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spring 2022 > MMJ > Flashcards

MMJ Flashcards

1
Q

Preferred Term for Medical Marijuana

A

Medical Cannabis

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2
Q

What is the main psychoactive ingredient in marijuana?

A

THC

Delta-9-tetracannabinoid

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3
Q

What is the active ingredient in Marinol and Syndros?

A

Dronabinol

-Synthetic THC

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4
Q

What is the active ingredient in Cesamet?

A

Nabilone

-Synthetic agent similar to THC

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5
Q

What is the active ingredient in Epidiolex?

A

Cannabidiol

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6
Q

What does Epidiolex treat?

A

Lennox-Gastaut and Dravet syndromes

-Epileptic disorders

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7
Q

Responsibility of Endocannabinoid System (ECS)

A
  • Maintain homeostasis
  • Naturally produces endocannabinoids
  • Modulates ECS
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8
Q

Where are CB1 receptors found?

A

CB1: Central and peripheral NS

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9
Q

Where are CB2 receptors founds?

A

CB2: Immune, blood, and PNS

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10
Q

CBD: Cannabidiol uses

A

Promising small trials: Anxiety, SUD, Parkinson’s, schizophrenia

Others: AD, MS, Huntington’s, hypoxia-ischemic injury, CVD, migraines, depression, cancer, nausea, inflammatory diseases, RS

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11
Q

CBD routes of adminitration

A

Edible oil
Vapes
Topical lotions/oils
Rectal/Vaginal suppositories

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12
Q

Adverse effects of CBD

A

fatigue, elevated LFTs, anemia, infections (pneumonia), diarrhea

Somnolence, sedation, lethargy, decreased appetite

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13
Q

CBD urine/blood toxicology

A

Will screen positive for marijuana with drug screen - need GC/MS testing to distinguish between CBD and THC

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14
Q

CBD and CYP2C9 Interaction

Ex: warfarin

A

Inhibits CYP2C9 enzyme

Increased INR and r/f bleeding

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15
Q

CBD and P-glycoprotein (P-gp) interaction

Eg: Direct oral anticoagulants (DOACs)-dabigatran, apixaban, rivaroxaban, clopidogrel

A

DOACs are substrates of P-gp

CBD may inhibit P-gp, increasing DOACs concentration/accumulation, increasing r/f bleeding

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16
Q

CBD and CYP219 interaction

Eg: Clopidogrel

A

Clopidogrel is converted to active form by CYP219
CBD inhibits CYP219
CBD may reduce clopidogrel conversion
May decrease effectiveness, increase r/f thrombus

17
Q

CBD and CYP2C19 interaction

Eg: Clobazam, n-desmethylclobazam (active metabolite)

A

CBD in a potent inhibitor of CYP2C19

Prolongs half-life of clobazam, increases serum concentrations

18
Q

CBD and CYP2C9. CYP2C19, CYP3A4, n-acetyltransferase, glucuronidation, carboxyl esterase interactions
Eg: Topiramate, zonisamide, eslicarbazepine, rufinamide

A

CBD inhibits all CYP enzymes involved in metabolism of topiramate and zonisamide
Increases drug levels

19
Q

Indications for THC use

A

Chronic neuropathic pain, neuropathy, MS, muscle spasticity, glaucoma, insomnia, appetite stimulation, nausea, anxiety

20
Q

Factors for THC prescribing related to dose and strength

A

THC% controlled
Dosages unregulated
Strains and terpenes ratios will cause different effects
Concentrates may contain 80% THC

21
Q

THC considerations for negative effects (Conditions)

A

Cannabinoid Hyperemesis Syndrome (CHS)
Pulmonary issues
Negative impact on developing brain (adult use preferred, 18+)
Increased r/f schizophrenia, CUD

22
Q

What is Cannabinoid Hyperemesis Syndrome (CHS)?

A

Cyclical n/v/periumbilical pain r/t THC use

23
Q

THC adverse effects (side effects, interactions)

A 
Drug-drug interactions (CV, psych)
Potentiated by alcohol
Motor/coordination impairment
Altered judgment
Paranoia/psychosis at high doses
Anxiety
Dizziness
Drowsiness
Lung infections
Dry mouth
24
Q

What are s/s of cannabis withdrawal?

A

Insomnia, decreased appetite, restlessness, unpleasant dreams

25
Q

THC dosage consideration

A

Start low, go slow

26
Q

What THC route of administration provides the fastest relief?

A

Inhalation

27
Q

What THC route of administration provides the longest lasting relief?

A

Topical

28
Q

What THC route of administration is best for insomnia?

A

Combined oral and inhalation (Get to sleep, stay asleep)

29
Q

Slide 12

A

Nope

30
Q

Potential patient qualifiers for MMJ therapy

A
  • Needs alt. to opioids for chronic pain
  • No relief from current pain regimen
  • Have side effects from current regimen that interfere with QOL
  • Have uncontrolled symptoms of chronic conditions
31
Q

What are the prescriber requirements for certifying patients for MMJ in NYS?

A
  • DEA number

- Hold a federal Drug Addiction Treatment Act of (DATA) 2000 waiver to be qualified to treat patients with SUD or OUD

32
Q

Steps to certifying patients for MMJ therapy

A

Review hx/dx
Discuss risks/benefits, safety, MH concerns
Identify support person
Obtain release of information for PCP/psych
Establish goals of treatment
Schedule follow-up
Create safety plan
Complete certificate on NYS website
Mail/Forward signed hard copy to patient
Patient registers through patient portal with DOH
Communicate with PCP/specialists regularly

33
Q

Steps to become a certified MMJ provider

A

Minimum 2-hour course

34
Q

What is the database for MMJ providers in NYS?

A

Medical Marijuana Data Management System (MMDMS) (MMUAS)

Preferred/New: Medical Cannabis Data Management System (MCDMS)

35
Q

Starting dose for THC edibles

A

THC 2.5 to 5 mg

36
Q

Time between doses for edibles

A

3 hours

37
Q

Time between THC inhalations

A

20 minutes

38
Q

Screening tool for cannabis use disorder

A

Cannabis Use Disorder Identification Test

CUDIT

spring 2022 (14 decks)

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