Drug Scheduling and Refill Requirements

A standard amount of medication to be administered.

Drugs with a low potential for abuse and dependence, like Xanax or Valium.

Drugs with the lowest potential for abuse and dependence, often used for cough or pain relief.

Pain resulting from damage to body tissues; for example a burn or appendicitis.

Pain caused by damage or dysfunction in the nerves. Examples include nerve damage from diabetes or cancer-related pain.

Pain with an unclear cause, often from conditions like recurring headaches.

Pain lasting less than one month.

Pain lasting 1-3 months.

Pain lasting more than 3 months.

Children often experience undertreated pain due to misconceptions about pain in infants, lack of assessment tools, difficulty quantifying pain, insufficient knowledge about pediatric pain treatment, and concerns about treatment time/effort and adverse effects.

Pain in children is multifaceted (physical/emotional) and makes kids/parents feel out of control. This worsens treatment.

Elderly pain management faces challenges including decreased kidney/liver function, risk of GI issues with NSAIDs, potential drug interactions, cognitive impairment, and needing adjusted medication doses.

Decreased renal and liver function in the elderly slows down how the body processes medications for pain.

Non-pharmacological methods are preferred during pregnancy and lactation, followed by acetaminophen. Opioids should be given in the lowest dose and for the shortest duration necessary.

Opioids cross the placental barrier, potentially increasing risks for neural tube defects, miscarriage, preterm birth, and stillbirth in the infant.

Prescribing opioids to family/friends raises ethical questions, as it demands a full evaluation and potentially risks a license. It might be beneficial for the person to get professional help.

Prostaglandins are important chemicals in the body involved in inflammation and pain signaling.

Blocking prostaglandins can reduce pain and inflammation, but may also have side-effects.

Medications taken when a migraine headache starts to relieve it.

Medications taken to prevent migraines from happening or to reduce their intensity or frequency.

Vasovagal response (fainting, lightheadedness) with pain or anxiety can occur.

Applied topically, for pain, but avoid contact with eyes and mucous membranes. Initially burning, then pain-reducing.

Treating neuropathic pain involves anticonvulsants (Gabapentin, Lyrica), TCAs (Amitriptyline), SNRIs (Cymbalta), and sometimes marijuana.

FDA-approved for chronic non-cancer pain, neuropathic pain, nausea/vomiting (from chemo), and other conditions.

Prescribers typically write a letter to the medical dispensary that is given along with the patient

A migraine treatment that selectively activates 5-HT receptors and reduces CGRP release.

Alters neurotransmitters, constricting intracranial blood vessels and inflammatory peptides.

Treatment for migraine, reducing inflammation and vasodilation (widening of blood vessels).

NSAIDs, Opioids, Triptans, Ergot Alkaloids, CGRP antagonists (Ubrogepant), Caffeine, and Anti-emetics (for Nausea)

Prostaglandins protect the mucosal lining and regulate hydrochloric acid secretion, causing renal and cardiac vasodilation, thus affecting blood flow.

Blocking prostaglandins can increase risks of cardiovascular disease (CVD) and gastrointestinal bleeding (GIB), depending on the drug and duration of use.

Constitutively expressed enzyme that always produces prostaglandins. Found in the lining of the stomach lining, Involved with gastric secretion.

An enzyme that produces prostaglandins in response to tissue damage or inflammation. It causes vasodilation (increased blood flow) at the site of injury.

Aspirin (ASA) inhibits thromboxane production in platelets, influencing blood clotting . The effect lasts for the life of the platelets (7-10 days).

Giving aspirin to children with viral illnesses, such as chickenpox, can cause Reye's syndrome.

Aspirin use is generally not recommended during pregnancy, especially high doses, as it may prematurely close the fetal ductus arteriosus.

Topical NSAIDs have lower serum concentrations but relatively high concentrations at the site of pain. They still have gastrointestinal bleeding risk, may lose effectiveness after a few weeks of use, and tend to be expensive.

Individuals with liver disease, those taking anticoagulants, heavy drinkers (more than 3 drinks/day) , should avoid acetaminophen due to potential risks.

Maximum adult dose of acetaminophen is 4,000 mg/day, but 3,000 mg/day for higher risks.

Combination products might contain medications the patient may not realize they're taking, resulting in unintentional overdose or allergic reactions.

Duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica) are the primary medications for fibromyalgia, explicitly approved by the FDA.

Medications, like cyclobenzaprine (muscle relaxant), might be used for fibromyalgia, but they are not first-line treatments and have varying FDA ratings (B or C).

Opioids are not considered effective for fibromyalgia treatment, and are given a C rating and are not first-line.

The CDC recommends individual pain management strategies; prioritizing non-opioid therapies; using opioids cautiously for acute pain and only when benefits outweigh the harms; and initially considering therapies like NSAIDs and exercise.

Clinicians should work with patients to adjust or taper opioid use, and offer naloxone (Narcan) along with opioid prescriptions.

Prescribing opioids should start with the lowest effective dose for the shortest duration possible.

Immediate-release opioids are preferred over extended-release or long-acting opioids, for initial prescriptions.

Mu receptors are associated with analgesia, respiratory depression, and feelings of euphoria when stimulated.

Kappa receptors, when stimulated, provide analgesia and sedation.

Agonists activate receptors, partial agonists partially activate receptors, and antagonists block receptor activation.

Affinity is the strength of a drug's connection to a receptor, while activation is the strength of the drug's impact on the receptor.

Naloxone has high affinity and blocks opioid receptor activation. This is stronger than the activation of an opiate agonist.

A standard amount of medication to be administered.

Drugs with low potential for abuse and dependence.

Drugs with the lowest potential for abuse and dependence.

Pain resulting from damage to body tissues.

Pain caused by nerve damage or dysfunction.

Pain with an unclear cause.

Pain lasting less than one month.

Pain lasting 1-3 months.

Pain lasting more than 3 months.

Classifying drugs based on their potential for misuse, abuse, and addiction.

Drugs with the highest potential for abuse and no accepted medical use.

Drugs with a high potential for abuse, leading to severe dependence, often with medical use.

Drugs with a moderate to low potential for abuse and physical/psychological dependence, allowing some refills.

Refill requirements differ based on drug schedule. Schedule I typically has few or no refill options.

The likelihood a drug will be misused, abused, or lead to addiction.

Children often experience inadequate pain management due to misconceptions about pain in infants, deficiencies in assessment tools, difficulty quantifying pain, insufficient knowledge of pediatric pain treatment, concerns about treatment time/effort and adverse effects.

Pain in children is complex (physical and emotional), causing children and parents to feel out of control. This complex pain makes treatment more challenging.

Elderly pain management is complicated by decreased kidney and liver function, increased risk of gastrointestinal issues with NSAIDs, potential drug interactions, cognitive impairment, and potential adjustments to initial dosages of medicine.

Reduced kidney and liver function in the elderly slows down the body's processing of medications, affecting pain management.

Non-pharmacological treatments are the first choice for pain management during pregnancy and lactation followed by acetaminophen . Opioids should be given at the lowest effective dose and for the shortest duration.

Opioids easily pass through the placental barrier, potentially increasing risks for birth defects, miscarriage, premature birth, and stillbirth for the infant.

Prescribing opioids to family or friends raises significant ethical concerns, requiring a full evaluation, and potentially risking medical licensure. It’s critical to encourage professional help.

Prostaglandins are important body chemicals that play roles in pain and inflammation.

Blocking prostaglandins reduces pain and inflammation but can have side effects like increased risk of cardiovascular disease and gastrointestinal bleeding, depending on type and duration of use.

Medications taken when a migraine starts to relieve it.

Medications taken to prevent migraines from happening or to reduce their intensity or frequency.

Medications used to relieve the pain of a gout attack.

Medications used to lower uric acid levels and prevent future gout attacks.

Duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica).

NSAIDs, Opioids, Triptans, Ergot Alkaloids, CGRP antagonists (Ubrogepant), Caffeine, and Anti-emetics.

Medications taken during a migraine attack to stop or ease the headache.

Medications taken regularly to reduce the frequency, intensity, or duration of migraines.

A vasovagal response (fainting, dizziness) can occur due to pain or anxiety.

Topical application for pain relief, but avoid eye and mucous membrane contact.

Treatments include anticonvulsants, TCAs, SNRIs, and sometimes marijuana.

Approved for chronic non-cancer pain, neuropathic pain, chemotherapy-related nausea, and other conditions.

A letter from a prescribing doctor to a medical dispensary.

A migraine treatment that acts on specific brain receptors.

Alters brain chemicals, constricts blood vessels, and reduces inflammation in migraines.

Reduces brain inflammation and blood vessel widening in migraines.

These medications are taken when a migraine is occurring to ease the pain.

4000mg/day, but 3000mg/day with liver/alcohol concerns.

Multiple medications in one product may lead to unintended overdoses or reactions.

Older antihistamines that have a quick onset (15-30 minutes) but significant anticholinergic side effects.

Newer antihistamines with less sedative effects, focusing on H1-histaminic receptors.

Antihistamines block histamine from binding to its receptors, reducing allergic symptoms.

Side effects of antihistamines due to their action on muscarinic receptors, not just histamine.

Drying mucous membranes and secretions due to anticholinergic action, not directly targeting histamine.

Antihistamines may offer slight relief from symptoms but do not target the underlying cause; they do not treat the actual infection.

Medications that block the H1 histamine receptors.

Antihistamines do not prevent the release of histamine from mast cells or basophils.

Over-the-counter medications that relieve nasal congestion by constricting blood vessels in the nasal passages.

A rebound effect from overuse of nasal decongestants, resulting in worsening nasal congestion.

Medications taken by mouth that relieve nasal congestion by constricting blood vessels in the nasal passages.

Medications used to prevent or relieve coughs, often non-productive ones.

Medications that thin respiratory secretions, making coughs more productive and easier to clear.

Unwanted or harmful effects of a medication, ranging from mild to severe.

The act of medically reducing or stopping a cough

Factors to consider when selecting or administering medications (especially concerning patient history, potential side effects, and duration of use).

A medication used to treat allergies and asthma, blocking leukotrienes to relieve symptoms.

Chemicals that trigger allergic reactions and nasal congestion.

Medications that reduce nasal inflammation by suppressing inflammatory mediators.

Using a medication in addition to other treatments, often leading to better symptom control.

A crucial safety alert about potential serious side effects such as suicidal thoughts or behavior.

Inflammation of the nasal passages due to an allergic reaction.

Treatment for allergic rhinitis, very effective when used continuously.

The effectiveness of a medication in reducing the severity of allergy symptoms.

Not a first-line treatment for rhinitis during pregnancy but may be used for short-term relief of acute congestion when other methods fail. Should preferably use nasal routes first.

A category C nasal spray decongestant suitable for short-term use (not more than 3 days) due to potential rebound congestion. Use caution in pregnancy.

Category C decongestant. Possibly linked to gastroschisis risk in first trimester, generally safe in the second and third. Usage may decrease milk production.

Safety of decongestant use during breastfeeding (lactation) is largely unknown, so caution is advised.

Safety of phenylephrine use in pregnancy is varied in some literature, with some sources claiming it might cause fetal hypoxia.

Some medications, like those with questionable effectiveness in infants, should be completely avoided and any possible risks avoided. Especially if infant exposure from maternal intake is likely smaller than when given directly.

Non-pharmacological treatments are recommended first in pregnancies during pregnancies, followed by acetaminophen. Opioids should be used cautiously.

Decongestants can be used to relieve acute congestion after other methods have been tried, ensuring that the use is kept short-term (less than three days).

Some antihistamines, particularly those structurally similar to Benadryl, might pass into breast milk and cause sedation or paradoxical CNS stimulation in infants. Safer, non-sedating options are preferred.

While some sources suggest codeine's safety during pregnancy, concerns exist, especially in the first trimester, about potential fetal malformations.

Codeine use during breastfeeding may cause drowsiness and sedation in newborns due to their sensitivity to even small amounts.

Antitussives like codeine, guaifenesin, and dextromethorphan may have associated fetal effects but are generally ineffective; avoiding those during pregnancy is usually the best choice.

The use of any narcotic during breastfeeding can lead to infant drowsiness and sedation.

Both guaifenesin and dextromethorphan are classified as pregnancy category C.

Antitussives are often ineffective in managing coughs, especially during pregnancy.

Limited research exists on guaifenesin's presence in breast milk and its effects on breastfed infants.

Systemic availability of drugs after inhalation by a pregnant person is generally low.

Drugs that have shown to present no direct evidence of harmful effect but may have risks during pregnancy and lactation.

Start with first-generation, sedating antihistamines for pregnancy, unless sedation is a problem. These have been thoroughly studied during pregnancy and are generally considered safe.

Chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), and doxylamine (Unisom SleepTabs) are examples of such type of medications, generally considered safe.

Small, occasional doses of some antihistamines are possibly safe while breastfeeding, but larger doses or prolonged use may pose risks (infant sedation, reduced milk supply).

Non-sedating 2nd-generation antihistamines are generally preferred during breastfeeding, especially in newborns or premature infants, to avoid sedation.

Cetirizine (Zyrtec), a 2nd generation antihistamine, is generally considered safe in pregnancy and lactation in small, occasional doses, but can reduce milk supply, especailly when paired with sympathomimetics.

Doxylamine, an antihistamine, has been researched thoroughly during pregnancy and is generally considered safe.