MMJ Flashcards
Preferred Term for Medical Marijuana
Medical Cannabis
What is the main psychoactive ingredient in marijuana?
THC
Delta-9-tetracannabinoid
What is the active ingredient in Marinol and Syndros?
Dronabinol
-Synthetic THC
What is the active ingredient in Cesamet?
Nabilone
-Synthetic agent similar to THC
What is the active ingredient in Epidiolex?
Cannabidiol
What does Epidiolex treat?
Lennox-Gastaut and Dravet syndromes
-Epileptic disorders
Responsibility of Endocannabinoid System (ECS)
- Maintain homeostasis
- Naturally produces endocannabinoids
- Modulates ECS
Where are CB1 receptors found?
CB1: Central and peripheral NS
Where are CB2 receptors founds?
CB2: Immune, blood, and PNS
CBD: Cannabidiol uses
Promising small trials: Anxiety, SUD, Parkinson’s, schizophrenia
Others: AD, MS, Huntington’s, hypoxia-ischemic injury, CVD, migraines, depression, cancer, nausea, inflammatory diseases, RS
CBD routes of adminitration
Edible oil
Vapes
Topical lotions/oils
Rectal/Vaginal suppositories
Adverse effects of CBD
fatigue, elevated LFTs, anemia, infections (pneumonia), diarrhea
Somnolence, sedation, lethargy, decreased appetite
CBD urine/blood toxicology
Will screen positive for marijuana with drug screen - need GC/MS testing to distinguish between CBD and THC
CBD and CYP2C9 Interaction
Ex: warfarin
Inhibits CYP2C9 enzyme
Increased INR and r/f bleeding
CBD and P-glycoprotein (P-gp) interaction
Eg: Direct oral anticoagulants (DOACs)-dabigatran, apixaban, rivaroxaban, clopidogrel
DOACs are substrates of P-gp
CBD may inhibit P-gp, increasing DOACs concentration/accumulation, increasing r/f bleeding
CBD and CYP219 interaction
Eg: Clopidogrel
Clopidogrel is converted to active form by CYP219
CBD inhibits CYP219
CBD may reduce clopidogrel conversion
May decrease effectiveness, increase r/f thrombus
CBD and CYP2C19 interaction
Eg: Clobazam, n-desmethylclobazam (active metabolite)
CBD in a potent inhibitor of CYP2C19
Prolongs half-life of clobazam, increases serum concentrations
CBD and CYP2C9. CYP2C19, CYP3A4, n-acetyltransferase, glucuronidation, carboxyl esterase interactions
Eg: Topiramate, zonisamide, eslicarbazepine, rufinamide
CBD inhibits all CYP enzymes involved in metabolism of topiramate and zonisamide
Increases drug levels
Indications for THC use
Chronic neuropathic pain, neuropathy, MS, muscle spasticity, glaucoma, insomnia, appetite stimulation, nausea, anxiety
Factors for THC prescribing related to dose and strength
THC% controlled
Dosages unregulated
Strains and terpenes ratios will cause different effects
Concentrates may contain 80% THC
THC considerations for negative effects (Conditions)
Cannabinoid Hyperemesis Syndrome (CHS)
Pulmonary issues
Negative impact on developing brain (adult use preferred, 18+)
Increased r/f schizophrenia, CUD
What is Cannabinoid Hyperemesis Syndrome (CHS)?
Cyclical n/v/periumbilical pain r/t THC use
THC adverse effects (side effects, interactions)
Drug-drug interactions (CV, psych) Potentiated by alcohol Motor/coordination impairment Altered judgment Paranoia/psychosis at high doses Anxiety Dizziness Drowsiness Lung infections Dry mouth
What are s/s of cannabis withdrawal?
Insomnia, decreased appetite, restlessness, unpleasant dreams
THC dosage consideration
Start low, go slow
What THC route of administration provides the fastest relief?
Inhalation
What THC route of administration provides the longest lasting relief?
Topical
What THC route of administration is best for insomnia?
Combined oral and inhalation (Get to sleep, stay asleep)
Slide 12
Nope
Potential patient qualifiers for MMJ therapy
- Needs alt. to opioids for chronic pain
- No relief from current pain regimen
- Have side effects from current regimen that interfere with QOL
- Have uncontrolled symptoms of chronic conditions
What are the prescriber requirements for certifying patients for MMJ in NYS?
- DEA number
- Hold a federal Drug Addiction Treatment Act of (DATA) 2000 waiver to be qualified to treat patients with SUD or OUD
Steps to certifying patients for MMJ therapy
Review hx/dx
Discuss risks/benefits, safety, MH concerns
Identify support person
Obtain release of information for PCP/psych
Establish goals of treatment
Schedule follow-up
Create safety plan
Complete certificate on NYS website
Mail/Forward signed hard copy to patient
Patient registers through patient portal with DOH
Communicate with PCP/specialists regularly
Steps to become a certified MMJ provider
Minimum 2-hour course
What is the database for MMJ providers in NYS?
Medical Marijuana Data Management System (MMDMS) (MMUAS)
Preferred/New: Medical Cannabis Data Management System (MCDMS)
Starting dose for THC edibles
THC 2.5 to 5 mg
Time between doses for edibles
3 hours
Time between THC inhalations
20 minutes
Screening tool for cannabis use disorder
Cannabis Use Disorder Identification Test
CUDIT
