Controlled Substance Exam

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?

*5 mg/kg, do not exceed 300 mg and do not repeat within 3 hours *Lidocaine with epinephrine prolongs the duration of action. When lidocaine is mixed with epinephrine the maximum dose is 7mg/kg, not to exceed 500 mg [50 mL of lidocaine 1 percent epinephrine] (Hsu, 2020).

What are the unique characteristics of Oxycodone (Oxycontin), aside from its potency? What Controlled Drug Schedule is it?

*It's a long acting opioid that provides relief up to 12 hours and lengthens the actual time that pain relief occurs compared to other IR opioids *Schedule II

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.

*SNRI's (serotonin-norepinephrine reuptake inhibitors) such as Cymbalta *Muscle relaxants such as cyclobenzaprine *Anti-convulsant such as gabapentin and pregabalin

What are the criteria for being classified as dangerous controlled substance drugs by the federal Drug Enforcement Agency (DEA)?

*The drug or other substance has a high potential for abuse. *The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. *Abuse of the drug or other substances may lead to severe psychological or physical dependence.

What class of pain medications typically should not be ordered for a moderately hepatic-impaired patient, or must be hepatic dosed adjusted?

Acetaminophen, under non-opioid analgesics should be limited for patients with advanced or chronic liver disease to 2 grams per day (Hamilton, Goldberg, & Chopra, 2020)

According to the Pharmacotherapeutics for Advanced Practice Providers textbook, among ultrarapid metabolizers who carry copies of the CYP2D6 gene, codeine is unusually effective and has led to __________ in some children.

Adverse drug reactions such a respiratory depression, due to the fact that ultra-metabolizers convert codeine to morphine at a faster and greater extent

According to the Pharmacotherapeutics for Advanced Practice Providers textbook, severe toxicity has occurred in ___________ infants whose mothers are taking codeine.

Breast fed

According to the Pharmacotherapeutics for Advanced Practice Providers 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.

Constipation, Nausea, Itching, Mild skin rash, Sweating GI Upset, Serotonin Syndrome

List two (2) different Schedule I substances (of which NPs are not permitted to prescribe).

Heroin, LSD, marijuana, peyote, ecstasy, and methaqualone

What are the signs and symptoms of opiate withdrawal?

High heart rate, GI upset, Sweating, Tremors in hands, Restlessness, Yawning during assessment, Anxiety or irritability, Bone or joint aches, Gooseflesh, Runny nose or tearing

What is the control schedule (I, II, II, IV, V)-Marijuana (THC)

I

What is the control schedule (I, II, II, IV, V)-Acetaminophen/Hydrocodone (Vicodin, Norco)

II

What is the control schedule (I, II, II, IV, V)-Adderall (Amphetamine/dextroamphetamine)

II

What is the control schedule (I, II, II, IV, V)-Fentanyl (Duragesic)

II

What is the control schedule (I, II, II, IV, V)-Guiafenesin/Hydrocodone (Hycotuss)

II

What is the control schedule (I, II, II, IV, V)-Methadone

II

What is the control schedule (I, II, II, IV, V)-Methylphenidate (Ritalin)

II

What is the control schedule (I, II, II, IV, V)-Morphine

II

What is the control schedule (I, II, II, IV, V)- Androgel (Testosterone)

III

What is the control schedule (I, II, II, IV, V)- Alprazolam (Xanax)

IV

What is the control schedule (I, II, II, IV, V)- Carisoprodol (Soma)

IV

What is the control schedule (I, II, II, IV, V)- Zolpidem (Ambien)

IV

What is the control schedule (I, II, II, IV, V)-Diazepam (Valium)

IV

What is the control schedule (I, II, II, IV, V)-Phentermine

IV

What are the criteria for a Nurse Practitioner to be able to prescribe Buprenorphine (Suboxone) for heroin addiction to prevent opiate withdrawal?

Just like physicians, since 2016 nurse practitioners and PA's are now allowed to prescribe Suboxone. But any practitioner that is prescribing the medication must have the additional training and have a buprenorphine waiver under the drug and treatment act of 2000

According to the Pharmacotherapeutics for Advanced Practice Providers textbook, about 10% of each dose of codeine in the liver converts to ____________.

Morphine

What class of pain medications typically should not be ordered for a renal-impaired patient (GFR < 50 ml/min)?

NSAIDs, can lead to renal ischemia and an increase in plasma creatinine concentration

What are some common side effects of opioid medications?

Nausea, itching, mild skin rash, headache, sweating, gastrointestinal upset, and constipation

How many refills can a patient have for Methylphenidate (Ritalin)?

None, pharmacies require a new hard copy of the prescription every month due to it being a schedule II stimulant

Cough medications with codeine or antidiarrheal are what type of Scheduled medication?

Schedule V, including cough medication with less than 200 mg/ 100 mL of codeine

Which DEA Schedule contains drugs that have very high abuse potential and are not usually used as prescribed medications?

Schedule I

Which DEA Schedule has the most potential for abuse?

Schedule I

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 through V in the state of California with the amended B & P code 2836.1, but must operate within standardized procedure set out by authorizing physicians

Vicodin has been changed from a Schedule III to a Schedule ________ drug due to its increased risk of abuse and addiction.

Schedule II, as of 2014 it was changed for all hydrocodone combination medications

Which DEA Schedule has the least potential for abuse?

Schedule V

Can Nurse Practitioners furnish or prescribe drugs or devices to family members or friends?

State laws vary regarding whether an NP can prescribe for family or friends . For a prescription to be legitimate a patient must be assessed and there must be record of it. Furthermore, although it may be legal he question of whether it is ethical for a nurse practitioner to do so

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

Tapered

True or false: Using benzodiazepines can lead to a potential for tolerance and dependency.

True

What is the control schedule (I, II, II, IV, V)-Lomotil

V

1. According to the assigned reading handout "OTC Analgesia Checklist", what indications show that your patient may be at risk if you prescribe acetaminophen? And when should your patient have a risk vs. benefit analysis and/or medication adjustment completed by you before prescribing acetaminophen? (Select 4)

When a patient has comorbidities and is on concomitant medication, it is appropriate to use the analgesia checklist to assess if the patient is at risk when taking acetaminophen. Risk vs. benefit analysis should be done when there is: *Drink 3 or more alcoholic drinks in a day *Take warfarin Have liver disease *Take any prescriptions with acetaminophen in them or acetaminophen containing opioids

According to the assigned reading handout "OTC Analgesia Checklist", what indications show that your patient may be at risk if you prescribe NSAIDs? And when should have a risk vs. benefit analysis and/or medication adjustment before prescribing NSAIDs?

When a patient has comorbidities and is on concomitant medication, it is appropriate to use the analgesia checklist to assess if the patient is at risk when taking an NSAID. Risk vs. benefit analysis should be done when there is: *Increased risk for GI bleeds History of GERD or peptic ulcers *Kidney disease Cardiovascular disease or history of stroke *Hypertension *Taking aspirin to prevent heart attack or stroke *Liver cirrhosis, Asthma Increased alcohol intake *Concurrent use of any NSAID/HTN medication, or anticoagulant agents *Use of cough, sleep, cold, allergy, sleep aids, antipyretics that contains NSAIDS. *Use of steroids or condition that requires long term use of steroids. *Over 60 years of age *Recent heart surgery or about to have heart surgery *Have any allergies to taking any pain relievers.