Respond and critique the following post. Citations: At least one high-level scho

Respond and critique the following post. Citations: At least one high-level scholarly reference in APA per post from within the last 5 years.
Concerns I have about the 54-year-old patient’s current regimen is that she is taking an anti-convulsant, benzodiazepine, and opioid together. I am also concerned with her smoking and drinking 2-3 cans of beer on the weekends as she is taking all this pain medication. It is also my concern that the patient is also requesting her medication to be refilled for 6 months like her doctor in Mexico, so she does not have to make a co-pay and come back to see me often. I would discuss non-pharmacologic therapy such as cognitive behavior therapy (CBT), exercise to reduce pain and improve function, and glucocorticoid injections for her rotator cuff pain. Since the patient is already taking an anti-convulsant for her neuropathic pain, I would also offer non-opioid pharmacologic therapy such as acetaminophen and NSAIDs and consider discontinuing the concurrent use of Diazepam and Norco, as it can cause central nervous system and respiratory drive depression. I would have to see her every three months or more frequently to evaluate the benefits and harms of opioid therapy (Dowell et al., 2016). Other screenings I might apply would be the Brief Pain Inventory (BPI) Short Form, Pain, Enjoyment of Life and General Activity (PEG) Scale, Numeric Pain Rating Scale (NPRS), Verbal Rating Scale (VRS), Wong-Baker FACES Pain Rating Scale, or the McGill Pain Questionnaire (MPQ) (American Academy of Family Physicians [AAFP], 2022).
Steps to ensure safe prescribing: 1. Evaluate and clearly define the patient’s problem; 2. Specify the therapeutic objective; 3. Select the appropriate drug therapy; 4. Initiate therapy with appropriate details and consider nonpharmacologic therapies; 5. Give information, instructions, and warnings; 6. Evaluate therapy regularly (e.g., monitor treatment results, consider discontinuation of the drug); 7. Consider drug cost when prescribing; 8. Use computers and other tools to reduce prescribing errors (Pollack et al., 2007). The registry to search prior to any prescribing in California would be the Controlled Substance Utilization Review and Evaluation System (CURES).
The laws in California state that the quantity of a controlled substance dispensed as a refill for Schedule III or IV drugs must be limited to a 120-day supply. In addition, all controlled substance prescriptions must be filled and refilled within six months of the date written. Schedule III medications cannot be refilled more than five times. Scheduled II drugs cannot be refilled (Department of Consumer Affairs [DCA], 2022).
The DCA (n.d.) states that “most prescriptions issued by a licensed healthcare practitioner to
a California pharmacy must be submitted electronically,” including “prescriptions issued by out
of-state healthcare practitioners to be filled in a California pharmacy.” The exceptions are if “transmission of the prescription is temporarily unavailable because of technological or electrical failure; if the prescription is dispensed by a pharmacy located outside California; or if the prescription is issued to a patient who has a terminal illness” (DCA, n.d.). Elements required to include on the prescription form (paper or electronic signature) for the scheduled medications are prescriber name, license number, and contact information, prescriber U.S. Drug Enforcement Administration (DEA) number, if applicable, patient name and date of birth, patient allergies, name of medication, indication of medication, medication strength, dose of medication and frequency, number of tablets or capsules to dispense, and number of refills (Burchum & Rosenthal, 2021, p. 5).
After I prescribe, my staff and I will report specified dispensing information to CURES,
under the State of California Department of Justice as soon as possible, but not more than one working day after the date a controlled substance is released to the patient or their representative (Office of the Attorney General [OAG], 2022).
American Academy of Family Physicians. (2022). AAFP chronic pain toolkit.
American Academy of Family Physicians. (2016, September 20). Opioid medication for chronic
pain agreement.
Board of Registered Nursing. Criteria for furnishing number utilization by nurse practitioners.
Burchum, J., & Rosenthal, L. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice
Nurses and Physician Assistants (2nd Edition). Elsevier Health Sciences (US).
California Association for Nurse Practitioners. (n.d). Ordering scheduled controlled substances
Department of Consumer Affairs. (n.d.). AB 2789 bulletin: New prescribing laws take effect
January 1, 2022.
Dowell, D., Haegerich, T. M., & Chou, R. (2016, March 18). CDC guideline for prescribing
opioids for chronic pain — United States, 2016. Centers for Disease Control and
Office of the Attorney General. (2022). Controlled Substance Utilization Review and Evaluation
Pollack, M., Bazaldua, O. V., & Dobbie, A. E. (2007, January 15.) Appropriate prescribing of
medications: An eight-step approach. American Academy of Family Physicians.

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