Butrans and Anesthesia
Can you anesthesia trained folks please direct me to guidelines for butrans and anesthesia?
My understanding is that it is safe to continue butrans (which fairly low dose compared to belbucca or oral bup), even in patients having GETA, because anesthesia can still give intraop/post op fentanyl and post-op PO oxy/Vicodin even while the patient continues butrans patch, because the fentanyl and post op oxy will overcome and supplement the butrans.
I’d appreciate it some of the anesthesia...
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Source: Student Doctor Network - May 6, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Opiods/Benzodiazepines Combination
We have been getting a lot of new patients trying fill the Norco/Xanax Combination. If the patient is not also getting a maintenance anxiety medication such as an SSRI, the pharmacists I work with and I will typically require documentation on failed treatment therapies and rationale for being on the combination. Most of the time we receive nothing more from the prescriber stating that "the patient has been on the Benzodiazepines forever and they can't tolerate anything else." Most of the...
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Source: Student Doctor Network - January 16, 2023 Category: Universities & Medical Training Authors: drakegrad2011 Tags: Pharmacy Source Type: forums
Controlled Rxs- fill or refuse?
Hey everyone,
When do you feel it's appropriate for a patient to be on high doses of Norco, oxycodone, lyrica, modafinil and xanax? Considering it's not a cancer patient and the doctor has been disciplined in the past by the medical board for over-prescribing. Would you keep filling these prescriptions? Or how would you go about refusing to fill them? What would you say to that regular customer and doctor? Do you often see people being on 2 short acting opioids?
I'd appreciate your input...
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Source: Student Doctor Network - April 16, 2022 Category: Universities & Medical Training Authors: mimi06bg Tags: Pharmacy Source Type: forums
CVS refusing to fill opioid when patient is also on a benzo
Over the last 2-3 weeks, I have had CVS pharmacies in my area, Indiana, refusing to fill pain medications when a patient is on benzos.
The medications I prescribe 99% of the time is T#3, Tramadol, or belbuca/butrans. On occasion it is a 7-day norco rx. This is not just for new RX, but also for patients with pre-existing RX.
Pharmacist refuses to fill even if I call, so I stopped calling.
Now patients are calling my office to re-send RX elsewhere.
Anyone else dealing with this? What have...
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Source: Student Doctor Network - September 17, 2021 Category: Universities & Medical Training Authors: myrandom2003 Tags: Pain Medicine Source Type: forums
Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms
in childhood: Meta-analysis in six European population-based cohorts
The potential etiological role of early acetaminophen exposure on Autism Spectrum Conditions (ASC) and Attention-Deficit/Hyperactivity Disorder (ADHD) is inconclusive. We aimed to study this association in a collaborative study of six European population-based birth/child cohorts. A total of...
link.springer.com
I wonder if this will change practice or more of the same as with the epidural- autism paper. (Source: Student Doctor Network)
Source: Student Doctor Network - May 29, 2021 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Anesthesiology Source Type: forums
Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms
Will this change your care of pregnant patients with pain? (Source: Student Doctor Network)
Source: Student Doctor Network - May 29, 2021 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Pain Medicine Source Type: forums
Why is nursing so looked down upon?
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Why is nursing so looked down upon?
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Source: The Student Room - December 14, 2020 Category: Universities & Medical Training Authors: fossybaby Tags: Medicine Source Type: forums
Pain Management Advice?
Current 4th year med student on an audition rotation in EM. Seems like it should be simple but for some reason I'm having issues when it comes to deciding which pain medications to order for my patients. Tylenol/NSAIDs seem like a safe bet and simple choice most of the time, but choosing when to jump to Norco/Morphine/Fentanyl/etc. and which one to choose at the time seems to be tripping me up. For some reason I feel hesitant to as I'm nervous about overmedicating the patient. Does anyone...
Pain Management Advice? (Source: Student Doctor Network)
Source: Student Doctor Network - November 1, 2020 Category: Universities & Medical Training Authors: Pokedoc Tags: Emergency Medicine Source Type: forums
case - options for pain control
40 yo F morbid obesity (BMI 50 w/ OSA requiring CPAP) presents for bariatric surgery - laparoscopic. H/o Chiari malformation, h/o hydrocephalus w/ ventricular-thoracic shunt and lumbar-peritoneal-shunt s/p multiple revisions for failure and optic nerve fenestration for blindness, chronic neck/headaches on Norco 10-325, gabapentin 300 once daily, flexeril, fibromyalgia.
Thoughts on pre-intra-post operative pain control options? Neuraxial? Multimodal?
How would you manage her preop opioid use? (Source: Student Doctor Network)
Source: Student Doctor Network - July 28, 2020 Category: Universities & Medical Training Authors: mtu620 Tags: Anesthesiology Source Type: forums
A PA sees a patient in the ED: Guess what happened next?
In July 2017, a sixty-four-year-old woman (“Patient A”) presented to an emergency department, where you were on duty, with complaints of abdominal pain, nausea, and vomiting after having an endoscopy performed at an outside facility earlier that same day. You evaluated Patient A and treated her with oral medications (Zofran OTD and Hydrocodone/Acetaminophen) to address the nausea and pain. After some improvement in the symptoms, you diagnosed Patient A with right upper quadrant pain and...
A PA sees a patient in the ED: Guess what happened next? (Source: Student Doctor Network)
Source: Student Doctor Network - April 22, 2020 Category: Universities & Medical Training Authors: jkdoctor Tags: Emergency Medicine Source Type: forums
Holy trinity-would you put your name on this?
Not a pharmacist, but I’ve been a tech for the past five years while completing my undergrad, and I’m starting med school this July.
While home for the summer, I was filling at my local (chain) store. At work today, I received a script for Vicodin 10. After looking at their recent fills, I noticed they were also getting morphine IR 30, klonopin 0.5, and soma 350 for the past several months. I pointed it out to my pic, and she said to just continue to fill as is.
Forces notes stated...
Holy trinity-would you put your name on this? (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2019 Category: Universities & Medical Training Authors: pharmchica15 Tags: Pharmacy Source Type: forums
Chronic pain
90 year old patient with chronic low back (prior lami/fusion) and continued knee pain after TKA. I’m the 3rd PM doc she’s seen. She failed to follow up with the other PM bc she says nothing was helping. per chart review she’s been tried on multiple meds(meds all with side effects or no relief: gaba, Lyrica, cymbalta, savella, Tylenol #3, Vicodin, oxycodone) I’m hesitant to try TCA at her age and she has afibb. I tried her on Butrans but didn’t help. Compound cream slightly helpful. Starting...
Chronic pain (Source: Student Doctor Network)
Source: Student Doctor Network - April 28, 2019 Category: Universities & Medical Training Authors: Bsb2015 Tags: Pain Medicine Source Type: forums
PO Tylenol superior to Ofirmev
Impact of Intravenous Acetaminophen on Perioperative Opioid Utilization and Outcomes in Open Colectomies: A Claims Database Analysis. - PubMed - NCBI (Source: Student Doctor Network)
Source: Student Doctor Network - May 9, 2018 Category: Universities & Medical Training Authors: linkin06 Source Type: forums
31yo Stg IV Lymphoma Pt with h/o opioid abuse and psych history
Was on opioids previously for various pains, but became addicted and overtook and used her friend's pills etc
H/o ER admission for suicidality, withdrawl, etc.
Coming to see me monday
Currently on Norco 5's 2 tablets every 4 hours for what she describes as diffuse bony pain.
PET scan shows lypmh nodes lighting up in the neck/mediastinum/groin
On high dose chemo and going to undergo bone marrow transplant after it.
What would you do?
Appreciate in advance any advice in this delicate...
31yo Stg IV Lymphoma Pt with h/o opioid abuse and psych history (Source: Student Doctor Network)
Source: Student Doctor Network - April 20, 2018 Category: Universities & Medical Training Authors: Timeoutofmind Source Type: forums
NBME 17 Question - Acetaminophen Toxicity
A 20-year-old man is brought to the physician because of a 4-hour history of abdominal pain, nausea, and vomiting. He says that he had been drinking ethanol heavily all weekend, and he took three doses of acetaminophen within two hours after the onset of a severe headache Monday afternoon. This patient is at increased risk for liver injury because of which of the following actions of ethanol?
A) Activation of IgE-mediated mast cell degranulation
B) Decreased acetaminophen clearance via...
NBME 17 Question - Acetaminophen Toxicity (Source: Student Doctor Network)
Source: Student Doctor Network - April 6, 2018 Category: Universities & Medical Training Authors: bananafish94 Source Type: forums
