MMJ Flashcards

1
Q

Preferred Term for Medical Marijuana

A

Medical Cannabis

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2
Q

What is the main psychoactive ingredient in marijuana?

A

THC

Delta-9-tetracannabinoid

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3
Q

What is the active ingredient in Marinol and Syndros?

A

Dronabinol

-Synthetic THC

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4
Q

What is the active ingredient in Cesamet?

A

Nabilone

-Synthetic agent similar to THC

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5
Q

What is the active ingredient in Epidiolex?

A

Cannabidiol

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6
Q

What does Epidiolex treat?

A

Lennox-Gastaut and Dravet syndromes

-Epileptic disorders

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7
Q

Responsibility of Endocannabinoid System (ECS)

A
  • Maintain homeostasis
  • Naturally produces endocannabinoids
  • Modulates ECS
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8
Q

Where are CB1 receptors found?

A

CB1: Central and peripheral NS

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9
Q

Where are CB2 receptors founds?

A

CB2: Immune, blood, and PNS

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10
Q

CBD: Cannabidiol uses

A

Promising small trials: Anxiety, SUD, Parkinson’s, schizophrenia

Others: AD, MS, Huntington’s, hypoxia-ischemic injury, CVD, migraines, depression, cancer, nausea, inflammatory diseases, RS

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11
Q

CBD routes of adminitration

A

Edible oil
Vapes
Topical lotions/oils
Rectal/Vaginal suppositories

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12
Q

Adverse effects of CBD

A

fatigue, elevated LFTs, anemia, infections (pneumonia), diarrhea

Somnolence, sedation, lethargy, decreased appetite

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13
Q

CBD urine/blood toxicology

A

Will screen positive for marijuana with drug screen - need GC/MS testing to distinguish between CBD and THC

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14
Q

CBD and CYP2C9 Interaction

Ex: warfarin

A

Inhibits CYP2C9 enzyme

Increased INR and r/f bleeding

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15
Q

CBD and P-glycoprotein (P-gp) interaction

Eg: Direct oral anticoagulants (DOACs)-dabigatran, apixaban, rivaroxaban, clopidogrel

A

DOACs are substrates of P-gp

CBD may inhibit P-gp, increasing DOACs concentration/accumulation, increasing r/f bleeding

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16
Q

CBD and CYP219 interaction

Eg: Clopidogrel

A

Clopidogrel is converted to active form by CYP219
CBD inhibits CYP219
CBD may reduce clopidogrel conversion
May decrease effectiveness, increase r/f thrombus

17
Q

CBD and CYP2C19 interaction

Eg: Clobazam, n-desmethylclobazam (active metabolite)

A

CBD in a potent inhibitor of CYP2C19

Prolongs half-life of clobazam, increases serum concentrations

18
Q

CBD and CYP2C9. CYP2C19, CYP3A4, n-acetyltransferase, glucuronidation, carboxyl esterase interactions
Eg: Topiramate, zonisamide, eslicarbazepine, rufinamide

A

CBD inhibits all CYP enzymes involved in metabolism of topiramate and zonisamide
Increases drug levels

19
Q

Indications for THC use

A

Chronic neuropathic pain, neuropathy, MS, muscle spasticity, glaucoma, insomnia, appetite stimulation, nausea, anxiety

20
Q

Factors for THC prescribing related to dose and strength

A

THC% controlled
Dosages unregulated
Strains and terpenes ratios will cause different effects
Concentrates may contain 80% THC

21
Q

THC considerations for negative effects (Conditions)

A

Cannabinoid Hyperemesis Syndrome (CHS)
Pulmonary issues
Negative impact on developing brain (adult use preferred, 18+)
Increased r/f schizophrenia, CUD

22
Q

What is Cannabinoid Hyperemesis Syndrome (CHS)?

A

Cyclical n/v/periumbilical pain r/t THC use

23
Q

THC adverse effects (side effects, interactions)

A
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
24
Q

What are s/s of cannabis withdrawal?

A

Insomnia, decreased appetite, restlessness, unpleasant dreams

25
THC dosage consideration
Start low, go slow
26
What THC route of administration provides the fastest relief?
Inhalation
27
What THC route of administration provides the longest lasting relief?
Topical
28
What THC route of administration is best for insomnia?
Combined oral and inhalation (Get to sleep, stay asleep)
29
Slide 12
Nope
30
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
31
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
32
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
33
Steps to become a certified MMJ provider
Minimum 2-hour course
34
What is the database for MMJ providers in NYS?
Medical Marijuana Data Management System (MMDMS) (MMUAS) | Preferred/New: Medical Cannabis Data Management System (MCDMS)
35
Starting dose for THC edibles
THC 2.5 to 5 mg
36
Time between doses for edibles
3 hours
37
Time between THC inhalations
20 minutes
38
Screening tool for cannabis use disorder
Cannabis Use Disorder Identification Test | CUDIT