Headaches, Herbal Products, Prescription Writing

Question 1

Selective Serotonin Agonists for headaches (4)

Answer 1

1. Known as triptans
2. Bind to 5-HT1B and 1D receptors to cause vasoconstriction with reduced inflammation
   * Subtype of 5H5 receptors
3. Acute treatment of migraines
4. Not used commonly in pediatrics

Question 2

Triptan agents (2)

Answer 2

1. Sumitriptan (Imitrex)

2. Rizatriptan

Question 3

Triptan ADEs (6)

Answer 3

1. Dizziness
2. Visual disturbances
3. Jaw pain
4. Chest pain
5. Flushing
6. Caution with 5HT syndrome
   * Avoid in combination with an SSRI or Linezolid

Question 4

Pharmacological treatments used for headaches (4)

Answer 4

1. Selective serotonin agonists
2. CCBs
3. Topiramate
4. Valproic Acid

Question 5

Herbal Product information (5)

Answer 5

1. OTC products are not FDA regulated
   * No standardization on concentration or quality
2. Insurance coverage may not be there
3. Herbal products vs. nutraceuticals
   * Nutrition supplements (Isoleucine, citrulline)
   * Used for metabolic issues in children if need special diet or deficient in something
   * FDA doesn’t consider them a drug
4. Safety is an issue because there is no standardization or testing of it
5. Usually OTC

Question 6

Betaine

Answer 6

Used for muscle building but also good for children with certain genetic disorder

Question 7

Rx Writing: National Provider Identifier (3)

Answer 7

1. Issued by CMS to both institutions and providers
2. All electronic and written prescriptions issued in New York State (NYS) must include an NPI
3. If a NP is prescribing a medication for patient in his/her hospital of practice, the NP may use institutions’ NPI

Question 8

DEA Number (3)

Answer 8

1. Issued by the U.S. Department of Justice – Drug Enforcement Administration
2. Provided to both institutions and providers
   * May use institution’s DEA # if applicable
3. Required ONLY when prescribing controlled-substances

Question 9

Internet System for Tracking Over Prescribing Law (I-STOP)

Answer 9

1. New York law mandates prescribers to register with the Prescription Monitoring Program Registry
2. Electronic tracking of all CII-IV prescribing
3. Goal to better combat opioid misuse, abuse and diversion

Question 10

Medical Marijuana Federal vs. State

Answer 10

Federal: Schedule I (after 4th request to change its classification schedule)

State

1. NY is allowed to dispense for certain medical conditions
2. Requires registration of providers
3. NP can register to dispsense

Question 11

Non-controlled prescription components required (8)

Answer 11

1. Prescriber’s name, practicec address, contact information, NPI, DEA number
2. Date written
3. Patient’s first and last name
4. Name of drug to be dispensed
5. Strength, quantity, directions
6. Number of refills
7. DAW - dispense as written to mandate brand if necessary
8. Prescriber’s signature

Question 12

Controlled prescription components required (9)

Answer 12

1. Prescriber’s name, DEA number
2. Date written
3. Patient’s first and last name
4. Name of drug, strength, directions to be dispensed
5. Quantity (numerical and written)
6. Number of refills (# and written) and federal code if applicable
7. DAW if necessary
8. Maximum daily dose (MDD)
9. Prescriber signature

Question 13

QD or OD

Answer 13

every day

Question 14

QOD

Answer 14

Every other day

Question 15

BID, TID, QID

Answer 15

BID: 2x/day

TID: 3x/day

QID: 4x/day

Question 16

AC vs. PC

Answer 16

AC: before meals

PC: after meals

Question 17

HS or QHS

Answer 17

bedtime

Question 18

Disp

Answer 18

dispense

Question 19

Sig

Answer 19

directions

Question 20

Extremely preterm

Answer 20

Less than 32 weeks gestation

Question 21

Late preterm

Answer 21

34-36 weeks gestation

Question 22

Early Term

Answer 22

37-38 6/7 weeks gestation

Question 23

Full Term

Answer 23

39-40 6/7 weeks gestation

Question 24

Low birth weight

Answer 24

birth weight less than 2500 grams

Question 25

Very low birth weight

Answer 25

birth weight less than 1500grams

Question 26

Chronological age/birth age

Answer 26

time since birth