without completing a residency program,
and there is scant evidence that postgraduate resi-
dencies affect patient care. Nonetheless, the 2010
Institute of Medicine report " The Future of Nursing"
recommended the rapid expansion of residency
programs, with the implication that they become a
mandatory part of education for entry-level NP
practice: "State boards of nursing, accrediting bod-
ies, the federal government, and health care organ-
izations should take actions to support nurses'
completion of a transition-to-practice program
(nurse residency) after they have completed a preli-
censure or advanced practice degree program or
when they are transitioning into new clinical prac-
tice areas."
2,4
For such recommendations to become a reality,
policymakers would have to address the issue of
funding, as money is needed for preceptors, resident
stipends, and administrative costs. And, as these
programs evolve, researchers will need to evaluate
their impact on patient care.
•
References
1. Nicely KL, Fairman J. Postgraduate nurse practitioner resi-
dency programs: supporting transition to practice. Acad Med.
2014;Dec 30. [Epub ahead of print]
2. The Institute of Medicine. The future of nursing: leading
change, advancing health. 2011. Available at: http://
www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-
Change-Advancing-Health.aspx.
3. Flinter M. From new nurse practitioner to primary care
provider: bridging the transition through FQHC-based resi-
dency training. Online J Issues Nurs. 2011;17(1):6.
4. Boyar KL. Nurse practitioner residency programs and
healthcare reform. Advance Healthcare Network for NPs &
PAs. Available at: http://nurse-practitioners-and-physician-
assistants.advanceweb.com/Features/Articles/Nurse-
Practitioner-Residency-Programs-and-Healthcare-Reform.aspx.
Residency & Fellowship Programs Continued from page 3
Continued on page 15