According to Dynamed Chronic nonspecific low back pain is a diagnosis of exclusion in patients with pain in the low back lasting for more than 3 months without a pathologic cause identified.
- In this case a 79year old white male is taking hydrocodone/APAP 10/325 for lower back pain (pt diagnosed with degenerative disc disease several months ago). After a Doctor visit, prescription of Vicodin 10/325 Q 4-6 hrs PRN with a quantity of 120.
If patient take pain meds Every 6 hrs/day PRN, patient will be taking a maximum of 4 tablets a day.
If patient is taking this medicine Q4hrs/day PRN, the total maximum tablets /day will be 6 tablets.
In this case, this patient is taking 12 tablets /day because the pain is too much and it is unbearable. This is an overdose of narcotic that could put patient to tolerance for this pain medication and need conversion to a new drug that could best control the pain.
According to the opioid calculator recommended by the instructor, Morphine extended release should be prescribe as: 10mg Q4-6hrs PRN for more consistent pain control.
3.CM is suffering of migraine, she has some precipitating factors such as sleeping problem, her use of inhaler for her asthma treatment can be a trigger to her migraine because inhalers are vasodialtors Until recently, the major contributing pathophysiological event thought to initiate migraine was cerebral and meningeal arterial vasodilation (Jacobs &Dussor, 2016).
Non-pharmacological treatment: sleep hygiene such as sleeping at least 6-8hrs a day, drinking warm milk or taking warm bath during bedtime, decrease white light in the room and darkening the room during her sleep.
I will also recommend a different Asthma medications, relaxation technic could also help in management of migraine.
Base on CM condition, she may benefit from prophylactic treatment. She is qualified for the prophylactic treatment because she has headache that last 2 to 3 days and 2 times a month, and a severe and prolonged migraine attack. According to Peters (2019)Preventive therapy should be considered for patients with migraines who routinely have more than 6 headache-days per month, or in other special circumstances, such as recurring migraines producing disability, acute therapies that are ineffective or contraindicated, when serious adverse reactions are produced, or even when it is the patients preference.
The 1st line prophylactic treatment will be: Preventive migraine agents that are FDA approved include propranolol, timolol, divalproex sodium, and topiramate (Peters, 2019).
References
Dynamed: Chronic low back pain
https://wilkes.idm.oclc.org/login?url=http://www.dynamed.com/topics/dmp~AN~T116935/
http://opioidcalculator.practicalpainmanagement.com/
Jacobs,B., Dussor, G. (2016). Neurovascular contributions to migraine: moving beyond
vasodilation
Peters, G.L(2019). Migraine Overview and Summary of Current and Emerging Treatment Options