Posted: September 8th, 2023

Ms. ML is currently on two control substances which are Diazepam

Expectations

Length: A minimum of 180 words, not including references or attachments
Citations: At least two high-level scholarly references in APA from within the last 5 years

Nakamura et al. (2022) investigated how the combination of buprenorphine, a partial opioid agonist, and diazepam, a benzodiazepine, affects respiration in rats. Their study aimed to elucidate the mechanisms of respiratory depression caused by concurrent use of these drugs, which is a significant clinical concern. Through experiments, they found co-administration led to additive respiratory-depressant effects compared to either drug alone. This occurred through synergistic actions at both μ-opioid and GABAA receptors in respiratory-related neurons in the brainstem.
Specifically, administration of a sub-analgesic dose of buprenorphine combined with a sub-hypnotic dose of diazepam suppressed respiratory rate, tidal volume and minute volume to a greater extent than expected based on individual drug effects. Both drugs facilitated GABAergic neurotransmission, with buprenorphine also inhibiting glutamatergic excitation of respiratory centers. These findings provide valuable insights into how even low doses of buprenorphine and benzodiazepines in combination can dangerously impair breathing. Clinicians should be aware of this drug interaction risk.
In summary, Nakamura et al. (2022) offered timely experimental evidence elucidating the mechanisms behind respiratory depression from concurrent buprenorphine and benzodiazepine use. As a research tutor and writer, I hope this brief analysis and direct emphasis of the key recent study was helpful for your work. Please let me know if you need any clarification or have additional questions.

Ms. ML is currently on two control substances which are Diazepam (TID) and Norco (maximum 5 times/day) for pain control and the overlapping of using these two medications can severely depress the respiratory and central nervous system which can lead to fatal consequences (Vodovar, et al., 2022); hence, as her healthcare provider, I would educate Ms. ML about the interval frequency of taking the two medications to prevent the adverse effects. The NP should emphasize that mixing narcotic agents with alcohol can cause life-threatening events, especially since Ms. ML is taking care of her grandchild and can cause harm to her grandchild. Moreover, Norco has acetaminophen which can damage the liver when used with alcohol so the NP should explain to Ms. ML this fact (American Addition Centers, 2023a)

To ensure patient and family safety, I’d schedule Ms. ML’s pain medication to prevent overlapping, as well as recommend physical therapy to improve her daily function. Also, I would recommend urine drug testing for Ms. ML as the Centers for Disease Control and Prevention’s advice for patients on chronic opioid therapy (CDC, 2016).

Pain contract suit Ms. ML’s pain management and safety concerns
Pain and pain treatment are different for each person. My prescriber will routinely check how I am doing and educate me about the side effects to determine whether the benefits of opioid medicines outweigh the side effects of continuing to use them (Food and Drug Administration, n.d.).

Opioid medicine can impair my judgment and responses. I understand that I must be cautious and alert to ensure sure I can perform daily activities safely (FDA, n.d.)

Safe Prescribing
The APRN in CA needs to register with the Controlled Substance Utilization Review and Assessment System (CURES) and acquire the Federal Drug Enforcement Administration Controlled Substance Registration certificate.

The APRN in Massachusetts (MA) needs to follow the regulations from the MA Department of Public Health (DPH), register with the United States Drug Enforcement Agency (DEA), and obtain the prescriptive authority from the Massachusetts Controlled Substance Registration (MCSR) (Commonwealth of Massachusetts, 2015).

To ensure safety in prescribing medications, I’d review the patient’s medical history, and physical and neurological assessments, identify potential drug-drug and drug-food interactions, and educate the patient about compliance with medication dosage and frequency. Moreover, I’d consult advice and approval from supervision.

The state of California does not allow a Schedule II to be refilled (CA BOP, 2023). Controlled Substances III can be refilled up to 5 times with a 120-day total supply of refills (CA BOP, 2023).
MA allows Controlled Substances II and Controlled Substances III to have a 30-day supply and cannot be refilled (Mass.gov, 2020). However, for patients with brain dysfunction or narcolepsy, Methylphenidate and Dextroamphetamine sulfate (both are CII) can have a 60-day supply (Mass.gov, 2020).

Losartan, Gabapentin, and Atorvastatin can be prescribed via electronic order. I’d write written prescriptions for Norco and Diazepam for Ms. ML. Elements should include my name, my facility, my supervisor, date, controlled substance information including name, dosage unit, quantity to be dispensed, instructions for use, caution (if needed), number of times to be refilled, and Ms. ML full name and address.
Immediately after the controlled substance is prescribed, the NP should report to the state registry using the Massachusetts Prescription Awareness Tool (MassPAT).
The NP with restricted authorization needs to follow the standardized protocol as the following approach (BoRN, n.d.)
Acquire a certificate from the Board of Registered Nursing and a Drug Enforcement Administration registration number.
The controlled substances ordered need to be approved by the treating physician or supervising physician.
Furnish the drug based on which categories of patients may be furnished this class of medications.
The protocol may include the limit amount to be furnished or the criteria for consultation.
References
American Addition Centers. (2023a). Mixing Norco and Alcohol. Retrieved from https://alcohol.org: https://alcohol.org/mixing-with/norco/

American Addition Centers. (2023b). The Effects of Mixing Diazepam and Alcohol. Retrieved from https://alcohol.org: https://alcohol.org/mixing-with/diazepam/

BoRN. (n.d.). CRITERIA FOR FURNISHING NUMBER UTILIZATION BY NURSE PRACTITIONERS. Retrieved from https://www.rn.ca.gov/: https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pd…

CA BOP. (2023). Frequently Asked Questions. Retrieved from https://www.pharmacy.ca.gov: https://www.pharmacy.ca.gov/publications/faq_askin…

CDC. (2016). .CDC Guideline for Prescribing Opioids for Chronic Pain – Urine Drug Testing. MMWR .

Commonwealth of Massachusetts. (2015). PRESCRIBING PRACTICES POLICY AND GUIDELINES.Wakefield: Board of Registration in Medicine.

Food and Drug Administration. (n.d.). Opioid Patient Prescriber Agreement (PPA). Retrieved from https://www.fda.gov: https://www.fda.gov/files/drugs/published/Opioid-P…

Mass.gov. (2020). Mass. General Laws c.94C § 23. Retrieved from https://www.mass.gov: https://www.mass.gov/info-details/mass-general-law…

Vodovar, D., Chevillard, L., Caillé, F., Risède, P., Pottier, G., Auvity, S., . . . Tournier, N. (2022). Mechanisms of respiratory depression induced by the combination of buprenorphine and diazepam in rats. Respiration and the Airway.

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