Advanced Pharmacology Discussions
Discussion 1
Howard appears to have chronic pain which needs multidisciplinary approach. All clients presenting with chronic pain require an extensive physical evaluation including neurological, cardiovascular, renal and mental status examination to try and identify underlying etiologies and associated features such as decreased overall physical and mental function, depression, sleep disturbances and fatigue (Henry et al., 2017). In addition, Howard complains of previous ulcer problem hence pain medications that cause gastric irritation such as Non-Steroidal Anti-inflammatory Drugs (NSAIDs) should be avoided.
Five schedules of controlled substances exist in their decreasing order of potential risk for addiction and dependence according to the united Nations classification of drugs (Uzuegbu-Wilson, 2019). Schedule 1 medications include Marijuana, Heroine, Methaqualone, Mescaline, Lysergic acid etc. Schedule 2 medications are the opioid class, including morphine, meperidine, fentanyl, hydromorphone and barbiturates such as pentobarbital. Schedule 3 medications are easily prescribed and include ketamine and anabolic steroids. Schedule 4 medications include benzodiazepines and tramadol. Finally, schedule 5 drugs are less likely to be misused and include drugs with codeine less than 200mg per 100 ml, pregabalin.
A long-acting narcotic will be a valuable prescription to this patient over the short acting. This helps to improve compliance, reduces opioid overdose and dependence associated with habit forming potential of the short acting drugs.
Discussion 2
Howard can benefit from analgesics such as paracetamol and adjuncts of pain management such as corticosteroids, antidepressants, anticonvulsants and skeletal muscle relaxants (Weyker & Webb, 2018). For such, advise the patient on the side effects of the above drugs and advise the patient to take the drugs as instructed by the physician.
According to WHO analgesic ladder and opioid crisis, which specifies treatment on pain intensity, Step 1 entails Non-opioid alongside optional adjuvant analgesics, which are recommended for mild pain. Step 2 entail Weak opioid medications alongside non-opioid and adjuvant analgesics, recommended for mild to moderate pain. Step 3 entail Strong opioid medications alongside non-opioid and adjuvant analgesics recommended for moderate to severe pain. For this patient, I would recommend step 2 and even step 3 depending on the response.
Discussion 3
Screening tools available include abnormal urine testing and opioid risk tool score. The former being most reliable because the sample is collected from the patient and subjected to laboratory testing (Kaye, 2017).
Substance abuse problem is a complex but manageable condition that affect the brain behavior and function. At first, I will consider a rehabilitation program for Howard. Howard will also benefit from counselling services and behavioral therapies. In addition, I will constantly evaluate his mental status and treat any underlying anxiety and depression. Withdrawal medications and devices for treatment of withdrawal symptoms cannot be ignored. Long term follow-up strategies to prevent relapse is ideal as well (NIDA, 2019).
I will refer Howard to a psychiatrist to try and institute cognitive behavioral and psychotherapy. Howard will also see a neurologist and a physician to assess his neurological health status and prescribe any withdrawal medications.
Discussion 4
The use of epidural injections as a way of managing chronic pain permits the use of smaller doses of other analgesics including opioids to reduce their toxicity (Weyker & Webb, 2018). This, therefore means that I will prescribe smaller doses of narcotics to Howard.
Howard can also be given alpha-2 adrenergic agonists such as clonidine, botulinum toxin and neuroleptics such as haloperidol and fluphenazine. Acupuncture, cognitive and behavioral therapy, heat and cold, assistance with vocational training, exercises, music, hypnosis, relaxation and biofeedback techniques (Gokhale, 2017) will all be of help to Howard.
Discussion 5
Substance abuse programs for Howard include family therapy, cognitive behavioral therapy, group therapy, individual therapy in addition to harm reduction model and inpatient addiction treatment (Miller, 2021). The nurse practitioner must be licensed under the respective state laws to prescribe schedule 3-5 drugs for pain, must have completed not less than 24 hours of appropriate education through a qualified provider and demonstrates the ability to treat and manage opioid disorder through training and experience (“Buprenorphine Waiver Management”, 2021).
The patient enrolled in a medication assisted opioid treatment program requires a consent for treatment, a plan for relapse prevention, a procedure through which the patient can discuss the treatment and doses with a staff at request and a regular assessment.
References
- Buprenorphine Waiver Management. ADVOCACY. (2021). Retrieved 21 April 2021, from https://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-managementhttps://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-managementhttps://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-management.
- Gokhale, S. (2017). “Non-Pharmacological Methods for Pain Management”. JOJ Nursing & Health Care, 4(4). https://doi.org/10.19080/jojnhc.2017.04.555642
- Henry, S., Bell, R., Fenton, J., & Kravitz, R. (2017). Goals of Chronic Pain Management. The Clinical Journal Of Pain, 33(11), 955-961. https://doi.org/10.1097/ajp.0000000000000488
- Kaye, A. (2017). Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1. Pain Physician, 2(20;2), s93-s111. https://doi.org/10.36076/ppj.2017.s111
- Miller, L. (2021). Types of Addiction Treatment Programs. Drug Rehab Options. Retrieved 21 April 2021, from https://www.rehabs.com/addiction/types-of-treatment-programs/.
- NIDA. (2019). Treatment Approaches for Drug Addiction DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
- Uzuegbu-Wilson, E. (2019). Narcotics Drug Use in West Africa and Its Impact on Human Security. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3456528
- Weyker, P., & Webb, C. (2018). Comprehensive Pain Management in the Rehabilitation Patient. Anesthesia & Analgesia, 127(1), 299. https://doi.org/10.1213/ane.0000000000003390