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. Locatehttp://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 forVicodin® 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 can't stand it!". He also tells the provider he is "constipated so bad it somtimes hurts to sit, bend or walk". o What is the problem with the way the patient is taking this medication versus the way it was prescribed? o 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 as well as any other recommendations you may have. 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. o Provide an evaluation of CM's condition including non-pharmacological interventions and treatment options for abortive therapy o Is Cm a candidate for prophylactic therapy, and if so, what option would be best suited to her? The 79-year-old patient is taking medication incorrectly. He increased the frequency because of his increased pain. Instead of taking q6, he is taking the medication q4. Thus, pain management and control in patients with immense and serious pain need to be given the medication that they need to relieve the pain. According to the case scenario, we can see that the patient had been prescribed hydrocodone/APAP 10/325 by the physician to reduce the pain that
the patient is experiencing. Based on the patient's condition he meets the criteria of nonmalignant chronic pain. Because his pain is uncontrolled with this regimen it would be beneficial to convert him to morphine extended-release to help with his pain management. Currently, he's prescribed a daily dose of 40 mg of hydrocodone per day as a rescue medication. The MME conversion factor of morphine mg is 1. 40 mg x 1= which would equal to 40mg of morphine per day (Mercadante et al., 2022).Because he will be prescribed an extended release I will change his order to a standing order. His new medication regimen would be 10mg of morphine tablet by mouth q6. I would advise the patient to stop taking hydrocodone immediately. Constipation is a common adverse effect of opioids (Chisholm-Burns et al., 2022). I will also prescribe the patient one capsule at bedtime of casanthranol-docusate and one tablet of Senna. According to research, migraine is one of the challenges that face most people around the globe. The condition is often accompanied by nausea, vomiting, and a high rate of sensitivity to sound and light. The efficacy of interventions in headaches is often measured based on the patient's subjective assessment factors including durations, frequency, duration, and severity of headaches as well as associated symptoms (Hosseini et al., 2020). There are several options that may help manage her headache such as stress management, refraining from any activities that may trigger stress, acupuncture though there is limited proven data, and advising the patient to avoid alcohol and tobacco use (Chisholm-Burns et al., 2022). It is recommended that she be started on migraine prophylaxis. The first line is typically a β-blocker, but it is contraindicated in patients with comorbid reactive airway disease (Chisholm-Burns et al., 2022). I would consider starting her on a low dose of Amitriptyline. I believe that would be the choice because it will not only prevent her
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