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A 79 year old white male is taking hydrocodone

There are hundreds of opioid conversion calculators available online, though they are not all of good quality.  I would like to direct you to one of the opioid conversion calculators that I find to be most useful and evidence based.  Locate http://opioidcalculator.practicalpainmanagement.com/ and evaluate the following case using the calculator as necessary. 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  i-ii 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 can’t stand it!”.
    • What is the problem with the way the patient is taking this medication versus the way it was prescribed
    • 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).

Migraine is a major neurological disease that affects more than 36 million men, women and children in the United States. There is no cure for migraine. Most current treatments aim to reduce headache frequency and stop individual headaches when they occur. Let’s look at a case example:

  • CM is 20 years old female with severe, prolonged 2 to 3 day migraines twice per month. She has difficulty sleeping and is mildly anxious. She occasionally utilizes an inhaler for asthma.
    • Provide an evaluation of CM’s condition including non-pharmacological interventions and treatment options
    • Is Cm a candidate for prophylactic therapy, and if so, what option would be best suited to her?

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