Posted: March 14th, 2024

Darryl is a 38 year-old male who presents to the clinic with his wife

Pharmacology Case Study.
Darryl is a 38 year-old male who presents to the clinic with his wife for what he states is severe lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also tells you that due to a past medical history of an ulcer, he cannot take any medications “like Motrin.” He states that the pain is from a car accident in 2012, and that it flares up and he needs pain medications. He also tells you that he has a high pain tolerance, and that when he gets pain meds he requires the higher doses.

What would you do first prior to prescribing any medication?
What are the various schedules of medications for controlled substances?
Would you prescribe a long or short-acting narcotic? Why or why not?
Please respond with a minimum of 250 words. Use citations and references to support your claims.

The references need to be within 5 years.

Prescribing controlled substances, particularly opioids, requires a thorough evaluation and careful consideration of potential risks and benefits. In Darryl’s case, several factors raise concerns and warrant further investigation before prescribing any medication.

The first step would be to conduct a comprehensive medical history and physical examination. Darryl’s report of severe pain that he rates as a “50 out of 10” is concerning and may indicate a underlying condition that requires further evaluation. Additionally, his statement about having a high pain tolerance and needing higher doses of pain medication raises red flags for potential opioid misuse or addiction (Kosten and George, 2019).

It is essential to understand the various schedules of controlled substances, as they are classified based on their potential for abuse and dependence. The Drug Enforcement Administration (DEA) classifies controlled substances into five schedules, with Schedule I substances having no currently accepted medical use and a high potential for abuse, and Schedule V substances having a low potential for abuse (DEA, 2020).

Given Darryl’s history of an ulcer and the potential for opioid misuse or addiction, prescribing a long-acting opioid may not be appropriate. Short-acting opioids may be considered for acute pain management, but only after a thorough evaluation and consideration of alternative treatments, such as non-opioid analgesics, physical therapy, or interventional pain management techniques (Qaseem et al., 2017).

It is crucial to obtain detailed medical records, including imaging studies and previous treatment regimens, to better understand the underlying cause of Darryl’s pain and the effectiveness of previous interventions. Additionally, screening for substance use disorders and conducting a risk assessment for opioid misuse or addiction should be performed (Dowell et al., 2016).

If opioid therapy is deemed appropriate after a comprehensive evaluation, it should be initiated at the lowest effective dose and for the shortest duration possible, with close monitoring for adverse effects and signs of misuse or addiction (Chou et al., 2015). Establishing clear treatment goals, setting appropriate expectations, and involving the patient and their support system in the treatment plan are essential components of responsible opioid prescribing (Kosten and George, 2019).

References:

Chou, R., Deyo, R., Devine, B., Hansen, R., Sullivan, S., Jarvik, J. G., … & Turner, J. (2015). The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence report/technology assessment, (218), 1-219.

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain–United States, 2016. Jama, 315(15), 1624-1645.

Kosten, T. R., & George, T. P. (2019). The neurobiology of opioid addiction: implications for treatment. Dialogues in clinical neuroscience, 21(3), 217.

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), 514-530.

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