Combat Methamphetamine Epidemic Act CMEA of 2005 Requirements for purchase

Combat methamphetamine epidemic act cmea of 2005

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Combat Methamphetamine Epidemic Act (CMEA) of 2005-Requirements for purchase: photo ID, sign written or electronic log per purchaseoMust keep personal records for at least two years-**it is a national database = National Precursor Log Exchange (NPLEx)-Limitationso3.6 g per dayo9 g per monthEfficacy and Safety of Phenylephrine (PE)-Efficacy: patients report no difference in decongestion between PE and placebo; 10 mg dose did not show to be more effective than placebo (only higher 25 mg dose did)-Safety: oral PE showed no consistent effect on heart rate or blood pressure at dose under 25 mgBottom Line with Oral Decongestants-Phenylephrine: not very effective, not many side effects, very easy to purchaseoNot recommended for children under 6 years of age-Pseudoephedrine: more effective, more side effects, more concern over CV and other side effects, harder to purchase due to regulationsoNot recommended for children under 12 years of age-Ask a doctor before use if you have:oHeart diseaseoHTNoThyroid diseaseoDMoDifficulty urinating due to enlargement of prostateoCan still recommend if disease states are under controlTopical Nasal Decongestants → arteriolar vasoconstrictors, direct on receptorsDrug Duration of actionDoseNaphazolineShort acting1 to 2 sprays every 6 hoursPhenylephrineShort acting2 to 3 sprays every 4 hours
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OxymetazolineLong acting2 to 3 sprays every 12 hoursAll of these lose potency after 2-3 months of opening and need to be discarded afterwardsLocal effects: stinging burningRhinitis Medicamentosa= rebound congestion-In order to prevent, limit use to 72 hours-Discontinue 1 nostril at a time, use saline or topical steroids-Generally takes 1 to 2 weeks to recoverBottom line: can be used safely in many people, effect is usually shorter than oral decongestants, less side effects than oral decongestants, NOT recommended for childrenRhinorrhea (runny nose) = Treatment with 1stGeneration Antihistamines-DiphenhydramineoMarketed for allergies but effective for cold symptomsoAlso effective for cough symptoms as cough suppressantoMarketed as a sleep aid-ChlorpheniramineoMarketed for allergies but may be effective for cold symptoms-Others: brompheniramine, doxylamine, triprolidine-Class: Histamine-1 Receptor antagonists-MOA: competitively inhibit histamine-1 receptors (non-selective)-PK: wide Vd, hepatic metabolism and renal elimination-Precautions: Beers Criteria, Exacerbation of certain disease states like glaucoma, BPH, thyroid disorders-Side note: there is no histamine involvement in the pathophysiology of a cold-ADEs (really important to know these!! Anticholinergic effects)oPeripheral EffectsDecreased salivationDecreased bronchial secretionsDecreased sweatingPupil dilation, inhibition of accommodationIncreased heart rateDifficulty urinatingDecreased GI motilityoCentral EffectsDrowsinessImpaired concentrations, confusionAttention deficitMemory impairmentoOther effectsParadoxical effects in children
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