of breath. Symptomatic treatment is available. However, there is no lasting treatment (Broderick, 2023). Vaping-related lipoid pneumonia develops when fatty acids enter the lungs from the oily substances found in the e-liquid. This induces inflammatory responses in the lungs, demonstrated by chronic cough, shortness of breath, and blood-tinged mucus. Therefore, the most crucial treatment is eliminating vaping while the lungs heal themselves (Broderick, 2003). Primary spontaneous pneumothorax . Those who develop a collapsed lung due to vaping often develop air blisters on the top of the lungs that rupture and create tiny tears (Broderick, 2003). In addition, rapid growth in adolescence is prone to blisters that create a weak point. The blisters do not produce symptoms, but smoking and vaping increase the risk of pneumothorax (Broderick, 2003). Signs of a pneumothorax
include sharp chest or shoulder pain and dyspnea. Immediate treatment includes oxygen and chest radiograph (CXR) confirmation with supportive treatment. E-cigarette/vaping-associated lung injury (EVALI) is strongly associated with vitamin E, found in the lung fluid of individuals with EVALI but not those without EVALI (CDC, 2021). EVALI is a diagnosis of exclusion, but rapid recognition is critical to reducing severe outcomes. During a comprehensive review of systems, the clinician should ask about the recent use of e-cigarettes or vaping. If confirmed, ask about the type of substance (THC, nicotine) utilized. Laboratory tests should be guided by clinical findings as well as practice guidelines. Community-acquired pneumonia and influenza are evaluated since EVALI is challenging to differentiate from these diagnoses (CDC, 2019).
OPIOIDS
Controlled Substance Act (CSA) The Comprehensive Drug Abuse Prevention and Control Act of 1970 , the Controlled Substance Act (CSA), regulates pharmaceutical and illicit controlled substances in the United States 2010 Statement of Policy: Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies (DEA, 2010b). The CSA requires registration, outlines specific rules about dispensing pharmaceutical controlled substances, and determines the legality of these substances (DEA, 2018a). The U.S. Drug Enforcement Agency (DEA) was formed in 1973 to enforce the CSA. For pharmaceutical controlled substances, the DEA is responsible for preventing the diversion and abuse of controlled drug substances. The agency also ensures that an adequate and uninterrupted supply of pharmaceutical controlled substances is available to meet legitimate medical, scientific, and research needs. Along
with state and other federal agencies, the DEA regulates the registration of manufacturers, distributors, and dispensers of controlled pharmaceutical substances and the import and export of these substances. The DEA prosecutes anyone who violates this law (DEA, 2020a). Self-Assessment Quiz Question #2 Which agency is responsible for enforcing the Controlled Substance Act (CSA) and preventing the diversion and abuse of pharmaceutical controlled substances in the United States? a. Food and Drug Administration (FDA). b. Drug Enforcement Administration (DEA). c. Centers for Disease Control and Prevention (CDC). d. National Institutes of Health (NIH). ● Been convicted of a felony relating to a controlled substance of a Schedule I chemical ● Had their state license or registration suspended, revoked, or denied ● Committed an act that would render the DEA registration inconsistent with the public interest ● Been excluded from participation in the Medicaid or Medicare program Clinicians who are agents or employees of a hospital or other institution (e.g., interns, residents, staff physicians, advanced practice providers) may, in the normal course of their duties, administer, dispense, or prescribe controlled substances under the registration of the hospital or other institution provided that: ● The dispensing, administering, or prescribing is in the ordinary course of practice ● Practitioners are authorized by the state in which they practice ● The hospital or institution has verified that the practitioner can dispense, administer, or prescribe controlled substances within the state. ● The practitioner acts within the scope of employment in the hospital or institution. ● 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. In response to the opioid epidemic, many states have enacted policies to address the crisis yet still provide access to appropriate pain management. Procedures include guidelines for or limits on opioid prescriptions in Title 21 of the Code of Federal Regulations (CFR), Sections 1308.11 through 1308.15 (DEA, 2018b). The DEA (2010a) defines a prescription as an order for medication dispensed to or for an end user. Furthermore, to be effective, a prescription for a controlled substance must
PRESCRIBING PRACTICES FOR CONTROLLED SUBSTANCES
A physician, dentist, podiatrist, veterinarian, or advanced practice provider (i.e., chiropractor, nurse practitioner, midwife, optometrist, pharmacist) may issue a prescription for a controlled substance. Others may issue a prescription under the following conditions. ● They are authorized to prescribe controlled substances by the jurisdiction of practice. ● They are registered with the DEA or exempted from registration (e.g., U.S. Public Health Service, Federal Bureau of Prisons, or military practitioners); to obtain a DEA registration, the clinician must complete DEA Form 224 (www.DEAdiversion.usdoj.gov). ● Effective May 11, 2022, DEA requires all registration applications and renewal forms to be submitted electronically. ● An agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution that is registered instead of the individual practitioner being registered provided additional requirements as outlined in the Code of Federal Regulations (DEA, 2018b). DEA registration grants federal authority to practitioners to handle controlled substances as part of their professional practice or research. A clinician may prescribe controlled substances only under the state’s laws where their practice is located. When federal and state laws differ, the practitioner should follow the more stringent aspects of both the federal and state requirements. This principle has led to much concern about the state legalization of medical marijuana, despite the DEA maintaining its controlled substance Schedule I status. The DEA may deny, suspend, or revoke a clinician’s DEA registration upon finding that the registrant has ● Materially falsified any application filed
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Book Code: AUS3024
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