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Pharmacy Practice I > Prescription Drug Abuse > Flashcards

Prescription Drug Abuse Flashcards

1
Q

3 National Epidemics Related to PDA

A
  1. Chronic pain: causes additional problems (decreased sleep/QoL, increased anxiety/depression)
  2. Depression/Anxiety: 60% of white adults received no treatment for mental illness (increase in % of A, AA, H)
  3. Prescription Drug Abuse (ie opioid epidemic)
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2
Q

3 Classes of Medications Commonly Misused

A
  1. Opioids: used to treat pain
  2. Central nervous system (CNS) depressants: used to treat anxiety and sleep
  3. Stimulants: most often used to treat attention-deficit hyperactivity disorder (ADHD)
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3
Q

How Did We End Up with 3 Epidemics?

A

• Unimodal treatment

  • Usually medication therapy
  • Reimbursement on non-medication therapy??

• Single discipline

  • Usually a physician (or a medical provider)
  • +/- Pharmacist involvement (optimizing pharmacology of medications and non-pharmacological approaches?)
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4
Q

Pain and Prescription Pain Relievers

A

• Pain is how our bodies warn us something is wrong
- It can alert us to an illness, injury or impending injury
- Sometimes when pain is chronic and persistent, it can be debilitating and impact daily functions
• The goal of pain medications in the setting of chronic pain is to enable individuals to function

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5
Q

Opioids

A

• Opioids are one class of pain relieving medications (vicodin/norco, percocet, oxycontin, morphine)
• Please do not call opioids “narcotics”
• Studies have shown that when opioids are (1) prescribed for the appropriate indication; (2) taken exactly as prescribed AND (3) monitored appropriately
- They are safe to use
- Manage pain effectively
- Less likely to lead to misuse/abuse
- Especially if they are take for short-term

• Appropriate medical reasons?

  • Physical pain? Yes
  • Emotional pain? No
  • Sleep? Only if physical pain is contributing to insomnia
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6
Q

Prescription Pain Relievers and Misuse

A

• When “misused” (aberrant drug seeking behaviors):

  • Taken by someone other than the patient for whom the medication was prescribed
  • Or taken in a manner of dosage other than what was prescribed (e.g. taking more than prescribed)
  • Or taking it for an indication other than what was prescribed
  • When taken aberrantly then prescription pain medication can produce serious adverse health effects
  • And can lead to substance use disorder
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7
Q

How are Opioids Abused?

A
  • Pills can be crushed and the powders snorted or injected
  • Some slow release formulation (previous Oxycontin formulation) when injected or snorted cause rapid release in bloodstream, exposing patient to high doses resulting in overdose
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8
Q

What Occurs in Opioid Overdose?

A
  • Overdose reactions: excessive drowsiness, including breathing difficulties, and sometimes death
  • Naloxone (Narcan) (opioid antagonist) should be given in the setting respiratory depressions
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9
Q

How do Opioids Affect the Brain?

A
  • Opioids can change a way a person experiences physical pain
  • It can also impact parts of the brain where you feel pleasure, a sense of feeling “high” and well-being
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10
Q

What Adverse Effects Can Be Associated with Opioids? What Happens When You Stop Taking Opioids?

A

• Opioids can cause
- Constipation, drowsiness, nausea or stomach upset, pruritus and if taking too high of doses can affect breathing
• Monitoring, prevention and education are important
• Also be aware of drug-drug interactions
- Especially with other medications that can cause drowsiness

• You can experience symptoms of withdrawal

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11
Q

Opioid Abstinence (Withdrawal) Syndrome

A
  • Insomnia (take sleep med)
  • Fever/chills (acetaminophen)
  • Runny nose (clonidine)
  • Nausea/vomiting (prochlorperazine)
  • Dilated pupils
  • Goose bumps
  • Yawning
  • Anxiety (clonidine)
  • Agitation (clonidine)
  • Muscle aches (clonidine)
  • Increased tearing
  • Sweating (clonidine)
  • Abdominal cramping (clonidine)
  • Diarrhea (loperamide, hydration)
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12
Q

Are There Treatments for Opioid Use Disorder?

A

Yes
• Needs to be done under medical supervision
• By a provider with special training

Medication-Assisted Therapy (MAT)
• Methadone- opioid agonist; daily liquid
• Naltrexone- opioid antagonist; daily pill or monthly injection
• Buprenorphine- mix of opioid agonist/antagonist; daily dissolving tablet, cheek film, or 6-month implant under the skin

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13
Q

Ways to Dispose of Controlled Substances

A

• Prescription Drug Drop Boxes

  • Sheriff locations
  • UC San Diego Health (2 different locations)
  • Some participating pharmacies

• DisposeRx

• TakeAway Medication Recovery System
- Mix with cat liter, coffee grind, or in bleach container and then throw it away

• Flush it down the toilet

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14
Q

Oxycontin (Oxycodone CR)

A
  • Strong opioid
  • Common medication of abuse in those seeking help for heroin use disorder
  • Purdue Pharmaceutical pleaded guilty to misleading the public about Oxycontin’s risk of opioid use disorder, and agreed to pay $600 million (2007)
  • Reformulated Oxycontin(2010) -> abuse deterrent formulation
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15
Q

Ultram (Tramadol)

A
  • Opioid (acts on the opioid receptor)
  • Mistaken by prescribers and patients as the “safe alternative” to an opioid
  • “chill pills”, “ultras”, “OxyContin lite”
  • Can cause euphoria even at low doses
  • Scheduled CIV (vs. CII of other opioids)
  • Rise in tramadol prescriptions -> misuse/abuse and overdose deaths
  • Tramadol claiming more lives than any other drug – including heroin and cocaine
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16
Q

Lomotil (Diphenoxylate/Atropine)

A
  • Prescribed for the treatment of diarrhea
  • Diphenoxylate acts on the opioid receptor
  • Atropine can produce nausea and weakness, and is combined with opioid products as a way to discourage misuse and abuse
  • 30 or 40 pills will cause euphoria
17
Q

Cough Syrups

A

• Phenergan (promethazine) with codeine

  • Codeine is an opioid, promethazine antihistamine which increases the euphoria of opioids
  • Drinking promethazine-codeine cough syrup mixed with soda plus a jolly rancher.
  • “sizzurp”, “purple drank”

• Dextromethorphan

  • At high doses, dextromethorphan is classified as a dissociative general anesthetic and hallucinogen
  • Common drug of abuse amongst teenagers
  • California: SB-514 Dextromethorphan: sale to minors prohibited
  • “robo-tripping”
18
Q

Benzodiazepines (CNS Depressant)

A

Xanax (alprazolam), Ativan (lorazepam)
• Benzos, downers, tranks, roofies, xannies, and roches
• Enhances the effect of the neurotransmitter gamma- aminobutyric acid (GABA)
- Sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties
- Over time the sedation reduces and you need to take higher doses to obtain the same effects
• Risk of death significantly increased with concurrent alcohol use

19
Q

CNS Stimulants and Pseudoephedrine

A

Ritalin (methylphenidate) and Adderall (mixed amphetamines)
• Used for ADHD and sleep disorders
• “performance enhancement,” study aid, increased concentration

Pseudoephedrine
• Behind the counter
• Used to make methamphetamine

20
Q

Gabapentin/Pregabalin

A
  • Neurontin (gabapentin), Lyrica (pregabalin)
  • Used to treat neuropathic pain
  • GABA-mimetic properties
  • Abuse can cause euphoria, improved sociability, a marijuana-like ‘high’, relaxation and sense of calm
  • Other patients report feeling “zombie-like”
21
Q

Cannabis/Marijuana

A 
Marijuana = Cannabis
Cannabis = THC + CAnnabidiol

• Plant Cannabis sativa (60-70 cannabinoids) with two main components

  • Delta-9-tetrahydrocannabinol (THC): May contain more of the CNS depressant effect (causing sedation, dizziness) and causing euphoria or dysphoria
  • Cannabidiol (CB) compound that may have more of the therapeutic effects

How is it used?
• Smoked (hand-rolled joints, pipes, cigars)
• Ingested via teas, edibles, topical oils

22
Q

State and Federal Medical Marijuana Laws

A

STATE
• State laws differ: Legalized, medical and decriminalized, medical, decriminalized, fully illegal
• 17 states & D.C : Legalized

FEDERAL
• Schedule I substance
• Definition: illegal drug that has high potential for abuse and no established medical use

23
Q

FDA Approved Medications

A
  • Marinol (schedule III) is a synthetic form of THC FDA approved for chemotherapy-induced nausea and vomiting, and anorexia from AIDS
  • Epidiolex (not scheduled) is a cannabidiol oral solution FDA approved for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients 2 years of age and older
24
Q

Medicinal Marijuana: Your Approach as a Pharmacist

A
  • Ask if the patient if they are using marijuana, cannabis, cannabidiol during your assessment of the patient’s social history
  • Separate your personal opinion versus your professional responsibility to make sure patients are using medication therapies safely
25
Q

Cannabis Counseling

A

• Cannabis, as a CNS depressant, can cause sedation and impair judgment with any activity that requires alertness
- Caution when marijuana is combined with other medications that cause sedation
- May be taken with other pain medications with carefully monitoring by pain provider/marijuana provider
• Eachproductmayhavedifferentvariationsof cannabinoids and different potency -> use caution when using a product for the first time
• Avoid smoking it as it may cause lung infections
- Some known drug-drug interactions with cannabis

26
Q

Cannabis Withdrawal Symptoms

A
  • Restlessness
  • Insomnia
  • Fatigue
  • Irritability
  • Anxiety
  • Depression
  • Stomach discomfort
  • Sweating
  • Tremor
  • Fever and chills
  • Headache
  • Diminished appetite
27
Q

Complications with Cannabis

A 
• Associations between cannabis may worsen symptoms of mental illness in some patients
- Schizophrenia/psychotic disorders 
- Depression
- Suicide ideations
- Anxiety disorders
• Cannabis Use Disorder (CUD)

Pharmacy Practice I (27 decks)

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