List 3 common classes and examples of drugs often prescribed as ADJUNCTIVE first line therapies in combination with analgesics, opioids, and non-opioid for pain
Anticonvulsants: Neuropathic pain (gabapentin, pregabalin) * check renal function
Antidepressants: neuropathic pain, co-analgesic for cancer pain, concurrent treatment of depression (TCA-amitriptyline *caution with ederly, cardiac; SSRI- paroxetine; SNRI- Venlafaxine-liver
Local anesthetics: topic/local discomfort, neuropathic pain- lidoderm patch, lidocaine injections
Steroids: inflammatory neuropathic pain, chronic cancer pain; short term only (IE Dexamethasone)
Muscle Relaxants: temporary relief of acute muscle injury
Which DEA schedule has the least potential for abuse?
Schedule V
Which DEA schedule has the most potential for abuse?
Schedule II
What are the COMMON side effects of opioid medications?
constipation, dry mouth, nausea, vomiting, drowsiness, confusion, tolerance, physical dependence, withdrawal symptoms
What is the maximum dose of Lidocaine into a subcutaneous site at one time?
What drug can be added to Lidocaine for subcutaneous injection to potentiate its effects?
Lidocaine without epinephrine: 4.5 mg/kg, max 300mg or 30 mL
Lidocaine with epinephrine: 7g/kg, max 500 mg or 50mL of Lidocaine 1%
Can nurse practitioners furnish or prescribe drugs or devices to family members or friends?
No
Certified NPs who hold active prescribing or furnishing licenses and valid DEA registration numbers can prescribe or order controlled substances from what schedules?
Schedule II-V
What are the criteria for being classified as dangerous controlled substance drugs by the federal Drug Enforcement Agency (DEA)?
Substances are placed in their respective schedule based on their relative abuse potential and likelihood of causing dependence when abused
- What controlled schedules (I, II, III, IV, V) are the following drugs?
Methylphenidate (Ritalin)
Diazepam (Valium)
Lomotil
Marijuana (THC)
Fentanyl (Duragesic)
Morphine
Guaifenesin/Hydrocodone (Hycotuss)
Acetaminophen/Hydrocodone (Norco, Vicodin)
AndroGel (Testosterone)
Phentermine
Alprazolam (Xanax)
Carisoprodol (Soma)
Zolpidem (Ambien)
Adderall (amphetamine/dextroamphetamine)
Methadone
Methylphenidate (Ritalin): II
Diazepam (Valium): IV
Lomotil: V
Marijuana (THC): I
Fentanyl (Duragesic): II
Morphine: II
Guaifenesin/Hydrocodone (Hycotuss): II
Acetaminophen/Hydrocodone (Norco, Vicodin): II
AndroGel (Testosterone): III
Phentermine: IV
Alprazolam (Xanax): IV
Carisoprodol (Soma): IV
Zolpidem (Ambien): IV
Adderall (amphetamine/dextroamphetamine): II
Methadone: II
- Vicodin has been changed from a Schedule ? to a Schedule ? drug due to its increased risk of abuse and addiction.
Schedule III to a Schedule II
- List two (2) different Schedule I substances (of which NPs are not permitted to prescribe).
- Heroin and marijuana
- What class of pain medications typically should not be ordered for a renal-impaired patient (GFR < 50 ml/min)?
- NSAIDs
According to the Pharmacotherapeutics for Advanced Practice Providers textbook, among ultra rapid metabolizers who carry copies of the CYP2D6 gene, codeine is unusually effective and has led to ? in some children
fatalities
- What class of pain medications typically should not be ordered for a moderately hepatic-impaired patient, or must be hepatic dosed adjusted?
- Acetaminophen
- According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, pure opioid agonists such as Morphine have the effects such as respiratory depression. From your textbook, list 5 more possible effects of pure opioid agonists.
Relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, respiratory depression
- serotonin syndrome: high body temp., agitation, hyperreflexia, tremor, dilated pupils
- Cough medications with codeine or antidiarrheal are what type of Scheduled medication?
- Schedule V
- Benzodiazepines must be (fill in the blank) when you plan to discontinue them? Here’s your choices- Abruptly stopped, tapered, dosed around the clock to be effective, or have thorough renal and hepatic labs before prescribing.
- Slowly tapered
- How many refills can a patient have for Methylphenidate (Ritalin)?
- No refills – no prescription schedule II substances may be refilled
- What are the unique characteristics of Oxycodone (Oxycontin), aside from its potency? What Controlled Drug Schedule is it?
- Time released, Schedule II
- According to the Pharmacotherapeutics for Advanced Practice Providers textbook, severe toxicity has occurred in ? infants whose mothers are taking codeine.
breastfed
- What are the signs and symptoms of opiate withdrawal?
similiar to a severe influenza infection: n/v, sweating, joint aches, agitation, tremor
pulse >120
sweat streaming off face
unable to sit still for more than a few seconds
pupils so dilated
rubbing joints or muscles & unable to sit still because of discomfort
nose constantly running or tears streaming down face
multiple episodes of diarrhea or vomitting
gross tremor or muscle twitching
yawning several times/ minute
irritable and anxious
prominent piloerrection
- Which DEA Schedule contains drugs that have very high abuse potential and are not usually used as prescribed medications?
- Schedule I
- According to the Pharmacotherapeutics for Advanced Practice Nurse Prescribers textbook, about 10% of each dose of codeine in the liver converts to ? .
morphine
- True or false: Using benzodiazepines can lead to a potential for tolerance and dependency.
- True
