Barbiturates, such as mephobarbital (Mebaral), phenobarbital (Luminal) and pentobarbital (Nembutal), are less commonly used medications for anxiety and sleep disorders due to their high risk of potential overdose, but are still used in seizure disorders and during surgical procedures. Ramelteon (Rozerem) is a prescription option that acts as a synthetic melatonin antagonist, binding to MT1 and MT2 receptors, helping to induce sleep without any abuse or addiction potential. The consistent and diligent review of best practices and the most recent evidence in the field of pharmacology are necessary components to a safe and effective medical practice (Hudspeth, 2016). As a benefit of membership, CANP offers a Controlled Substance II (CS II) Study Materials and Exam home study course at no charge to members. Clinics, 68(9), 1274-1287. https://dx.doi.org/10.6061/clinics/2013(09)15, Safe and Effective Prescription of Controlled Substances Nursing CE Course (4.0 Contact Hours). All Rights Reserved. A positive result for an unexpected drug could mean the patient was taking the drug illicitly, it is a metabolite of a prescribed drug, or the positive result was false. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. authority to include pharmaceutical drugs that are classified as Schedule ll controlled substance under the California Uniform Controlled Substance Act. Prescribing Controlled Substances Safely3. In the case of benzodiazepine overdose, there exists a benzodiazepine antagonist, flumazenil, that can be administered via an IV by emergency medical personnel (NIDA, 2018). Document every time PDMP reports are reviewed and any concerning findings. They act on the same GABA type A receptors in the brain as traditional benzodiazepines, but with a different chemical structure, thought to result in fewer side effects and less risk of dependence. Family history should include substance use/abuse or psychiatric diagnoses specifically. Medication-Assisted Treatment (MAT). (2017, October 03). So I am applying for the Controlled Substance license and the DEA. Retrieved August 21, 2018, from https://www.health.ny.gov/regulations/task_force/reports_publications/when_death_is_sought/, Pain Assessment and Management Initiative. © Assessment Technologies Institute, LLC. Barkley & Associates, Inc. is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. Addiction is defined as a primary, chronic, neurologic, relapsing disease that is characterized by dependence along with a constant, focused need for something (for the purposes of this article, a medication) despite any cost and possible harmful consequences to the individual or others. For example, hydrocodone has been detected in the results of patients using codeine, and hydromorphone has been detected in the results of patients using hydrocodone as these drugs are metabolites. This two day course, designed by nurse practitioners specialized in the field of geriatric care, is a companion course to Excelling in the Care of the Older Adult. It typically stays in the patient’s system for 30-90 minutes, depending on the patient’s body mass, metabolism, etc., and may require more than one dose depending on the half-life of the opioid ingested. NSAIDs appear safe to use during breastfeeding, however. To identify general precautions associated with prescribing controlled substances. The presence of that drug then becomes a calming and reassuring presence in the patient’s life, similar to a comfort or security object. The 2015 American Geriatric Society Beers Criteria: Implications for Nurse Practitioners. Finally, an opioid abuse risk assessment tool, a urine drug test (UDT), and a review of your state’s prescription drug monitoring program (PDMP) should be completed before any controlled substance prescriptions are given. Misuse of Prescription Drugs. Get up-to-date information to expand your practice with online advanced nursing courses from Nurse.com. An Online Resource for Certified Nursing Assistants, Licensed Practical Nurses, Registered Nurses, Clinical Nurse Specialists, Advanced Registered Nurse Practitioners, Nursing Assistant Training & Pre-Licensure Nursing Education Programs Licensure, Renewal and Information. This course complies with the Florida Board of Nursing requirement for 3.0 continuing education hours of controlled substance education in each biennial license renewal. To identify indications and contraindications for CS prescribing, particularly in pediatric and geriatric populations. All CNS depressants can commonly cause drowsiness, confusion, and poor coordination. Extreme caution should be used when prescribing methadone, which is extremely complicated to dose, and tapentadol, which is a centrally acting analgesic with an added mechanism of norepinephrine reuptake inhibition in addition to its mu-receptor agonism (USFDA Center for Drug Evaluation and Research, 2018). Controlled substances encompass a wide variety of medications from pain relievers to diet medications. To understand why agents are classified in each of the CS schedules, and how each schedule has rules affecting prescribing. As with most medical conditions, treatment should begin with a comprehensive history and physical, including information and assessment specific to pain. As previously stated, periodic review of your state’s PDMP (and possibly neighboring states depending on your proximity to the state line), pill counts, and UDTs should also be an important aspect of screening for misuse. Pain severity is self-reported and should be consistent from visit to visit to allow for trend identification. Retrieved August 23, 2018, from https://regs.health.ny.gov/, New York State Department of Health. At a minimum, risks should include possible overdose, respiratory depression, development of physical dependence or tolerance, drug interactions, inadvertent ingestion by children or others, and drug misuse or abuse by the patient/household contacts/friends. To recognize high-risk use of certain controlled substances, and ways to decrease this risk, including opioid rotation, or planned discontinuance as methods of treatment. Retrieved August 17, 2018, from https://www.cdc.gov/drugoverdose/pdmp/states.html, Choi, Y., Mayer, T. G., Williams, M. J., & Gatchel, R. J. NursingCE.com is a comprehensive online resource to help nurses meet continuing education (CE) and licensing requirements for all 50 states, Washington, D.C. and Guam. Virtual Mentor, AMA Journal of Ethics,15(5), 403-409. doi:10.1001/virtualmentor.2013.15.5.ecas1-1305, Buhrman, M., Syk, M., Burvall, O., Hartig, T., Gordh, T., & Andersson, G. (2015). Advanced Pharmacology is an ever-changing field. Federal and state laws continue to evolve to support safe use of controlled substances, while prescriptive authority of various practitioners is expanding. In 2016, the opportunity to undergo the required training for a prescribing waiver for buprenorphine was extended to NPs and PAs on a national level. Trends, symptomatology and treatment of stimulant drugs of abuse including cocaine and crack, methamphetamine, bath salts and Ecstasy, Trends, symptomatology and management of depressant drugs of abuse including marijuana, Spice, GHB, alcohol and inhalants, The problem of prescription drug abuse, including trends, most problematic drugs, management of patients who become addicted to these agents, Basics of drug testing including knowledge of persistence of drugs in the system, the immunoassay, GC-MS, and checking for adulterants of a drug test. Learning Objectives—Prescribing Controlled Substances Safely. Physicians, nurses, and patients must be aware that psychological and physical dependence on pain medication are distinct phenomena. Complete a Board of Registered Nursing-Approved Controlled Substance II (CS II) Authority Course. Abruptly stopping a stimulant can cause a withdrawal characterized by depression, fatigue, and sleep disturbance. In general, this group of medications should be used with great caution for short-term use only due to a very high risk of tolerance, dependence and addiction. Substance abuse disorders are brain disorders that can be effectively treated, although treatment must be multi-factorial and individual, often involving detoxification, counseling, and medications. Fitzgerald Health Education Associates, Inc.(FHEA) TNP members are eligible for a 15% discount when you enroll in Fitzgerald Health Education courses including certification review courses. The half-life of methadone is significantly longer than morphine (8-59 hours), with lipophilic storage, so great care should be taken with this drug in order to treat pain safely. Advanced practice nurses have been professionally trained to effectively and safely prescribe medications to both treat and manage medical conditions as a component of their overall treatment plan and care. Poppy seeds or the herb Papaveris fructus may cause positive morphine results. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. No prescriptions exceeding a 30-day supply of schedule II drugs is permitted, and additional prescriptions may not be issued for at least 23 days. It utilizes 12 adjectives describing pain and the patient is asked to rate each adjective from 0 to 10. All prescribers licensed under Title Eight of the Education Law in New York to treat humans and who have a DEA registration number to prescribe controlled substances, as well as medical residents who prescribe controlled substances under a facility DEA registration number, must complete at least three (3) hours of coursework or training in pain management, palliative care, and addiction every three years. WELCOME!We are proud to sponsor this educational initiative, dedicated to providing free CME & CEUs required by many state boards for NP, Advanced Practice Nurse license renewal.Check back often for new free Nurse Practitioner CME courses offering free CEUs that are posted frequently.Through extensive content review, our staff approves NP CEU courses that are timely and approved by the … Review of systems should include questions related to controlled substances and their use, such as nausea, constipation, cognitive changes/impairment, and a full pain assessment including pain severity rating, location, quality, duration, treatment history, and aggravating/alleviating factors. Concerns within these populations continue to be overdose, respiratory depression, and potential loss of consciousness or hastening of end-of-life. When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context. We will briefly highlight general safe prescribing practices all prescribers should abide by. This class of medications was historically used more commonly for conditions such as asthma and obesity, but due to the risks of misuse, abuse and potential addiction, they are now predominantly used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and rarely depression. Naloxone prescriptions should also be granted to caregivers who request them. Prescribers should become familiar with access to a calculator to regularly, quickly, and accurately determine a patient’s current MME and use this formula during any medication dosage changes, and for transitions between different medications to establish equivalent dosages (CDC, 2017). Assessment of depression in medical patients: A systematic review of the utility of the Beck Depression Inventory-II. Opioid Overdose. https://www.cdc.gov/drugoverdose/prescribing/guideline.html, https://www1.nyc.gov/site/doh/health/health-topics/naloxone.page, https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs, https://dx.doi.org/10.6061/clinics/2013(09)15, Describe the three different classes of controlled substances most commonly misused: indications, risks, benefits, common adverse effects, and alternatives for opioids, central nervous system (CNS) depressants and stimulants, Define medication tolerance, dependence and addiction, Discuss general guidelines for safe prescribing practices, Discuss pain management, including both acute and chronic pain and special considerations needed for controlled substance use in the elderly and pregnant populations, Review the special circumstances involved in palliative medicine and end-of-life care, Review the prevention, screening, and signs of potential substance abuse and addiction, Describe appropriate response to and current treatment options for substance abuse and addiction, Review the New York State and federal requirements for prescribing controlled substances, Hydrocodone (Vicodin, Lortab, Norco): commonly combined with acetaminophen, most commonly prescribed opioid in the United State, Oxycodone (Percocet, Oxycontin): available as immediate or extended release formula, fast onset, Morphine sulfate (IR, MSContin): available as immediate or extended release formula, PO/IV, Oxymorphone (Opana, Opana ER): available as immediate or extended release, long half-life, Hydromorphone (Dilaudid, Exalgo ER): made from morphine, but with a faster onset, PO/IV, Fentanyl (Duragesic): transdermal patch lasts 72 hours, also available as IV, Opioid Risk Tool (ORT): 5-question self-administered tool that assesses personal/family history, screens only for future risk of drug misuse and is designed for adult patients, Tobacco, Alcohol, Prescription medication, and other Substance Use Tool (TAPS)- self-administered tool that combines screening, and if positive, a brief assessment for adult patients (NIDA, 2018), NIDA Drug Use Screening Tool: Quick (NM ASSIST) is a clinician-administered tool for adult patients, or the American Psychiatric Association’s adapted version NIDA-modified ASSIST is a self-administered version, CAGE Adapted to Include Drugs (CAGE-AID): a brief questionnaire based on the original CAGE tool utilized for alcohol, Screening to Brief Intervention (S2BI) and Brief Screener for Alcohol, Tobacco and other Drugs (BSTAD) are both self-administered tools designed specifically for adolescents, Diagnosis, Intractability, Risk, and Efficacy (DIRE) aims to determine suitability for long-term opioid use, Benzodiazepines should be avoided for insomnia, agitation, or delirium due to fall risk and high rate of physical dependence, especially longer acting versions, Non-benzodiazepine, benzodiazepine receptor agonist hypnotics (eszopiclone, zaleplon, zolpidem) should be avoided for insomnia regardless of duration due to fall/fracture risk and high rate of physical dependence, especially in patients with dementia/cognitive impairment, Opioids should be avoided in those with a history of falls or fractures, Antipsychotic drugs should be avoided as a first line treatment for delirium unless patient is a threat to self or others due to increased risk of stroke and mortality in the elderly with dementia and olanzapine syncope, Tricyclic antidepressants and skeletal muscle relaxants (cyclobenzaprine, carisoprodol) should be avoided/used with caution secondary to anticholinergic effects, Indomethacin and ketorolac (PO/IV) should be avoided due to risk of gastrointestinal (GI) bleeding and kidney damage, replaced instead with celecoxib, nabumetone, naproxen or ibuprofen in combination with proton pump inhibitor for GI prophylaxis (Terrery & Nicoteri, 2016), Buprenorphine- partial opioid agonist (binds to receptors but only partially activates) used to reduce cravings- prescriber must be certified to prescribe, implantable or once-monthly injection available, Methadone- synthetic opioid agonist that has been used for over 40 years to help limit symptoms of withdrawal/cravings, available only through specially licensed opioid treatment programs (OTPs), Naltrexone- opioid antagonist (prevents opioids binding to/activating receptors) used for addiction treatment, available as long-acting injection, can be prescribed by any licensed prescriber, patient must detoxify/abstain for 7-10 days prior to starting, lower abuse/diversion potential, Practitioners shall maintain a written record of prescriptions of all controlled substances, as well as a medical record for all patient receiving controlled substances that includes patient identification data, chief complaint, present illness, physical examination as indicated (which must be completed prior to any prescriptions being issued, but may have been performed by a consulting physician or hospital and those records are available for review by the prescriber), diagnosis, data which support diagnosis or treatment, and the treatment regimen to include amount, strength, and directions for use of any controlled substances.

controlled substance course for nurse practitioners

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