Latest Comments by BostonFNP

Latest Comments by BostonFNP

BostonFNP Moderator 33,612 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,038 (58% Liked) Likes: 9,182

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  • 1
    blondy2061h likes this.

    Quote from sailornurse
    Hi Boston;
    I'm familiar with contracts for controlled substances but had not considered testosterone as requiring one. Can you explain why testosterone is on the list?
    It's a schedule III with abuse potential as an anabolic steroid and abuse puts patients at significant risk; it is also dangerous for children if exposed. Our contract sheet just states it's filled at a single pharmacy from single provider, patient agrees to monitoring (CBC, T levels, PSA, etc), agrees to keep medication locked and take only as prescribed, no early fills or replacement scripts, and acknowledges the risks associated with routine treatment as well as misuse.

  • 4
    LadyFree28, roser13, Elladora, and 1 other like this.

    Quote from writerartistnurse
    Yes that is harsh. I am playing neutral party here, but it's not like she injected heroin, diverted meds from a hospital, or sold drugs. She took an ativan.
    Playing devil's advocate here, but why wouldn't the BON or the nursing program say "if he/she would take a pill without a script from a friend would they take a pill from the hospital or street?"

  • 1
    pixierose likes this.

    Quote from elkpark
    I don't know how it works where you are, but the internal medicine and family practice physicians I work around hand out benzos like they are M&Ms, to pretty much any client who is having a bad day.

    I am pretty sure that none of these providers have ever even considered the possibility of a "signed controlled substance agreement" and would laugh heartily at the idea.
    So you think this is a good thing? Honestly?

    I feel it highlights inappropriate and dangerous prescribing for both he patient and the provider.

    In my office we have every patient on chronic controlled substance use sign a contract (opioids, benzos, stimulants, testosterone, hypnotics). In fact it is a policy of our IPA and all the offices follow it.

  • 3

    Quote from Slhengy
    There are plenty of other studies that support the hypothesis. You can't disregard them just because you disagree with the data.
    I have no personal investment in this issue and I am not disregarding anything, as I stated, it is not really related to the discussion on hand (cognitive-behavioral impairment and intelligence). You also can't disregard parts of the study that don't fit your preconceived decision, that is the danger of pseudoscience. Please share these other studies so we can all read them and discuss.

    There is a wealth of extant data demonstrating the cognitive impairments associated with alcohol use and marijuana use, both acutely and chronically. Even more-so is when the agents are used in tandem which they often are. I have no real opinion on whether one is better than the other, but it really doesn't matter, as one is legal and one is not.

  • 0

    Quote from MunoRN
    11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties.
    THC itself is very lipofilic, it has a Vd of 3.5/kg and is also highly protein bound. THC has a half-life of more than 30 hours. 11-hydroxy-THC also is lipofilic and has a similar half-life. Drugs screen look for THC-carboxylase because it is even further downstream and persists the greatest amount of time and while not psychoactive it is diagnostic for use, just like methadone metabolites. Drug screening is not done for psychoactive reasons, it's done to diagnose substance use/abuse.

  • 4
    Alicia777, Maevish, elkpark, and 1 other like this.

    Quote from sauce
    None of them had any clue how to diagnose, prescribe, or even really do a true physical exam. Basic stuff they should have learned in nursing school, much less an MSN program.
    This is what your job is as a preceptor when you agree to take first semester students. First semester NP students need to learn proper physical exams, basic differentials, diagnostics, and prescriptive practices. RNs don't learn how to diagnose or prescribe. They might not even learn a proper physical exam.

    The NP program I precept for has a structured standardized patient experience semester prior to clinical rotations so this isn't an issue or me in clinic.

  • 3
    roser13, Altra, and pixierose like this.

    Quote from Studentnurse365
    Can you get a prescription from your doc? Tell the doc how anxious you've been and that you think you need an rx for lorazapam. Then if the doc gives you a rx you have the rx to show them and you won't have to take your mom's anymore. Win win.
    This is a really bad piece of advice.

  • 2
    Rocknurse and AlphaM like this.

    Quote from MunoRN
    That may have come out differently than you intended, since what accumulates in your body are non-psycho active metabolites, not active components of the drug. Both alcohol and marijuana have acute impairment and longer term impairment phases, both are dose dependent and the evidence for each is similar. The way our laws work is that federal laws only apply to what state's have not addressed, which is why in states where the two conflict it's residents are held to the state law.
    I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...

    Quote from MunoRN
    Blood testing for active THC levels was not all that common a decade ago, in Colorado it's now widely available and is as common as blood testing for alcohol blood levels, which is why there has been a predictable increase in the number of people who test positive. There's no doubt it's unsafe to drive under the influence of either marijuana or alcohol, but there's no evidence there has been sudden increase in the number of marijuana-caused accidents.
    There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.

    I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.

  • 0

    Quote from Slhengy
    This is a recent study.

    By Emily Underwood Jan. 18, 2016 , 3:00 PM
    Roughly half of Americans use marijuana at some point in their lives, and many start as teenagers. Although some studies suggest the drug could harm the maturing adolescent brain, the true risk is controversial. Now, in the first study of its kind, scientists have analyzed long-term marijuana use in teens, comparing IQ changes in twin siblings who either used or abstained from marijuana for 10 years. After taking environmental factors into account, the scientists found no measurable link between marijuana use and lower IQ.

    Twins study finds no evidence that marijuana lowers IQ in teens | Science | AAAS

    There is a big difference between long-term use and IQ and short-term use and impairment at work, and further, the study found "marijuana users had lower test scores relative to nonusers and showed a significant decline in crystallized intelligence between preadolescence and late adolescence". Twin studies are great but the data on twin users/abstinent is a very small sample size and does nothing but prove there isn't a genetic predisposition to marijuana-related IQ decline.

    Either way, it is of limited application to short-term impairment, which is what employers are concerned with, besides the law.

  • 3

    Quote from Slhengy
    We can make those same claims with the use of alcohol and even more so, per multiple studies. There is absolutely no difference.

    There is a difference, alcohol is federally legal and marijuana is not. Alcohol also does not accumulate in the body and impair function several weeks out from a single use, there could be an argument that chronic alcohol abuse does have lasting cognitive effects, but again, the law is the law regardless.

  • 2
    LadyFree28 and pixierose like this.

    Quote from fawnmarie
    I don't think she has any idea that it is a controlled substance, and I doubt she knows that some medications are "controlled." It's a cultural thing.
    It may be a "cultural thing" but the blame falls on the prescriber. Controlled substances are dangerous medications if used inappropriately and the prescriber is responsible for clear patient education. Most offices have (and all offices should) have a signed controlled substance agreement which details the risks of use and that sharing medication is considered a breach of contract.

    As for the OP, it's a bad situation. The school could even report it to the BON I would think which would make future licensure difficult. Best of luck. I would be honest if asked...

  • 3
    Horseshoe, canigraduate, and Farawyn like this.

    Quote from Horseshoe
    I'd like to see more research on long term pot use, as well as research on driving impairment after consuming marijuana.
    Li, M. C., Brady, J. E., DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., & Li, G. (2012). Marijuana use and motor vehicle crashes. Epidemiologic reviews,34(1), 65-72.

    Salomonsen-Sautel, S., Min, S. J., Sakai, J. T., Thurstone, C., & Hopfer, C. (2014). Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug and alcohol dependence, 140, 137-144.

  • 2
    canigraduate and Anonymous865 like this.

    I'm not sure that using an illicit substance to treat the symptoms of a chronic disease caused by used of other illicit substances is a solid platform for an argument.

    Regardless of personal opinions, using marijuana in any form, is against federal law and could result in a loss of license. Most of us, I would assume, have too much invested in our careers to risk it on a cheap high. Even more concerning is the issue of patient safety, as numerous studies have demonstrated cognitive impairment evident up to 4 weeks after use. It is highly lipophilic and is altering at very low concentrations in the blood stream.

  • 2
    kaysho and evolvingrn like this.

    Much of the "I made more and an RN than an NP" talk is comparing apples to oranges: if you are working night/weekends/overtime as an RN and you make more than an NP working a 40 hour M-F work week than good for you, but its not a salary to salary comparison.

  • 2
    sailornurse and WKShadowRN like this.

    ED and primary care would be the best in my opinion.


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