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NSAG / Continuing Education / Pharmacy · CPE
ENROLLMENT NOT YET OPEN Accreditation applications in process across all 7 CE types. Book a discovery call to discuss institutional access or co-accreditation partnerships.
CE Specialty Track PREREQUISITE: Core CE Program Required

Cannabis Drug Interactions and Documentation Governance for Pharmacists

Cannabis plus warfarin. Cannabis plus phenytoin. Cannabis plus cyclosporine. These interactions are happening in your pharmacy. The documentation gap is institutional — you are the last clinical checkpoint before dispensing, and this session gives you the framework to make that checkpoint functional.

0.1 CEU (1.0 Contact Hour)
CPE Credit Hours
1
Add-On Sessions
On-Demand
Self-Paced Format
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CPE Specialty Track

Pharmacy CE

Cannabis is metabolized through CYP450 pathways (CYP3A4, CYP2C9, CYP2C19, CYP1A2) shared with warfarin, phenytoin, clobazam, antidepressants, statins, and immunosuppressants. Cannabis use is documented in approximately 5% of patient EHRs despite 35% implicit use prevalence. Pharmacists are positioned as the last clinical checkpoint before dispensing. Without a cannabis documentation governance framework, that checkpoint cannot function.

Session P1 covers CYP450 pharmacology for cannabis in depth, with specific drug category examples and interaction directions; a validated cannabis screening approach adapted for pharmacy practice; NSAG M4 and M9 governance dimensions applied to pharmacy operations; and a complete cannabis counseling script for patients on high-risk medications. Application-based credit.

Who This Is For
  • Pharmacists (RPh, PharmD)
  • Pharmacy technicians (CPhT)
  • Pharmacy directors and clinical pharmacy specialists
  • Pharmacy students in ACPE-accredited programs
Accreditation Status
ACPE (Accreditation Council for Pharmacy Education)
0.1 CEU / 1.0 contact hour — Activity Type: Application-Based — pending ACPE provider accreditation
In Process

Applying for ACPE provider accreditation or pursuing joint provider through University of Hawaii at Hilo College of Pharmacy; ACPE Universal Activity Number (UAN) required before CPE Monitor integration can be completed.

What’s Included

Each Session Includes

  • ✓Pre-test (5 questions per session)
  • ✓Timed prerecorded video session (60 minutes)
  • ✓Post-test (5 questions per session; minimum 80% required for credit)
  • ✓Practice application exercise (active written or structured response required)
  • ✓Certificate of completion (issued on post-test completion; includes CE type and credit hours)
  • ✓Written materials package (substantive outline, authority map, and hypothetical with model analysis)
Prerequisite

Core CE Program Required

This specialty track is an add-on to the 15-session NSAG Core CE Program. The core curriculum must be completed before enrolling in this track. The core program introduces the four-tier governance framework, six-dimension scoring model, and module-specific evidence bases that this track builds on.

View Core CE Program →
Session Structure

60-Minute Timed Agenda · Every Session

Both sessions in this track follow the same 60-minute structure. Pre-test and post-test are required for credit. The practice application exercise requires an active written or structured response.

Time Duration Segment Content Credit-Eligible
0:00–0:03 3 min Welcome & Disclaimers No legal/medical advice disclaimer; speaker conflict of interest disclosure; CE accreditation status statement; content validation date stated No
0:03–0:08 5 min Pre-Test 5-question pre-test assessing baseline knowledge of the session’s governance domain content. Required for credit. Yes
0:08–0:12 4 min Overview & Learning Objectives Three learning objectives stated; governance problem for this session introduced in one sentence with the primary evidence source named Yes
0:12–0:22 10 min The Governance Problem Evidence base for the governance gap: primary source cited, verbatim key finding presented, governance implication stated Yes
0:22–0:35 13 min Evidence Base & Research Foundation 2–3 primary peer-reviewed sources: study summary, verbatim key finding, DOI displayed; governance implication per source Yes
0:35–0:45 10 min Six Governance Dimensions Each dimension defined and illustrated with a profession-specific institutional example Yes
0:45–0:50 5 min PIONEERING Governance Standards Full PIONEERING tier criteria for this module — observable, documentable governance standards that distinguish PIONEERING from EMERGING Yes
0:50–0:57 7 min Practice Application Exercise Structured exercise requiring active written or multiple-choice response. Completion required for credit. Yes
0:57–1:00 3 min Post-Test & Certificate 5-question post-test; minimum 80% score required for credit; certificate of completion issued on successful completion Yes
Learning Outcomes

What You’ll Be Able to Do

Session P1 · 0.1 CEU / 1.0 Contact Hour (Application-Based)

Cannabis Drug Interactions and Documentation in Pharmacy Practice

1

Identify the CYP450 pathways implicated by cannabis use — CYP2C9, CYP3A4, CYP2C19, CYP1A2 — and explain the clinical significance of each for anticoagulants, antiepileptics, and immunosuppressants

Competency: Drug Information; Pharmacokinetics Evidence: Post-test: given patient medication list including cannabis, identify specific CYP pathway and likely interaction direction
2

Apply a cannabis screening approach to a described patient counseling scenario, writing appropriate intake language and a documentation standard for pharmacy practice

Competency: Patient Counseling; Patient Care Services Evidence: Application exercise: write a cannabis intake question and EHR documentation standard for a pharmacy practice setting
3

Assess a described pharmacy’s cannabis documentation governance against NSAG M4 governance dimensions and identify the highest-priority institutional intervention

Competency: Medication Management; Quality Improvement Evidence: Post-test: given a pharmacy description, identify governance gaps and recommend the highest-priority intervention
Sample Course Content

Practice Hypothetical & Model Analysis

The following is a representative hypothetical from this specialty track. Each session includes a practice application exercise based on a realistic institutional scenario. The model analysis below represents the level of analysis expected from practitioners completing this course.

Session P1 · Cannabis Drug Interactions and Documentation

Hypothetical P1: The Warfarin Counseling Encounter

Maria, 67, presents to your community pharmacy for a warfarin refill. Her INR was 4.8 at her last check — her physician increased monitoring frequency but has not changed her dose. She is also on phenytoin (epilepsy) and sertraline (depression). She mentions she started a ‘hemp gummy’ (25mg CBD/day) three weeks ago for sleep — approximately the time her INR started rising.

Cannabis is not documented in her patient profile. She has not mentioned it to her physician.

Discussion Questions
  1. Identify the CYP450 pathways implicated by CBD use with warfarin, phenytoin, and sertraline. For each, explain the interaction direction and clinical significance.
  2. Maria does not have cannabis documented in her profile. Who is responsible for this governance failure? Justify using Lapham et al. (2022) and the NSAG disclosure safety governance dimension.
  3. Draft the counseling language you will use with Maria right now. Include: acknowledgment without stigma; explanation of the interaction risk; what you recommend she do today; and what you will document.
  4. Draft the patient profile documentation entry you will add to her EHR record.
Model Analysis
  1. CYP pathways: (a) CBD + warfarin via CYP2C9 inhibition: CBD inhibits CYP2C9, reducing warfarin metabolism, elevating plasma levels, and increasing anticoagulant effect — INR elevation is the direct consequence. Most clinically urgent. (b) CBD + phenytoin via CYP2C9/CYP3A4: CBD inhibition of CYP2C9 may elevate phenytoin levels (toxicity risk); phenytoin also induces CYP3A4, potentially reducing CBD plasma levels, making the CBD effect less predictable. (c) CBD + sertraline via CYP2C19/CYP3A4: CBD inhibition of CYP2C19 may elevate sertraline levels — serotonin syndrome risk at high CBD doses (less likely at 25mg/day but important for monitoring).
  2. Governance failure: Lapham et al. (2022) confirmed the gap originates from institutional design — no intake question, no structured EHR field, no disclosure safety policy. Maria disclosed voluntarily when given the opportunity in your encounter. The institutional failure: no proactive screening, no structured documentation field, no disclosure policy communicating that cannabis use is clinically necessary information with no adverse consequence for disclosure.
  3. Counseling script: ‘Maria, thank you for telling me about the CBD gummy — that’s exactly the kind of information I need to help you stay safe. The hemp CBD product you’re using is processed by the same liver enzymes as your warfarin, and it can slow down how quickly your body clears the warfarin. This could explain why your INR has been higher than usual. I want to contact your physician today to let them know, and I’d recommend you hold the CBD until you’ve discussed it with them. I’ll make a note in your profile so all your providers are aware. Is that okay with you?’
  4. Documentation entry: ‘Patient reported current use of CBD gummy, 25mg/day, began approximately 3 weeks ago, coincides with INR elevation to 4.8. CYP2C9 inhibition relevant to warfarin therapy. Prescriber notified [date/time]. Patient counseled on interaction risk and advised to hold CBD pending prescriber guidance. Cannabis use documented in discrete EHR cannabis field. Follow-up INR monitoring recommended within 7 days.’

This model analysis represents the depth of reasoning expected in the practice application exercise. The post-test (minimum 80%) assesses conceptual mastery of the session’s evidence base and governance framework.

View the full Evidence Library → for the primary sources cited in this and all other specialty track sessions.

Related Tracks

Practitioners Who Take This Track Also Benefit From

CNE
Nursing Specialty Track

The Nursing track (Session N1) covers cannabis documentation from the nursing perspective, including the same CYP450 pathways and screening approaches. Nurses and pharmacists are the two clinical professions most frequently positioned to catch cannabis interactions. Both tracks use the same primary evidence base.

View track →
CME
Medicine Specialty Track

The Medicine track (Session M-CE2) covers integrative medicine governance including cannabis from the physician’s perspective. Understanding the physician’s evidence integration obligations helps pharmacists counsel patients about cannabis use and communicate with prescribers effectively.

View track →
Institutional Access

License This Track for Your Organization

Institutional licensing includes cohort enrollment across both the Core CE Program and this specialty track, facilitator support, and options to integrate with existing CE tracking systems. Pricing includes all 15 core sessions plus this specialty add-on.

$5,000
1–50 employees
Core CE + This Specialty Track
$10,000
51–200 employees
Core CE + This Specialty Track
$15,000
201+ employees
Core CE + This Specialty Track
Inquire About Institutional Access
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Program description · All learning outcomes · Full 60-minute timed agenda · Accreditation status · No enrollment required.

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