How do you Approach This Patient in the community setting|My homework aider

Posted: March 3rd, 2023

Read the following case studies and search for the guidelines that answers the specific questions?

Case 1

A 54-year-old woman with chronic pain due to inflammatory arthritis presents to your clinic stating that she is having a “flare” of her arthritis but is out of her Oxycontin® and immediate-release oxycodone. She is aware that it is too early to fill her prescriptions, but she insists that she will be traveling out of state and “really needs” her medications.

Question: How do you Approach This Patient in the community setting?

What is the implications of prescribing this medication? Please provide evidence.

Case 2

A 27-year-old woman on buprenorphine-naloxone (Suboxone®) for treatment of opioid dependence is admitted to the hospital with severe abdominal pain due to a perforated gastric ulcer. She received hydromorphone in the ED, and is urgently taken to the operating room. Postoperatively, she is on a patient-controlled analgesic (PCA) pump containing fentanyl. Her last dose of buprenorphine-naloxone was 20 h prior to the surgery; her daily dose is 16 mg.

Question: How can Pain be Managed in Patients who are Taking Buprenorphine-Naloxone? What Adjustments to her Medication Regimen can be Recommended?

SOLUTION

What is the implications of prescribing this medication? Please provide evidence.

Answer:

For both cases, the approach would be to take a detailed medical history and conduct a thorough physical examination to determine the underlying cause of the pain and anxiety symptoms. It is important to assess the patient’s current medications, including any over-the-counter medications or supplements that they may be taking, and their medical history to evaluate the risks and benefits of any new medication. In both cases, the prescription of controlled substances should be avoided unless it is necessary and justified by the patient’s medical condition. In the first case, the patient’s request for early refill of opioid medications due to a flare-up of inflammatory arthritis may be a sign of opioid dependence or addiction. The physician should evaluate the patient’s pain management plan and consider alternative therapies, such as non-opioid analgesics, physical therapy, or alternative modalities like acupuncture or mindfulness practices. Prescribing opioids to patients with chronic pain can increase the risk of addiction, overdose, and death. Moreover, early refills of opioid medications can be indicative of misuse and can pose a risk to the patient and society at large, including diversion to the black market.

 

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