Pharmacology · patient case question
Under the DEA schedules, hydrocodone and oxycodone are classified as:
Patient case: The Last Patient of the Day
Patient: 37-year-old male, not a patient of record
Chief Complaint: “I'm in agony. Oxycodone is the only thing that touches it. I just need a prescription.”
Background: Walked in at closing time. Says he is from out of town, cannot name a regular dentist, declines to give a pharmacy. Becomes insistent when questioned.
Medications: “Nothing regular.”
Vital Signs: BP 132/84 mmHg · HR 84 bpm · RR 16 · T 98.6°F
Findings: Examination reveals no swelling, no caries into dentin, no periodontal defect, no percussion tenderness and no radiographic pathology corresponding to the area he indicates.
Show answer and explanation
Correct answer: A. Schedule II
- A. CORRECT. Both oxycodone and hydrocodone — including hydrocodone-acetaminophen combinations, which were rescheduled from III to II in 2014 — are SCHEDULE II. Schedule II drugs have accepted medical use but high abuse potential with severe psychological or physical dependence. Practically, this means NO refills are permitted and a new prescription is required each time.
- B. Schedule I drugs have NO accepted medical use and cannot be prescribed at all: heroin, LSD, and (federally) cannabis.
- C. Schedule III includes codeine combinations (Tylenol with Codeine), buprenorphine and ketamine. Up to five refills within six months are allowed.
- D. Schedule IV includes the benzodiazepines — diazepam, midazolam, triazepam, alprazolam — and tramadol. Also up to five refills in six months.
Note: Dental-relevant memory aid: II = oxycodone, hydrocodone, morphine, meperidine, amphetamine. III = codeine combinations. IV = benzodiazepines and tramadol. V = low-dose codeine cough preparations.