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Prescription: yes generic available: yes preparations: tablets: 250 and 500 mg, and 1 capsules: 250, 333, 500 and 750 mg, because sav on pharmacy. This subject is dealt with in detail in Chapter 2 as this is most relevant when dealing with HIV-infected patients. If any controlled drug is to be dispensed from the WGH please follow the following procedure: A prescription should written on the usual prescription form inpatient or outpatient ; . In addition a hand written prescription for the controlled drug only should be written on headed Trust note paper and sent along with the usual prescription form to pharmacy. Dispensing of the drug will be recorded by the nursing staff as per usual on the prescription form.
AMPHETAMINE in powder form usually white ; is most commonly referred to as speed. `Ice' usually refers to methamphetamine hydrochloride, which differs from amphetamine by the addition of a methyl group on the chain. Methamphetamine can be smoked or injected -- an increasingly common practice. Amphetamine and methamphetamine are synthetic substances structurally similar to dopamine and noradrenaline. Amphetamines act primarily on monoaminergic systems, increasing the release of dopamine, noradrenaline or serotonin from neuronal terminals as well as increasing neuronal activity by blocking reuptake. The ability of amphetamines to increase the release and activity of these neurotransmitters is dose dependent. The peak response occurs 1-3 hours after oral administration or 15 minutes after injection. Amphetamine has a 7-12-hour half-life, which may increase when urine is alkaline. Some users take urinary alkalinising agents to prolong the drug effect. About 1.5 million Australians have used amphetamines at least once in their lives and half a million people have used them within the last year. On average the age of first amphetamine use is 20 years. Figure 1: Proportion of different age groups who have used MDMA at some time in their lives. 30 Females Percentage using MDMA Males 20 Cocaine has a relatively short half-life, and effects can diminish within an hour. This tends to produce binge episodes of repeated use, often leading to problems associated with repeated injection, such as increased risk of blood-borne virus infections and vein damage. The freebase form `crack cocaine' ; is sufficiently volatile to be smoked, but this form of cocaine is rarely used in Australia. tured from its precursor, gamma-butyrolactone GBL [2 3H ; -furanone dihydro] ; , which is a solvent found in floor-cleaning products, nail polish and super-glue removers. The cost of a single dose is estimated to be only $5. LSD and psilocybin magic mushrooms ; are hallucinogens used by a small proportion 2% ; of the population -- usually students. Use is commonly recreational and dependence is rare. Prescription medications such as SSRIs, benzodiazepines and sildenafil V8agra ; are increasingly taken by psychostimulant users to increase the high or to reduce the impact of the withdrawal from the drug, termed the `crash' or `come down' period. A recent National Drug and Alcohol Research Centre survey indicated 25% of MDMA users reported taking prescribed medications to improve the effect of the drug or reduce the impact of the crash period. Research shows prescription drug users are significantly more likely to be male, to have used for many years and are more likely to have injected drugs. SSRIs may enhance the effect of MDMA but at the expense of an increased risk of serotonin toxicity see box ; . Stimulant medications such as dexamphetamine and methylphenidate Ritalin ; have also been reportedly used inappropriately, most often by young adults in student populations. The serotonin precursor 5-HTP 5-hydroxytryptophan ; , which is sold over the Internet, may also be taken with psychostimulant drugs in the belief that it may improve the initial euphoria or reduce the impact of the come-down. There is some suggestion that this practice may increase the risk of serotonin toxicity in MDMA users. All of the injectable agents require education of the patient in the techniques of drug storage, use and self-administration by injection. The prescribing physician must be confident that the patient can use the drug safely and effectively and that he has an appropriate dose. The majority of patients can be taught the technique if they are well-motivated and have reasonable manual dexterity, especially if they use one of the autoinjectable devices that are now available for self-injection therapy. Selection of an appropriate dose is made by the physician and needs to be made by careful titration prior to prescription. The dose selected is a balance between the efficacy of the treatment and the risk of possible side-effects. Patients with a major psychogenic aetiology to their problem will require a lower dose than those with a vasculogenic cause, though in all cases titration upwards from a low dose is necessary. 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Client #2 began receiving services May 30, 2006. The Daily Resident Care Schedule forms for May 30, 2006 through September 21, 2006, indicated that client #2 received assistance with medication administration. Client #3 began receiving services November 2, 2005. The Daily Resident Care Schedule forms for November 2, 2005 through July 23, 2006, indicated that client #3 received assistance with medication administration. Client #2 and #3's records lacked an assessment by the RN of the their functional status and need for assistance with self-administration of medications or medication administration. Also, the clients' service plans did not include the provision of medication administration. When interviewed September 20, 2006, the RN stated she had modified the Resident Plan of Care, which is the client's service plan, to include the type of assistance with medication administration that the client was receiving. 4. MN Rule 4668.0855 Subp. 9 AREA OF COMPLIANCE: # 6 Based on record review and interview, the licensee failed to have complete medication records for three of three clients' #1, #2, and #3 ; records reviewed. The findings include: Client #1 began receiving services November 1, 2005. The client's Resident Plan of Care, dated July 25, 2006, indicated the licensed practical nurse LPN ; set up the client's medications weekly in labeled containers and the client managed his medications with medication reminders from staff. Client #2 began receiving services May 30, 2006. The client's Resident Plan of Care, dated July 25, 2006, indicated the LPN set up the client's medications weekly in labeled containers and the client received assistance with self administration of medications. Client #3 began receiving services November 2, 2005. The client's Resident Service Agreement Plan of Care, dated December 1, 2005, indicated the client was to have assistance with self administration of medication. When interviewed September 19, 2006, the Health Care Manager stated that client #2 and #3's assistance with administration of medications consisted of the LPN filling the medication boxes with the medications on a weekly basis and the unlicensed staff bringing the medications to the client at the designated times, giving the medications and monitoring that the client took them. After administration of the medications the unlicensed staff documented their initials on the Daily Resident Care Schedule indicating that they had assisted with the administration of the medications. The records for clients #1, #2 and #3 lacked documentation of the name, date, time, quantity of dosage, and the method of administration of all prescribed legend and over-the-counter medications and the signature and title of the authorized person who provided assistance with self-administration of medication or medication administration. When interviewed September 19, 2006, the LPN stated she filled the medication boxes from the Drug Regimen Review form which indicated the medication, dosage, route of administration, date ordered, date discontinued, and comments. She would then, for example, pharmacy guild.

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