Discuss your approach to the overall case and results of your calculation.
- A 79 year old white male is taking hydrocodone/APAP 10/325 for lower back pain (pt diagnosed with degenerative disc disease several months ago). The physician had written a prescription for Vicodin 10/325 1 or 2 tablets Q4-6h prn pain with a quantity of 120. Her expectation was that this would last the patient for one month. The patient is now requesting refills about every 10-14 days. He states he has been taking 2 tabs Q4h (12 tablets per day) because the pain is so bad I just cant stand it!. He also tells the provider he is “constipated so bad it sometimes hurts to sit, bend or walk”.
- What is the problem with the way the patient is taking this medication versus how it was prescribed? Consider: maximum daily dose, frequency, intended as needed use versus scheduled use, acetaminophen exposure, and the risk of overuse/misuse.
- The patients pain pattern suggests inadequate control with short-acting opioids. Based on your assessment, it is determined this patient should be converted to extended release morphine for better, more consistent pain control. Perform this conversion and provide an appropriate recommendation (drug, dose, frequency) for the extended release morphine
- What additional recommendations would you make? Consider and address:
- Adjuvant analgesics appropriate for chronic low-back pain/DDD (e.g., neuropathic agents, muscle relaxants, antidepressants for chronic pain, topical options, non-opioid analgesics).
- Non-pharmacologic strategies that may improve outcomes.
- A bowel regimen appropriate for a patient on chronic opioid therapy, including both stool softener and stimulant components.
- Monitoring and safety considerations, especially in an older adult (fall risk, renal function, acetaminophen load, risk of opioid-induced harm).
- Clarifying expectations regarding chronic pain management and functional goal
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Requirements: 250
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