NR-565 Advanced Pharmacology Fundamentals Week 2 Quiz
Writing and transmitting the prescription
Correct Answer:
prescription format includes name, date, dea# (if controlled), drug, route,
dose, duration, frequency.
Ethical aspects of prescribing
Correct Answer:
Informed consent, patients ability to agree to therapy and understand the
risk/benefit of therapy.
OTC Medication characteristics and regulation
Correct Answer:
Characteristics: must be safe, low potential for abuse, can be labeled,
patient must be able to self-diagnose for the drug to be taken, and must be
for a condition where the patient does not require supervision.
OTC medication sales
Correct Answer:
CHPA (consumer healthcare products association) monitors physical
complaints for self-treatment with OTC meds
Hazards of OTC self-medication
Correct Answer:
overdose, toxic effects, misuse, lack of understanding of the drug all play a
role.
Drug interactions: Antacids, Anticholinergics, CNS depressants, NSAIDS, ans
ASA
Correct Answer:
Antacids, contain metallic ions which interfere with most drugs through
stomach acid alterations. separate antacid use by 2 hours
Anticholinergics: adverse effects of benadryl and doxylamine causes dry
mouth, difficulty urinating, hypertension, tachycardia, tinnitus, blurred
vision, constipation.
CNS depressants: CNS sedation which can be additive with other forms of
sedation meds
NSAIDS: GI bleeding from cox-2 (mucosal barrier breakdown) inhibition with
increased risk when combined with anti-platelet or anticoagulant therapy.
Abuse of OTC medications: Combat methamphetamine epidemic act
Correct Answer:
OTC antitussives can be used in the making of methamphetamine, this act
combats this by regulating how much can be purchased and tracks those
purchasing.
Referred Pain
Pain that is present in an area removed or distant from its point of origin.
Acute Somatic Pain
Arises from connective tissue, muscle, bone and skin.
Sharp and localized or dull and non-localized
Responds best to: acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics, ice, massage
Acute visceral pain
Pain in the internal organs and abdomen
Poorly localized (C-fibers)
Radiates
Most responsive to opiates
May also use corticosteroids, NSAIDs
Inflammatory response
Redness, heat, swelling, pain
Pain Medications
Patient factors such as age, ethnicity, gender, the presence of hepatic and/or renal impairment, genetic polymorphisms, and/or coexisting cardiorespiratory or cerebrovascular disease should be considered.
Drug factors
Drug metabolism, receptor binding strength, the potential for drug-drug interactions, and/or co-administration with other central nervous systems (CNS) depressants
Opioids
Drug indication: Prescribed for Moderate to severe pain
Opioids Adverse Drug Reactions
Sedation, drowsiness, mental clouding; constipation; nausea and decreased appetite; sexual dysfunction; tolerance/ dependency- ADRs worse when combined with alcohol or benzodiazepines.
Opioid drug interactions
Any other drug that causes a sedative effect.
Acetaminophen
Drug indication: Mild to moderate pain
Acetaminophen dosing considerations
Does appropriately.
Mild pain: 325 to 650 mg every 4 to 6 hours
Children: 10/kg/mg every 4 to 8 hours
Moderate pain: 500 to 1,000 mg every 4 to 6 hours drugging indication used for fever
Maximum: 4 gms/ 24 hours use for fever and or pain
Children: 15 mg/kg/dose
May need to add an opioid agonist
Acetaminophen Adverse drug reactions
Usually well-tolerated
Hepatic injury with overdose
Renal disease with chronic use
Drug interactions: alcohol
NSAIDs drug indication
Use for fever and/or pain; inflammation as an antiplatelet. Avoid in pregnancy and renal dysfunction.
NSAIDs dosing considerations
Ibuprofen dosing
200 to 800 mg/ dose every 6 hours or every 8 hours
Maximum: 3,200 mg/day
Children: 5 to 10 mg/kg/dose (Pediatric dosage maximum is 40mg/kg/day)
Naproxen dosing
500mg Then 500mg every 12 hours or 250mg every 6 hours to 8 hours
Maximum: 1,250 mg/day
NSAIDs adverse drug reactions
Gastrointestinal (GI) upset, dyspepsia, abdominal pain, GI bleed, fluid retention, edema, hypertension, renal damage.
Salicylates drug indication
Use for fever, pain, inflammation, antiplatelet use. Avoid in pregnancy, children, and renal dysfunction.
Salicylates dosing considerations
Dosing for pain: 325 mg to 1,00 mg every 4 to 6 hours (maximum: 4 gm/day)
Arthritis: 3.6 to 5.4 gm/day in divided doses
May need to add an opioid agonist..
Salicylates Adverse drug reactions
GI upset, dyspepsia, abdominal pain, GI bleed, renal impairment, tinnitus
Chronic Pain
Pain that persists beyond three months or the expected time of healing.
CDC guidelines for opioid prescribing
- Determining when to initiate or continue opioids for chronic pain 2. opioid selection, dosage, duration, follow-up, and discontinuation 3. assessing risk and addressing harms of opioid use.
12 Essential Considerations for Safe Pain Management
Opioids are not first-line therapy
Establish goals for pain and function
Discuss risk and benefits
Use immediate-release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to mitigate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzodiazepine prescribing
Offer treatment for opioid disorder
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-IV)
Describes opioid use disorder as a pattern of use that leads to significant impairment or distress. Typically, this disorder is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school, or home responsibilities.
Opioid use disorder
Can lead to severe withdrawal symptoms, uncontrolled pain, as well as psychological distress, and suicidal ideation.
Risk Evaluation and Mitigation Strategy (REMS)
Drug safety program to reinforce safe medication use. Ensure that medication is used according to FDA-approved prescribing and that the benefits outweigh the risk of misuse and abuse.
Naloxone
Used to quickly reverse an opioid overdose.
Prescription drug monitoring programs (PDMPs)
Electronic databases enable providers to access information regarding a patient’s prescription history of controlled substances.
Morphine milligram equivalent (MME)
Calculation to help dose medications appropriately and refer to pain specialists as indicated. Use extra precautions when increasing to ≥50 MME per day. Avoid or carefully justify increasing dosage to ≥90 MME/day
Assess: Factors to assess for risk of opioid misuse
Personal or family history of substance use disorder
Anxiety or depression
Pregnancy
Age 65 or older
COPD or other underlying respiratory conditions
Renal or hepatic insufficiency
Check: Consider urine drug testing
Possible drug interactions (such as benzodiazepines)
High opioid dosage (≥50 MME/day)
Obtaining opioids from multiple providers.
Discuss: patient concerns and determine any harms
Nausea or constipation
Feeling sedated or confused
Breathing interruptions during sleep
Taking or craving more opioids than prescribed or difficulty controlling use.
Observe: Early warning signs
Confusion
Sedation
Slurred speech
Abnormal gait
Four actions to take for potential harms of opioid therapy,
Assess
check
discuss
observe
Opioid use disorder (OUD)
Diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Addition (DSM-5) assessment criteria and not speculation alone.
MAT
Medication assisted therapy for opioid abuse. Buprenorphine, naltrexone, or methadone.
Consider offering naloxone if indicated (i.e. concurrent benzodiazepine use).
Renal/hepatic considerations
Patients with renal or hepatic insufficiency can experience greater peak effect and longer duration of action for medications, thereby reducing the dose at which respiratory depression and overdose may occur. patients ages 65 years and older, reduced renal function and medication clearance due to age can result in a smaller therapeutic window between safe dosages and dosages associated with respiratory depression and overdose.
CSA
Controlled Substances Act enacted by the DEA to regulate drugs and other substances based on their potential for abuse and dependency
Five schedules of controlled substances
Classes of scheduled substances include narcotics, depressants, stimulants, hallucinogens, and anabolic steroids.
Schedule I Drugs
Substances or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Heroin, Lysergic Acid Diethylamide (LSD), marijuana (cannabis), 3, 4- Methylenedioxymethamphetamine (ecstasy), Methaqualone, and Peyote
Schedule II Drugs
Substances or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (oxycontin) fentanyl, Dexedrine, Adderall and Ritalin
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