Drug Scheduling and Refills
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Questions and Answers

What is the primary reason drugs are scheduled or controlled?

  • Potential for use, misuse, and addiction (correct)
  • To ensure availability for research
  • To promote their medical usage
  • To limit the number of prescriptions

Which schedule includes drugs with the highest potential for abuse and no accepted medical use?

  • Schedule IV
  • Schedule III
  • Schedule II
  • Schedule I (correct)

Which of the following is an example of a Schedule II drug?

  • LSD
  • Diazepam
  • Codeine
  • Adderall (correct)

What is the refill policy for Schedule III drugs?

<p>Up to 5 refills permitted (D)</p> Signup and view all the answers

How must prescriptions for Schedule II drugs be handled?

<p>Written RX must be provided within 72 hours (B)</p> Signup and view all the answers

What effect typically characterizes drugs in Schedule I?

<p>Severe psychological or physical dependence (D)</p> Signup and view all the answers

Which of these drugs is classified under Schedule III?

<p>Vicodin (D)</p> Signup and view all the answers

Which statement is true regarding Schedule II drugs?

<p>They have a high potential for abuse. (B)</p> Signup and view all the answers

Which medication is classified as an FDA-approved primary treatment for fibromyalgia?

<p>Duloxetine (B)</p> Signup and view all the answers

What is the primary goal of the CDC guidelines on prescribing opioids?

<p>Tailor pain management to the individual needs of the patient (B)</p> Signup and view all the answers

Which receptor is primarily associated with analgesia and euphoria when activated?

<p>Mu receptor (B)</p> Signup and view all the answers

What does 'activation' of a receptor refer to?

<p>The intensity of the biological response following receptor binding (D)</p> Signup and view all the answers

Which non-opioid treatment options does the CDC recommend to consider first for pain management?

<p>NSAIDs and exercise (C)</p> Signup and view all the answers

What common side effect is associated with the local anesthetic lidocaine?

<p>Vasovagal response with pain/anxiety (C)</p> Signup and view all the answers

What is the recommended practice when starting opioid therapy according to the CDC?

<p>Begin with the lowest effective dose for the shortest time (B)</p> Signup and view all the answers

Which medication has a very strong affinity but blocks receptor activation?

<p>Naloxone (Narcan) (D)</p> Signup and view all the answers

What is important patient teaching when prescribing capsaicin?

<p>Avoid contact with eyes or mucous membranes (B)</p> Signup and view all the answers

Which medications are considered best for treating neuropathic pain?

<p>Anticonvulsants and TCAs (A)</p> Signup and view all the answers

What is a common misconception about the effectiveness of opioids for chronic pain management?

<p>Opioids are the best treatment for all chronic pain (C)</p> Signup and view all the answers

What conditions does medical marijuana have FDA approval for?

<p>Chronic non-cancer pain and epilepsy (D)</p> Signup and view all the answers

What distinguishes acute/abortive treatment from prophylactic treatment of migraines?

<p>Acute/abortive medications are used at the time of headache onset (D)</p> Signup and view all the answers

Which of the following is a possible effect of sumatriptan when used for migraine treatment?

<p>It suppresses CGRP release and constricts blood vessels (B)</p> Signup and view all the answers

What is the role of anti-emetics in migraine treatment?

<p>They reduce nausea and aid gastric mobility (D)</p> Signup and view all the answers

Which product is classified as a THC product used for appetite stimulation?

<p>Marinol (dronabinol) (C)</p> Signup and view all the answers

Which of the following medications is classified as a beta blocker used for managing headaches?

<p>Propranolol (A)</p> Signup and view all the answers

What is the primary purpose of prophylactic treatment for gout?

<p>To prevent future gout attacks by lowering uric acid levels (B)</p> Signup and view all the answers

Which medication is NOT one of the FDA-approved treatments for fibromyalgia?

<p>Probenecid (D)</p> Signup and view all the answers

Which of the following treatments is effective in augmenting the inhibitory effects of GABA for headache management?

<p>Amitriptyline (A)</p> Signup and view all the answers

What is the function of calcitonin gene-related peptide (CGRP) antagonists in headache treatment?

<p>To prevent inflammation and vasodilation (C)</p> Signup and view all the answers

Which of the following is a glucocorticoid used to manage acute gout pain?

<p>Prednisone (B)</p> Signup and view all the answers

What is a common alternative treatment for migraine prevention based on good data?

<p>Magnesium citrate (A)</p> Signup and view all the answers

Which of the following medications inhibits uric acid formation in the body for prophylactic gout treatment?

<p>Allopurinol (B)</p> Signup and view all the answers

What is the primary function of prostaglandins regarding the gastrointestinal (GI) tract?

<p>Protect the mucosal barrier (B)</p> Signup and view all the answers

Which demographic is at the highest risk for gastrointestinal bleeding (GIB) when using NSAIDs?

<p>Patients over 65 years (C)</p> Signup and view all the answers

Why should aspirin (ASA) be avoided in children?

<p>It can lead to Reye’s syndrome (C)</p> Signup and view all the answers

What happens to the effects of ASA when used concurrently with NSAIDs?

<p>The clotting effects of ASA are reduced (A)</p> Signup and view all the answers

What distinguishes Cox-1 from Cox-2 enzymes?

<p>Cox-1 has roles in gastrointestinal protection (A)</p> Signup and view all the answers

What is a potential problem associated with the long-term use of topical NSAIDs?

<p>Risks of gastrointestinal bleeding remain (B)</p> Signup and view all the answers

Who is advised to avoid acetaminophen?

<p>Individuals with liver disease (B)</p> Signup and view all the answers

What is the maximum daily dose of acetaminophen recommended for an adult?

<p>4,000 mg (B)</p> Signup and view all the answers

What is the primary function of a prescription drug monitoring program (PDMP)?

<p>To track controlled substance prescriptions for patient safety (C)</p> Signup and view all the answers

Which of the following is NOT a component of a pain management agreement?

<p>The patient has the right to choose any pharmacy (D)</p> Signup and view all the answers

Why can administering an opioid receptor partial agonist cause withdrawal symptoms in an opioid-addicted individual?

<p>It may displace other opioids from the receptors (D)</p> Signup and view all the answers

Which substance is known to prolong the QT interval?

<p>Methadone (D)</p> Signup and view all the answers

What is an important consideration for the safe storage of opioid medications?

<p>They need to be stored in a locked place away from children and pets (B)</p> Signup and view all the answers

How might information from PDMPs assist healthcare providers?

<p>By indicating if a patient is misusing medication through prescription patterns (C)</p> Signup and view all the answers

What is a potential consequence for a patient who does not follow the terms outlined in a pain management agreement?

<p>Discontinuation of opioid medications (A)</p> Signup and view all the answers

What is a critical aspect of overdose awareness in patients using opioids?

<p>Patients should be aware of the signs of overdose and have Narcan available if prescribed (A)</p> Signup and view all the answers

Flashcards

Drug Scheduling

A system to categorize drugs based on their potential for abuse and medical use.

Drug Scheduling Levels

Drugs are categorized into different schedules (I, II, III) based on their potential for abuse and addiction, medical use, and refill requirements.

Schedule I Drugs

High potential for abuse, no accepted medical use, severe psychological/physical dependence risk, and high potential for overdose and death.

Schedule II Drugs

High potential for abuse leading to severe psychological or physical dependence, but with some medical use.

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Schedule III Drugs

Moderate to low potential for abuse and dependence, with some medical uses.

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Refills for Schedule I Drugs

Generally, no refills allowed.

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Refills for Schedule II Drugs

Limited refills, and new written prescription required.

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Refills for Schedule III Drugs

Up to 5 refills are allowed, but a new written prescription might be required after 6 months.

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Prostaglandins' role

Prostaglandins protect the stomach lining and regulate blood flow, especially in the kidneys and heart.

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Blocking prostaglandins, risk

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

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COX-1 vs. COX-2

COX-1 is constantly present and involved in stomach lining protection, while COX-2 is induced in response to tissue damage and is involved in inflammation and pain response.

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Topical NSAIDs, concern

Topical NSAIDs provide higher concentrations at the pain site but might cause GI bleeding, lose effectiveness over time, and are expensive.

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Acetaminophen avoidance

Acetaminophen should be avoided by individuals with liver disease, those on blood thinners, and heavy drinkers.

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Max acetaminophen dosage

The maximum daily dose of acetaminophen for adults is 4,000 mg, with 3,000 mg for those with higher risk of toxicity.

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Combination products, concern

Combination products may include drugs a patient might not recognize, increasing the risk of accidental overdose or allergic reactions.

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ASA/NSAID avoidance in kids

Avoid ASA in children due to the risk of Reye's syndrome, typically associated with viral illnesses.

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ASA/NSAID in pregnancy

Avoid ASA in pregnancy, especially past 150mg/day, due to the risk of premature closure of the ductus arteriosus in the third trimester.

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ASA/NSAID in older adults

Older adults may have a higher risk of gastrointestinal bleeding and cardiovascular disease when using ASA/NSAIDs,and should be cautious due to drug interactions.

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NSAIDS and blood clotting

NSAIDs can reduce the blood-thinning effects of aspirin (ASA).

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Acute migraine treatment

Medication given at the onset of a migraine.

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Prophylactic migraine treatment

Medication that reduces the frequency, intensity, and duration of migraines.

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Local anesthetic lidocaine side effect

Vasovagal response, with pain and anxiety.

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Capsaicin patient teaching

Avoid contact with eyes and mucous membranes; child safety; do not take orally.

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Neuropathic pain treatment

Anticonvulsants (e.g., Gabapentin, Lyrica), TCAs (e.g., Amitriptyline), SNRIs (e.g., Cymbalta), and marijuana.

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Medical marijuana FDA-approved uses

Chronic non-cancer pain, neuropathic pain, chemo-induced nausea and vomiting, multiple sclerosis, epilepsy, HIV/AIDS, glaucoma, PTSD, Alzheimer's-related agitation.

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Medical marijuana recommendation process

The prescribing doctor sends a recommendation letter to the medical dispensary.

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Triptans (e.g. Sumatriptan)

Selective activation of 5HT receptors, constriction of blood vessels

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Ergot Alkaloids (Ergotamine)

Alters neurotransmitters, constricts blood vessels and inflammatory peptides

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CGRP Antagonists (e.g. Ubrogepant)

Reduces inflammation and vasodilation

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Fibromyalgia Medications

FDA-approved medications for fibromyalgia include Duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica).

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Off-Label Fibromyalgia Medications

Some medications, like cyclobenzaprine (muscle relaxant), are used for fibromyalgia but aren't FDA-approved as a first-line treatment for fibromyalgia.

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Opioids for Fibromyalgia

Opioids are not recommended as a first-line treatment for fibromyalgia because they have not demonstrated effectiveness and carry significant risks.

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CDC Opioid Prescribing Guidelines

The CDC recommends an individual approach, prioritizing non-opioid therapies, starting with lowest effective dose, and prescribing immediate-release opioids.

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Opioid Receptors

Opioids work by affecting mu and kappa receptors in the brain, leading to analgesia (pain relief), respiratory decrease, euphoria, and sedation.

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Opioid Receptor Types

Mu receptors primarily produce pain relief, respiratory depression, and euphoria. Kappa receptors primarily produce pain relief and sedation.

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Naloxone (Narcan)

Naloxone is an opioid antagonist used to reverse opioid overdose.

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Patient Education for Opioids

Patient education on opioids should include their risks, benefits, alternatives, and proper usage.

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Opioid + ETOH effect

Combining opioids with alcohol increases the risk of respiratory depression.

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Overdose S/sx

Signs and symptoms of an opioid overdose include slowed breathing or altered mental status.

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Narcan use

Narcan (naloxone) can reverse opioid overdose effects.

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PDMP/PDMS (Prescription Monitoring)

An electronic database tracking controlled substance prescriptions.

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PDMP benefits

PDMPs can identify overdose risks, and help in medication care transitions.

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Pain contracts

Written agreements between patient and provider detailing opioid use.

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Opioid receptor partial agonist withdrawal

A partial agonist can trigger withdrawal despite prescribing an opioid, due to receptor affinity.

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Drugs causing QT interval prolongation

Methadone and cocaine can lengthen the QT interval.

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Opioid use in preconception

Opioid use during preconception may have negative effects on development.

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Safe opioid disposal

Proper methods to dispose of unused opioids for safety and environmental protection.

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Safe opioid storage

Storing of opioids to prevent accidental use by children and pets

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Abortive Headache Treatment

Medications used to stop an ongoing headache attack quickly.

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Beta-blockers for HA

Prevent arterial dilation, easing headache pain.

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Antiseizure agents for HA

Broadly reduce seizures & possibly help headaches.

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TCAs for HA

Block neurotransmitters, possibly helping with headache pain.

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CGRP antagonists for HA

Reduce inflammation and vasodilation in the brain to treat headaches.

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Estrogen withdrawal HA

Headaches related to fluctuating estrogen levels, often managed with hormone replacement or birth control.

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Botox Injection

Inhibits the release of acetylcholine, potentially helping some headache types

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Acute Gout Treatment

Drugs to relieve the pain and inflammation of a gout attack.

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Prophylactic Gout Treatment

Drugs that help prevent future gout attacks by lowering uric acid levels.

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NSAID for Gout

Pain reliever and anti-inflammatory typically used to treat acute gout attacks.

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Glucocorticoids for Gout

Another type of anti-inflammatory used for the treatment of acute gout.

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Colchicine for Gout

Reduces white blood cells in the joint cavity to help reduce inflammation and pain in gout. Also used for prevention.

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Canakinumab (Ilaris)

Inhibits a pro-inflammatory cytokine to reduce inflammation, used in prophylactic gout treatment

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Allopurinol (Zyloprim)

Inhibits xanthine oxidase, reducing uric acid production - used for prophylactic gout.

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Probenecid (Probalan)

Increases uric acid excretion to lower uric acid levels, used in prophylactic gout treatment.

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Fibromyalgia Treatment (Milnacipran)

Decreases pain and fatigue, improving function.

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Fibromyalgia Treatment (Duloxetine)

SNRI, useful for pain, fatigue, & may treat concomitant depression.

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Fibromyalgia Treatment (Pregabalin)

Anticonvulsant that improves pain, fatigue, sleep, & overall well-being.

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Opioid/Muscle Relaxant Evidence for Fibromyalgia

Limited evidence supports their routine use in Fibromyalgia treatment- careful consideration of risks vs benefits is required.

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Study Notes

Drug Scheduling and Refills

  • Drugs are scheduled based on their potential for abuse, misuse, and addiction.
  • Schedule I drugs have the highest abuse potential and no accepted medical use.
  • Schedule II drugs have a high potential for abuse and are used medically with strict restrictions on refills. Refills for Schedule II drugs must always be written, and in an emergency, a phoned-in RX within 72 hrs is acceptable (but a new written RX is needed).
  • Schedule III drugs have a moderate abuse potential and are used medically. Refills are allowed up to 5, but can be phoned in or faxed in, and the RX is valid for 6 months.
  • Schedule IV drugs have a low abuse potential and are used medically. Refills are allowed up to 5, but can be phoned in or faxed, and the RX is valid for 6 months.
  • Schedule V drugs have the lowest abuse potential and are used medically. Refills are allowed up to 5, but can be phoned in or faxed, and the RX is valid for 6 months.

Types of Pain

  • Nociceptive Pain: This type of pain is due to damage to tissues. Examples include arthropathies, ischemic disorders, myalgias, skin and mucosal damage from burns, etc.
  • Neuropathic Pain: Nerve pain, often caused by damage or dysfunction of the nerves. Examples include conditions like neuropathies (alcoholism, diabetes), cancer-related pain, regional pain syndromes, HIV, multiple sclerosis, postherpetic neuralgia, trigeminal neuralgia, and post-CVA pain.
  • Mixed or Undetermined Etiology Pain: A combination of factors, often chronic in nature, with no clear single cause. Examples include chronic recurrent headaches and vasculitis.

Pain Management in Pregnancy and Lactation

  • First-line pain management during pregnancy and lactation should be non-pharmacological methods.
  • If pharmacological treatment is necessary, opioids should be used at the smallest dose for the shortest time period possible.
  • Opioid use carries increased risks in pregnancy, including neural tube defects, miscarriage, preterm birth, and stillbirth.
  • Opioid use during pregnancy can affect newborns requiring possible resuscitative measures.

Acetaminophen

  • Maximum adult dose is 4,000mg per day.
  • Risk of toxicity increases for those with certain health conditions, and for those who ingest large amounts.
  • Combination products containing acetaminophen may not be understood by patients, leading to unintentional overdoses.
  • Educate patients on safe usage of this medication, including storage and dosages.

###Local Anesthetic Lidocaine

  • Vasovagal response (fainting, nausea, lightheadedness) can occur.

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Description

This quiz covers the scheduling of drugs based on their potential for abuse, misuse, and addiction. Learn about the different schedules from I through V, including their medical usage and regulations regarding refills. It's essential for those in healthcare to understand these classifications for safe prescribing practices.

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