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Pain Control > Prescription Writing > Flashcards

Prescription Writing Flashcards

1
Q

What is included in prescription writing in terms of personal info?

A
  1. Doctors name
  2. address
  3. phone number
  4. patients name/date
  5. patients address/age
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2
Q

what is included in the Rx writing? and order of this

A

Rx
Drug Name/ Dosage Size
Disp: Number of tablets, capsules, to be dispensed (write out as precaustion for abused druges: Example - Dis: #15 tabs
Sig : Direction on how the drug is to be taken

Doc Signature
State License Number
DEA Number

Rx
Amoxicillin 500 mg
Disp: 4 (Four) tablets
Sig: Take four tabs. 1 hr before the procedure

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3
Q

consultations

A

requests for consultations carries different connotations

only expected to render an OPINION

consultant is expected to perform any test or procedures necessary to act on their opinion

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4
Q

describe inpatient consultation

A

should be written on standard hospital consultations forms - also may be on an electronic record

state the question to be answered

provide a brief statement of other active problems

should be answered within 24 hours or sooner

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5
Q

guidelines for answering consultations

A

state the reason for consultation in the opening sentence

state that the chart has been reviewed and patient examined

be brief but thorough

be specific with recommendations (ex- radiographs, extractions, etc.)

provide contingency plans

follow up wit verbal contact

follow patients progress

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6
Q

Disp includes?

A

number of tablets, capsules, to be dispensed and write it out

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7
Q

sig includes?

A

direction for how pt. should take medication

example –

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8
Q

q means

A

every (like every 6 hours)

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9
Q

d means?

h means?

A

day

hour

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10
Q 
prn means?
bid means?
tid means?
qid means?
hs means?
A

prn = as needed

bid = twice a day

tid = 3x a day

qid = 4x a day

hs = before bed time

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11
Q

how do you write an Rx that requires patient to receive two grams of Amoxicillin one hour prior to the appointment?

A

Rx
Amoxicillin 500mg
Disp: 4 (four) tablets
Sig: Take four tabs. 1 hr before the procedure

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12
Q

dosages in capsules of amoxicillin

A

250 mg and 500 mg

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13
Q

how many capsules of 250 mg or 500 mg needed for an amoxicillin rx of 2 grams?

A

4 capsules of 500mg or 8 capsules of

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14
Q

how many capsules of 250 mg or 500 mg needed for an amoxicillin rx of 2 grams?

A

4 capsules of 500 mg or 8 capsules of

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15
Q

consultant is expected to perform what?

A

is expected to perform any test or procedures necessary to act on their opinion in order to ACT ON THEIR OPINION

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16
Q

inpatient consultation should be answered within?

A

24 hour or sooner

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17
Q

what is in the opening sentence in consultation

A

state the REASON FOR CONSULTATION in the opening sentence

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18
Q

structured response of answering consultation

A
  1. state the problem
  2. state chart has been reviewed
  3. list medications / allergies
  4. perform an oral evaluation
  5. make recommendations
    - radiographs
    - extractions
    - etc.
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19
Q

medical clearance used?

A

not realLy anymore – we use MEDICALLY OPTIMIZED

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20
Q

DM, HTN, heart murmer, anticoagulant therapy need a consult?

A

no - not if they are controlled – these are unwarranted

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21
Q

who is responsible for tx decisions?

A

WHOEVER PERFORMS THE PROCEDURE –responsible for his/her tx decisions

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22
Q

pt with PMH of a-fib and taking coumadin comes in for routine dental care, which will involve restorative, scaling, and two extractions. is a medical consult needed?

A

DEPENDS IF HAVE AN INR value available and if you are comfortable treating patient with that value

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23
Q

pt with PMH signficant for DM and HTn comes to office for routine dental care. Blood pressure is 135/85 and pt. knows medication just got changed but doesn’t know what they are.
need consult??

A

good with blood pressure

good one to get a consult with to get updated information – want brief medical history and medication type and what levels of Hb1Ac are at – does this fall in within your range?

**but doesn’t know medication

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24
Q

pt. comes as emergency pt. with pain on tooth #4 - no swelling or trismus and states he has a ‘liver problem’ but does not know what it is. states he bruises easily and cuts take a long time to heal.
does he need consult??

A

YES – maybe pick up a phone or give medical consult form

  1. pt. needs extraction, states liver disease.. please provide the following
    -what disease
    - lab work w/
    pt INR and CBC with
    platalets
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25
Q

pt. with PMH of HTN comes for routine care. P is 124/74 with pulse of 84. He takes HCTZ only for HTN, and medication not changed for past 2 years - sees physician every 6 months.
need consult??

A

no- probably not

but maybe if medication not changed in 5 years and hasnt seen physician in a while – then we would have a problem with that

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26
Q

55 y/o male with PMH of MI 3 years ago, presents with pain on #32
Meds= tropol (beta-blocker), lipitor Linisopril (ace-inhbitor) aspirin 81 mg

allergies = NKDA
PSH - tonsillectomy
SH- denies tob or ETOH

physical exam - large decay below gingival margin, tooth non-restorable and needs surgical extraction

comfortable doing procedure?
what questions do you ask?

A

DEPENDS – on paper comfortable with what you see but ask some more questions

  • when did you see doc last?
  • chest pain since?
  • anticoagulansts?
  • how was it treated?
  • any recent testing
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27
Q

55 y/o male with PMH of MI 3 years ago, presents with pain on #32
Meds= tropol (beta-blocker), lipitor Linisopril (ace-inhbitor) aspirin 81 mg
NEEDS EXTRACTION –
what TECHNIQUE?
what anesthetic for adequate extended post-operative anesthesia?
recommended local LA?

A

technique= inferior alveolar + long buccal

marcaine or bepivicaine
limit on cardiac pt. is 0.04 mg

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28
Q

if pt. described also had a history of congestive heart failure are there any contraindications to the use of local anesthetics?

A

relative contraindication - as heart is not pumping as strong but can still use

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29
Q

why would patient feel discomfort even after giving an IANB and shows signs of being numb?

A
  1. no buccal nerve block
  2. ACCESSORY SENSORY INNERVATION – from nerve to mylohyoid
  3. missed the block
    - too low
    - too anterior
30
Q

what post op pain medication would you prescribe for following surgical extraction?

A

if need opoid – okay to prescribe but need to know for how long pain relief will be required

31
Q

if patient cannot tolerate NSAID’s what do you prescribe?

A

acetaminophen can be used (aka tylenol)

32
Q

if patient cannot tolerate NSAID’s what do you prescribe?

A

acetaminophen can be used (aka tylenol)

33
Q

opoid analgesics

A
  1. hydrocodone
  2. oxycodone
  3. meperidine
  4. proxyphene
  5. tramadol
34
Q

most important and useful non opoid analgesics in dentistry?

A

APAP - acetomitophen

NSAIDS

35
Q

motrin =

A

ibuprofen = advil

36
Q

motrin effects?

A

produces anti-inflammatory, analgesis, and antipyretic (fever) effects by inhibiting prostaglandin synthesis

37
Q

max daily dosage of motrin?

A

do not exceed 3.2 mg in a 24 hour period

38
Q

motrin drug interactions with antihypertensives?

A

may decrease the effectiveness

39
Q

motrin drug interactions with ASA or corticosteroids?

A

ASA (aspirin) and corticosteroids – could increase the risk of adverse GI effects

40
Q

motrin drug interactions with oral anticoagulants?

A

may increase the plasma levels or effects of these medications

41
Q

motrin drug interactions with methotrexate?

A

decreased clearance – thus increased toxicity

42
Q

adverse motrin effects on CNS and CV?

A

CNS – HA, dizziness

CV- fluid retention, edema

43
Q

adverse motrin effects on GI? GU?

A

GI= peptic ulceration

GU= acute renal failure

44
Q

adverse motrin effects on hematology? hepatic? respiratory?

A

hematologic – prolonged bleeding time

hepatic – elevated liver enzymes

respiratory – bronchospasm

45
Q

example rx for motrin?

A

Motrin 600 mg
Disp: #15 (fifteen)
Sig: one tab q 6 hrs prn pain
refills: none

46
Q

acetominophen action?

A

thought to produce analgesia by blocking generation of pain implses, probably by inhibiting prostaglandin synthesis in the CNS or the sybthesis or action of other substances that sensitize pain receptors to mechanical or chemical stimulation

thought to relieve fever by central action in the hypothalamic heat regulating center

effective in analgesic effects with antipyretic effects but LITTLE ANTI-INFLAMMATORY activity

APAP may function by inactivating COX enzymes responsible for the final catalytic reaction

47
Q

dosage for adult for acetaminophen?

A

325 to 650 mg P.O. every 4 to 6 hours; or 1 g P.O. three times a day as needed

48
Q

acetaminophen hepatic toxicity reached when? FDA request that dose of APAP contained in prescription opiod APAP analgesics be limited to max what?

A

when daily dose of 4000 mg is exceeded

prescription opoid APAP max = 325 mg ( so no more than 325 per capsule)

and with continued concern tylenol manufacturer reduced max daily recommendation from 4000 to 3000mg

49
Q

rx for one week of amoxicillin

A

Rx: amoxicillin 500 mg
Dis : 21 (twenty-one) capsules
Sig: one capsule P.O. tid until completed

Refills : none

50
Q

dosage for amoxicillin adult

A

250-500 mg P.O every 8 hours

51
Q

amoxicillin action

A

an aminopenicillin that inhibits cell-wall synthesis during bacterial multiplication

52
Q

how do bacteria resist amoxicillin?

A

by producing penicillinases (enzymes that hydrolyze amoxicillin)

53
Q

amoxicillin adverse reactions in CNS

A

lethargy, hallucinations, seizures, anxiety, confusion, agitation, depression, dizziness, fatigue

54
Q

amoxicillin adverse reactions in GI

A

Nauseau, vomitting, diarrhea, glossitis, gastritis, abdominal pain, PSEUDOMEBRANOUS COLITIS , entercoloitis

*can develop c-dif

55
Q

most side effects of amoxicillin occur where?

A

GI

56
Q

two adverse drxns to amoxicillin need to be aware of in prescribing

A
  1. anaphylaxis

2. overgrowth of nonsusceptible organism

57
Q

major concern with prescribing opoid analgesiscs in terms of adverse side effects

A

respiratory depression

can also cause sedation, euphoria, cough supression, constipation, miosis

58
Q

what type of analgesic used- general

A

full agonsist with minimal first pass effect – so more available to tx pain and also will include a non-opoid analgesisc as component of formula to provide added analgesia

59
Q

comparative oral dosing equivalents in opioid analgesics

A

5mg of oxycodone = 10 mg of hydrocodone = 65 mg of codeine= 75 mg of tramadol

60
Q

oxycodone aka

A

percaset

61
Q

hydrocodone aka

A

vicodine

62
Q

tylenol #3 has?

A

acetaminophen 300 mg and codeine phosphate 30 mg

63
Q

opiod administers effect how?

A

binds with opiate receptors in the CNS, altering both perception and emotional response to pain through unknown mechanism

also depresses the cough reflex by direct action on the cough center in the medulla

64
Q

adult opiod dosage

A

15 to 60 mg P.O. every 4-6 hours as needed for pain

65
Q

which is rate limiting for dosage between non opoid analgesis and opiod?

A

non -opoid so if 24 hour period can max out at 3000 mg and combo is 300 mg acetaminophen with 30 mg of codeine phospate
***so can give 10 total

66
Q

drug interactions with opiods?

A

CNS depressants – can all have addative effects

67
Q

rx example for tylenol #3

A

Rx: tylenol #3
Dis : 15 (fifteen(
Sig : 1 tab P.O. q4-6 hours
Refill: none

  • really do not need pt. on them for more than 2 days
68
Q

percocet composition?

A 
acetaminophen = 325 mg 
oxycodone = 5mg
69
Q

percocet rx example

A

Rx: Percocet 5/325
Disp: #12 (twelve)
Sig: one tablet P.O. q 6hrs. prn pain

refills: none

70
Q

vicodin and vicodin ES composition

A

Vicodin =Acetaminophen 300 and hydrocodone 5 mg

ES = Acetaminophen 300mg and hydrocodone 7.5 mg

71
Q

example rx for vicodin

A

Rx: vicodin 5/300
Disp: #15 (fifteen)
Sig: one to two tabs. P.O. q 6 hrs. prn pain

OR Sig: one tab P.O. q 4 hrs. prn

Pain Control (12 decks)

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