Rx writting and Rashes Flashcards
steps for PA prescribing
- National Commission on Certification of Physician Assistants (NCCPA) - pass PANCE
- apply for state license
- apply for DEA license
- apply for mass controlled substance license (MCR)
optional DEA-X / MAT waiver optional 24 hours of training to prescribe addiction management meds
superscription
Identifying info of
patient and prescriber
inscription
name of the medication,
dose, quantity, ingredient, dosage form
(tabs, capsules, syrups)
subscription
Directions for use of
medication
signature
Provider name, signature,
number of refills
key elements of written rx
Prescriber Supervising physician Prescription Controlled Substance Brand/Interchange Patient
define
BID
TID
QID
BID -2x a day
TID- 3x a day
QID- 4x a day
define QHS QAM QAC Q4H Q4-6 H
QHS - every bedtime
QAM - every morning
QAC - w/ meals
Q4H - every 4H
if prescribing PRN what must you also include
REASON “nausea” “pain” “insomnia”
when dispensing place a ___ before numeric value
#
JCAHO “do not use list”
U or u – unit IU – international unit QD/ QOD Always lead and never follow - we may write 0.5mg but do not write 5.0 MS – write out Morphine Sulfate MgSO4 – write out Magnesium Sulfate
No prescription for a controlled substance listed Schedule ___ or ____ shall be filled
more than _____ after the date of issue and may not be refilled more than ____
times.
III or IV
6 months after date of issue
refilled more then 5 times
T/F
Schedule II prescriptions CAN be refilled.
CANNOT
T/F
DEA number must be listed on the narcotic/ scheduled II-IV prescriptions.
TRUE
name schedule I drugs
heroin
marijuana / THC
ecstasy
peyote
name schedule II drugs
HIGH potential for abuse
roducts with less than 15 mg of hydrocodone per dosage
unit (Vicodin, Norco)
• Cocaine , methamphetamine
• methadone
• hydromorphone (Dilaudid) / Oxycodone/ OxyContin
• meperidine (Demerol)
name schedule III drugs
products with less than 90 mg of codeine per dosage unit (Tylenol with codeine) • ketamine • anabolic steroids • testosterone
name schedule IV drugs
xanax • soma • Valium • ativan • ambien • tramadol
name schedule V drugs
cough preparations with less than 200 mg of codeine per 100 ml (Robitussin AD) • Lomotil • Lyrica • parepectolin
name schedule VI drugs
abx
topical antifungals
verbal scripts are acceptable for schedule ___-____ but the prescription must be filled out w/ in ___ days
III-V
7 days
do pts need to present a hard copy of scripts for schedule III-VI
NO - just schedule II.
schedule II scripts may only be issued for ____days EXCEPT _____ or ______ can be issued a script of up to ____ days when used to tx adha, narcolepsu
30 days
methylphen / dextroamphetamine
60 days
Schedule III-IV: prescriptions 30-day supply - refilled up to ____ times within ____ months of the date of the prescription.
five times w/in 6 mo
schedule II re-evaluate at least once every ___ months.
4 mo
Schedule III-VI re-evaluate at least once every ___ months
6 mo
May be prescribed for pain management w/ special licensing requirements.
Methadone,
Buprenorphine (Subutex),
Buprenorphine/Naloxone(Suboxone),
primary survey of a pt assessment with SKIN findings
assess ABCs
immediate transfer to hospital if:
Signs of airway obstruction – CRITICAL
◦ Anaphylaxis
◦ May initially complain of feeling tightness in throat
◦ Audible airway noises (stridor and wheezing)
◦ May need surgical airway
Respiratory rate <10 or >29 Oxygen sat <92% on RA in a otherwise healthy person Pulse <50 or > 120 Systolic BP <90 Glasgow Coma Score <12
Normal Primary Survey but…
Admission and Close Monitoring
Suspected rash for meningococcal septicemia
Definite exposure to a trigger that previously lead to anaphylaxis
Self administration of epinephrine
A suspected anaphylactic reaction that has not fully developed
Cellulitis in a patient that appears toxic, or affecting periorbital tissues
Secondary Survey
These patients are in no immediate danger so take a careful hx and exam to determine how to treat patient
Hx - onset of sx rash - diffuse, localized, color assoc sx - how does pt feel, N/V, neck pain, eye pain progression of sx previous hx medication and drug hx family and social hx
Si/Sx of anaphylaxis
Oral: pruritus of lips, tongue, and palate and edema of lips and tongue; metallic taste in the mouth
Cutaneous: flushing, pruritus, urticaria, angioedema, morbilliform rash, and pilor erecti
GI: nausea, abdominal pain (colic), vomiting (large amounts of “stringy” mucus), and diarrhea
Respiratory (major shock organ): laryngeal: pruritus and “tightness” in the throat, dysphagia, dysphonia and hoarseness, dry “staccato” cough, and sensation of itching in the external auditory canals; lung, shortness of breath, dyspnea, chest tightness, “deep” cough, and wheezing; nose, pruritus, congestion, rhinorrhea, and sneezing
Cardiovascular: feeling of faintness, syncope, chest pain, dysrhythmia, hypotension
Other: periorbital pruritus, erythema and edema, conjunctival erythema, and tearing; lower back
pain and uterine contractions in women; aura of “doom
criteria for dx anaphylaxis
Highly likely when 1 of these 3 criteria are fulfilled:
(Syx of Shock, Respiratory distress, Skin)
two or more occur rapidly
involvement of skin-mucosal tissues
resp compromise w/ assoc end organ dysfunction
reduced bp (infants / children with 30% decrease in systolic BP)
what is considered reduced BP in pts w/ suspected anaplyaxis
30% decrease in systolic BP
tx of pediatric anaphylaxis
assess ABC IM adrenaline O2 / cardiac monitor Normal saline "wide open" nebulized adrenaline hydrocortisone diphenhydramine vasopressors / IV adrenaline
observe for at least 4-8 hours
how many refills in an epi pen jr
2 pack
11 refills
how toes epi work to tx anaphlyaxis
Works to increase peripheral vascular resistance and reverse peripheral vasodilation and decrease angioedema and urticaria
tx of contact dermatitis
topical steroids
abtihistamines (H1 blockers)
topical immunemodulators
abx
systemic steroids
phototherapy
when are super-high potency topical steroids used
used for severe dermatoses over non-facial and
non intertriginous areas.
Scalp, palms, soles, thick plaques on extensor
surfaces
<4 wks
when are medium-high potency topical steroids used
Class II-V mild to moderate non-facial and non
intertriginous areas. OK to use on flexor surfaces for short periods
<6-8 wks
when are low potency topical steroids used
Larger areas and thinner skin such as face, eyelid and
genitals.
1-2 wks on face
work-up of a rash
- CBC – Leukocytosis, Thrombocyopenia
- Mineral Oil mount – Scabies
- KOH scrapings – Dermatophytes
- Skin Biopsy
what are the 3 types of skin biopsys
shave
punch - dx rashes
excision - cancer
how do we tx drug eruption rashes
remove offending agent
antihistamines
topical steroids BID (hydrocortisone, desonide)
oral prednisone
Presented with well demarcated erythematous plaques with an overlying silvery scale on extensor surfaces
chronic plaque psoriasis
tx of chronic plaque psoriasis
Limited Dz: Topical Steroids (Class I) and Vitamin D Analogs (Calcitriol)
Severe Disease: Systemic Rx such as Methotrexate and Biologics (DMARDs)
Erythematous annular plaque with peripheral scale and central clearing
dermatophytoses / tinea
t/f
hair and nail infections respond well to topical antifungals
No usually need ORAL
most commonly used topical antifungal
Nystatin, most commonly used topical therapy, is a polyene drug that is not absorbed by the GI tract
three formulations: oral suspension ointment powder.
tx for candida and dermatophytes
imidazoles
ketoconazole
exonazole
clotrimazole
micoxonazole
Allylamines are (Worse / Better) for treating dermatophytes than Candida
BETTER
Naftifine
Terbinafine
Butenafine
best antifungal against candida
polyenes - nystatin
tx for tinea pedis
Topical Terbinafine or miconazole cream.
◦ Apply to affected area BID for 4-6 weeks
