Controlled substances.txt

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Controlled substances.txt
2012-03-11 19:40:16
controlled substances

controlled substances
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  1. What schedule is morphine and its derivatives?
    Schedule 2
  2. What schedule are the drugs for ADHD?
    Schedule 2 (amphetamines and methylphenidate)
  3. What drug is the most diverted drug in the US?
  4. What schedule is pentobarbital?
    Schedule 2
  5. What schedule are the benzo? (diazepam, alprazolam)
    Schedule 4
  6. What do you do if narcotics are stolen from your office?
    Fill a DEA 106 form
  7. How long is a Schedule 2 prescription valid in CA?
    6 months (it's state specific, no federal limit)
  8. Schedule II. Written, telephone or faxed?
    Only written is acceptable (Schedule III-V can be all 3 forms)
  9. # of refills for a Schedule II?
    NONE. can't be refilled.
  10. # of refills for a Schedule III-IV?
    up to 5 refills max
  11. # of refills for a Schedule V?
    not established. Up to discretion of prescriber and pharmacist
  12. If want to give a pt 90 day supply of a Schedule II, have to do what?
    Write 3 of same Rx, dated on same date (NO post-dating!), but write "DO NOT FILL UNTIL / / "
  13. natural, synthetic or semisynthetic: morphine, tramadol, codeine, hydrocodone, oxymorphone, meperidine, methadone, fentanyl
    • Natural: morphine and codeine
    • Semi-synth; derivatives of codeine and morphine
    • Synthetic: methadone, meperidine, fentanyl, tramadol
  14. The 2 pure opioid antagonists: names and route of administration?
    • Naloxone (Narcan) =IV/IM
    • naltrexone (Revia) = PO
  15. What's the min. suggested amount of laxative for constipation due to opioids?
    Docusate 200 mg BID- TID
  16. What are opioid peripheral effects on biliary tract, urinary tract, cardiac,
    • Biliary: increases biliary pressure
    • Urinary: increases muscle tone = less output
    • CV: may have bradycardia, peripheral vasodilation = hypotension. Also cerebral vasodilation = increase ICP
  17. Why higher dose IV compared to PO for opoiods?
    High first pass effect.
  18. How is morphine eliminated?
    • 90% = renally
    • 10%= feces via bile
  19. What other drug interactions does morphine have that produces a synergistic effect?
    CNS depressants, MAOIs, TCAs, phenothiazines (antipsychotics)
  20. What does heroin get metabolized to?
    morphine (it's 3x as potent for pain)
  21. What does 10% of codeine get converted to?
  22. What's the difference btw Oxycontin and oxycodone?
    Oxycontin is time released oxycodone.
  23. What are contraindications to opioids?
    • lungs: brochial asthma, COPD,
    • liver damage, head injuries, ETOH use, convulsive disorder, abd pain of unknown origin
  24. Which opioid should you never give to an opioid-naive patient?
    Fentanyl and hydromorphone extended release (Exalgo)
  25. What is diphenoxylate + atropine?
  26. What cardiac condition do you have to worry about w/ Methadone?
    Torsades (prolonged QT)so always do EKG first.
  27. What else does Tramadol do besides binding to the mu receptors?
    Inhibits NE and 5HT (serotonin) reuptake
  28. Is there cross tolerance or physical dependence for opioids w/ other CNS depressants?
    no, only among themselves.
  29. How do you estimate tolerance?
    by amt of drug needed to cause drowsiness
  30. What is the prototypal mixed agonist-antagonist opioid?
    Pentazocine (Talwin)
  31. What can high doses of pentazocine cause?
    cv effects (high bp,HR) dysphoria, psycho effects
  32. What's the difference btw anti-anxiety and sedative-hypnotic drugs?
    just the dosage (higher for insomnia)
  33. What are effects of sedative hypnotic drugs?
    sedation slurred speech, incoordination, unsteady gait, impaired attention/memory
  34. How are benzos metabolized?
    cyp450 in liver and CYP3A4 in intestines.
  35. What are contraindications for benzos?
    resp. disorders, severe liver/kidney dz, Hx of ETOH or drug abuse, hypersensitivity rxns
  36. Which benzo is most likely to cause seizures in w/drawl?
    Alprazolam (xanax)
  37. What's the recommend tapering of benzos?
    ~25% q 1-2 wks over 4-16 wks.
  38. Which 2 benzos don't depend on the P450 system? So good for which popns?
    Lorazepam (Ativan) and oxazepam (Serax) so good for elderly and those w/ liver dz. For ANXIETY
  39. Which benzo is ideal choice for elderly FOR insomnia?
    Temazepam (Restoril)
  40. How long is the max recommended time for using benzos?
    2-4 weeks (start losing effectiveness, and increasing chances of w/drawl sxs)
  41. What are some w/drawl rxns of benzos?
    insomia, anxiety, deprerssion, nausea, confusion (all these more pronounced in shorter-acting drugs)
  42. What are some side effects from stimulants?
    decreased appetite, HA, stomachache, insomnia,
  43. what are 3 ways you can check on pt.'s use/obtaining opoids?
    urine screen, CURES website, pill counts
  44. What % of Schedule II need to be countersigned by a MD? in what time period
    100% of the charts w/in 7 days
  45. What's a key phrase in the definition of addiction?
    continued use despite harm
  46. Treat opoids at home like what?
    a gun. Keep it locked up! when disposing, mix w/ coffee grounds or cat litter
  47. What is a better than the pain scale?
    • Measure of function
    • _of_life_scale.pdf
  48. What is the conversion rate for methadone?
    none exist!
  49. Opioids in pregnancy? what pregnancy category?
    Category C
  50. CURES database gives you a report on what schedule drugs?
  51. What are some opioids full agonists?
    morphine, hydromorphone, codeine and its derivatives,methadone, and fentanyl (all have no ceiiling effect)
  52. How to change opioids (opioid rotation)
    use equianalgesic chart and decrease by 25%
  53. strength of the following relative to morphine: hydromorphone, oxymorphone, oxycodone, hydrocodone, codeine, methadone, meperidine, tramadol
    • hydromorphone = 4X oxymorphone = 3X oxycodone =1.5X
    • hydrocodone = 1X
    • codeine = 1/6
    • methadone = unknown meperidine = 1/10
    • tramadol =1/10