• U.S. Department of Justice (DOJ). (2018). Justice Department issues memo on marijuana enforcement. http s://www.justice.gov/opa/pr/justice-department-issues-memo- marijuana- enforcement • U.S. Drug Enforcement Agency (DEA). (2010a). Electronic prescriptions for controlled substances (EPCS). http s://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html • U.S. Drug Enforcement Agency (DEA). (2010b). Role of authorized agents in communicating controlled substance prescriptions to pharmacies. http s://www.deadiversion.usdoj.gov/ fed_regs/rules/2010/fr1006.htm • U.S. Drug Enforcement Agency (DEA) (2018a). The Controlled Substances Act. http s:// www.dea.gov/drug-information/csa • U.S. Drug Enforcement Agency (DEA) (2018b). Drug scheduling. http s://www.dea.gov/ drug-information/drug-scheduling • U.S. Drug Enforcement Agency (DEA). (2018c). Drug policy. http s://www.dea.gov/drug- information/drug-policy • U.S. Drug Enforcement Agency (DEA). (2020a). Drugs of abuse: A DEA resource guide. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20 Version-508%20compliant-4-24-20_0.pdf • U.S. Drug Enforcement Agency (DEA). (2020b). Pharmacist’s manual: An informative outline of the Controlled Substances Act. http s://www.deadiversion.usdoj.gov/GDP/(DEA- DC-046 ) (EO-DEA154)_Pharmacist_Manual.pdf • U.S. Drug Enforcement Agency (DEA). (2022). Mid-level practitioners’ authorization by state. http s://www.deadiversion.usdoj.gov/drugreg/practioners/index.html • U.S. Food and Drug Administration (FDA). (2018). FDA education blueprint for health care providers involved in treating and monitoring patients with pain. http s://www.fda.gov/ media/99496/download Rationale: Poison Control (1-800-222-1222) is available 24 hours a day to patients and clinicians to answer any questions concerning accidental ingestion or contact with known or unknown substances. 2. The correct answer is D. Rationale: Clinicians who are agents or employees of a hospital or other institution (e.g., interns, residents, staff physicians, advanced practice providers) may, in the ordinary course of their duties, administer, dispense, or prescribe controlled substances under the registration of the hospital or other institution in which they are employed, provided that the dispensing, administering, or prescribing is in their ordinary course of practice; practitioners are authorized to do so by the state in which they practice; the hospital or institution has verified the practitioner is permitted to dispense, administer, or prescribe controlled substances within the state; the practitioner acts only within the scope of employment in the hospital or institution, and the hospital or institution authorizes the practitioner to dispense or prescribe under its registration and assigns a specific internal code for each practitioner so authorized.
• U.S. Food and Drug Administration (FDA). (2020). FDA and cannabis: Research and drug approval process. http s://www.fda.gov/news-events/public-health-focus/fda-and- cannabis- research-and-drug-approval-process • U.S. Food and Drug Administration (FDA). (2021). Approved risk evaluation and mitigation strategies (REMS). http s://www.accessdata.fda.gov/scripts/cder/rems/index.cfm? event=RemsDetails. p age&REMS=17 • U.S. Food and Drug Administration (FDA). (2022a). FDA warns about several safety issues with opioid pain medicines; it requires label changes. http s://www.fda.gov/drugs/fda-drug- safety-podcasts/fda-drug-safety-podcast-fda-warns-about-several-safety-issues-opioid-pain- medicines-requires-label • U.S. Food and Drug Administration (FDA). (2022b). FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. http s://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-drug-safety- podcast-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or-cough • U.S. Food and Drug Administration (FDA). (2022c). FDA restricts prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. http s://www.fda.gov/drugs/fda-drug-safety-podcasts/fda- drug-safety-podcast-fda-restricts-use-prescription-codeine-pain-and-cough-medicines-and- tramadol • U.S. Food and Drug Administration (FDA). (2022d). FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: Careful medication management can reduce risks. http s://www.fda.gov/drugs/fda-drug- safety-podcasts/fda-drug-safety-podcast-fda-urges-caution-about-withholding-opioid- addiction-medications-patients • U.S. Food and Drug Administration (FDA). (2022e). Medication guide s. https://www.fda.gov/ drugs/drug-safety-and-availability/medication-guides The correct answer is E. Rationale: If the prescriber institutes long-term opioid therapy, a written informed consent and treatment agreement are recommended. The informed consent may address several issues, such as evidence that the benefit of opioids or other medications in managing chronic pain is limited (except for cancer); potential risks and benefits of opioid therapy; potential short- and long-term side effects of opioid therapy; the likelihood that tolerance to and physical dependence on the medication will develop; the risk of drug interactions and oversedation; the risk of impaired motor skills; the risk of substance abuse disorder, overdose, and death; the clinician’s prescribing policies (e.g., number and frequency of refills, early refills, exceptions); reasons the drug may be changed or discontinued; and that the treatment may be discontinued without agreement from the patient, such as with violations of the treatment agreement. Educate the patient that complete elimination of pain should not be expected. 4. The correct answer is A. Rationale: Integrative medicine and integrative nursing are the same. In the past, these therapies were called complementary. 5. The correct answer is A. Rationale: Any tapering schedule must be patient-specific to minimize withdrawal symptoms while maintaining adequate pain management. A general recommendation is to begin with a 10% decrease of the initial dose per week.
PAIN MANAGEMENT: EVIDENCE-BASED GUIDANCE FOR PRESCRIBING OPIODS Self-Assessment Answers and Rationales 1. The correct answer is A. 3.
Course Code: ANCCUS05PG
Page 96
Book Code: AUS3024
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