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Neuro II > Controlled Substances > Flashcards

Controlled Substances Flashcards

1
Q

What are schedule I substances?

A

high potential for abuse & no accepted medical use in the US

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2
Q

What are schedule II substances?

A

substances that have high abuse potential with severe liability for psychic or physical dependence, but in general are substances that are approved by the FDA fro a therapeutic use

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3
Q

What are schedule III & IV substances?

A

include drugs with decreasing levels of abuse potential

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4
Q

What type of registration do you need to prescribe controlled substances?

A

MO-DNDD (mo-specific)
DEA

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5
Q

What are the four criteria for a legitimate prescription?

A
  • practitioner has to be registered
  • patient has to desire treatment for a legitimate illness
  • practitioner has to establish a legitimate need through pertinent technical diagnostic modalities
  • must be reasonable correlation between drug prescribed & the patient’s needs
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6
Q

What are the components for a legitimate prescription?

A
  • dated & signed on date when issued
  • patient’s full name & address
  • practitioner’s full name, address & DEA registration number
  • drug name
  • drug strength
  • drug dosage
  • quantity prescribed
  • directions for use
  • number of refills authorized
  • if a substitution is permitted
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7
Q

A practitioner must document reasoning for prescribing opiates over what number of days for acute pain?

A

7-day limit

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8
Q

What are the limitations in the mode of prescribing for a schedule II drug?

A
  • signed in original ink of written
  • verbal in an emergency by doctor only
  • faxed if injectable to LTCF or hospice
  • electronics per DEA guidelines
  • mid-levels have 5 day supply hydrocodone only
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9
Q

What are the limitations in refills for schedule II drug?

Length of prescription validity?

A

no refills allowed; partial dispensing allowed

6 month validity

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10
Q

What are the quantity limitations for prescribing for a schedule II drug?

A
  • 30 days for most
    • over 30 days requires medical reason
    • max is 90 day supply
  • can write multiple & separate Rx w/ “do not fill until” date written on bottom
    • can’t exceed 90 day supply
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11
Q

What are the limitations in the mode of prescribing for a schedule III & IV drug?

A
  • signed in original ink if written
  • phoned in or faxed
  • electronic per DEA guidelines
  • midlevels may prescribe
    • 30 day supply buprenophine w/o refill for substance abuse treatment only
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12
Q

What are the limitations in refills for schedule III/IV drug?

Length of prescription validity?

A

max refill of 5 w/in 6 months of issuing prescription

6 month validity

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13
Q

What are the quantity limitations for prescribing for a schedule III / IV drug?

A

90 days

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14
Q

What are the limitations in the mode of prescribing for a schedule V drug?

A
  • signed in original ink if written
  • oral phoned-in
  • faxed
  • electronic per DEA guidelines
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15
Q

What are the limitations in refills for schedule V drug?

Length of prescription validity?

A

as authorized by the physician, can be refilled PRN as prescriber allows for 1 yr

one year validity

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16
Q

According to CDC guidelines, when should you consider opioid therapy for chronic pain?

A

if expected benefits for both pain & function are anticipated to outweigh the risks to the patients

if opioids are used - should be combined with nonpharmacologic therapy as appropriate

17
Q

Before starting opioid therapy for chronic pain, clinicians should establish what treatment goals with patients?

A

realistic goals for pain & function

should how therapy will be discontinued if benefits do not outweigh risks

should only continue if clinically meaningful improvement

18
Q

Before starting & periodically throughout opioid therapy, physicians should have what discussion with patients?

A

known risks & realistic benefits

clinician responsibility for managing therapy

19
Q

When starting opioid therapy for chronic pain, what type of opioids should be prescribed?

A

immediate-release opioids instead of extended-release/long-acting

20
Q

Opioids should be started at what dose?

A

lowest effective dose

21
Q

Clinicians should carefully reassess evidence of individual benefit & risks when increasing opioid dosage above what value? Physicians should avoid / carefully justify increasing dosage to what level?

A

reassess - >50MME

avoid - >90 MME

22
Q

What guidelines should you consider when prescribing opioids for acute pain?

A

lowest effective dose of immediate-release

no greater quantity than expected duration of pain severe enough to require opioids (usually 3 days or less; rarely > 7 days)

23
Q

Clinicians should evaluate benefits & harm within what time period of starting opioid therapy? Then how long thereafter?

What should they do if they decide benefits do not outweigh harm?

A

within 1-4 weeks

every 3 months

if benefits do not outweigh harm → work with patients to taper to lower dosage or to discontinue

24
Q

Clinicians should incorporate management plan strategies to mitigate risk, such as?

A

offering naloxone when increase factors for opioid overdose

(history of overdose, history substance abuse disorder, higher opioid dosage, concurrent benzodiazepine use)

25
Q

How should physicians review patient’s history of controlled substance prescriptions?

A

state prescription drug monitoring program data

(starting for chronic pain & periodically during therapy; every prescription → ever 3 month)

26
Q

When should clinicians use urine drug testing during opioid therapy?

A

when starting & consider annually throughout treatment

assess for prescribed medications & other controlled prescriptions / illicit drugs

27
Q

What should clinicians offer or arrange for patients with opioid use disorder to manage chronic pain?

A

evidence-based treatment (usually w/ buprenorphine or methadone in combo w/ behavioraa therapies)

28
Q

What are the characteristics of drug-seeking patients?

A
  • feign physical problems
  • early requests for refill
  • eliciting sympathy or guilt or threat
  • claim to be referred by another clinician
  • unusual behavior in waiting rooms
  • inconsistent signs of acute pain
  • unusual knowledge of controlled substances
  • requests a specific drug
  • reluctance to try another drug
  • demanding or abusive to staff
  • more than one physician
  • unusual appearance
  • cutaneous signs of drug abuse
29
Q

Wha information do you need from patients to prescribe opioids?

A
  • what other practitioners they are seeing
  • when they were last seen
  • what drugs they have been previously prescribed
  • what drugs they are currently taking
  • have they ever been treated for alcohol or chemical dependency
  • request picture ID or SSN
  • call previous practitioner, pharmacist, or hospital
  • confirm telephone number & address
  • write for limited quantities
30
Q

What are strategies to prevent diversion & abuse?

A
  • lock unused prescription pads
  • number prescription blanks
  • never sign blank prescriptions
  • write amount clearly & in arabic or roman numerals
  • respond to pharmacists inquiry
  • carbon or photocopies
31
Q

What substances are you legally unable to prescribe for yourslef?

A

all schedule controlled substances

32
Q

What are the suggestions for what you should do to keep yourself out of trouble?

A

examine and document, document, document

ask questions

talk to pharmacists

Neuro II (30 decks)

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