Case Studies (June 2017)

JUNE 21, 2017
Craig I. Coleman, PharmD
CASE 1
HC is a 75-year-old man who comes to your pharmacy with a prescription for hydrocodone/acetaminophen 5 mg/500 mg (1-3 times daily as needed). He has been experiencing bothersome lower back pain for a few months now, and his pain has not been relieved by superficial heat application. HC has a history of hypertension (treated with lisinopril 20 mg and amlodipine 5 mg) and hyperlipidemia (treated with simvastatin 20 mg). He states he rarely takes OTC medications except acetaminophen occasionally at night to help him sleep.

As the pharmacist, what are your thoughts on HC’s prescription for hydrocodone/ acetaminophen?

CASE 2
You receive a call from HC’s primary care doctor, who tells you that she heeded your prior advice and started HC on meloxicam 7.5 mg once daily instead of the hydrocodone/acetaminophen while also prescribing him a skeletal muscle relaxant (cyclobenzaprine 10 mg). She explains that HC’s pain has improved from a score of 6 to a 3 on a 10-point pain scale and informs you HC has taken up tai chi as a form on nonpharmacologic pain management. Other than the meloxicam and cyclobenzaprine, there have been no additional changes to HC’s medication profile. HC’s doctor, impressed by your knowledge of guidelines and your earlier recommendation, asks your opinion about starting tramadol for HC’s chronic lower back pain.

What would be your recommendation regarding tramadol for HC’s chronic lower back pain at this time?

SEE THE ANSWERS ON PAGE 2.



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