Multimodal anesthesia
Have you all been using multimodal anesthesia? If so, what? My current choices are listed below.
In pre-op holding:
Acetaminophen 975 mg PO
Celebrex 400 mg PO
Gabapentin 600 mg PO
At the start of anesthesia:
50 mg/kg MgSO4 IV
On certain cases I will add 10 mg dexamethasone to the bupivacaine for the local.
Patients complained about nausea when I've used OxyContin pre-op so I stopped.
I think what's made the most noticeable drop in post-op pain...
Multimodal anesthesia (Source: Student Doctor Network)
Source: Student Doctor Network - December 15, 2017 Category: Universities & Medical Training Authors: NatCh Source Type: forums
What do you think of this verbiage??
From PCP referral paperwork...Patient takes oxycodone 15 mg TID, works at gas station. Family hx of alcoholism. Single mom. Also has fibro. How do you appraise the providers medical decision making to refer a patient who declines pain management to a pain clinic? Is this patient-centered care with justifiable shared decision making? Would the patient attest to receiving "high value," quadruple aim care responsive to her personalized needs?
What's your next move?
View attachment 226579 (Source: Student Doctor Network)
Source: Student Doctor Network - December 13, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Abuse deterrent C-II
Just to be clear...are any of the C-II opioid generic abuse deterrent? My knowledge and research suggests NOT and FDA are in the process of releasing a guidance for the mftrs to make such. On the similar note, I wonder then why we can substitute Oxycontin with oxycodone ER since Oxycontin is abuse deterrent and the generic is NOT ? (Source: Student Doctor Network)
Source: Student Doctor Network - October 5, 2017 Category: Universities & Medical Training Authors: ZakMeister Source Type: forums
Opioid Refugee Squatting in SNF; Refuses Discharge
Situation: 56 year old morbidly obese female with bilateral hip AVN status post bilateral THA with multiple medical comorbidities (RA, COPD, DM, HTN, and Crohn;s disease) admitted to SNF for post-acute care rehabilitation. Post-op course complicated by DVT and difficult to control pain. Acute care hospitalist RX's FNT TD 150 mcg/hr and oxycodone 30 mg Q 4 hrs PRN BTP prior to transfer to SNF. POD #21 patient now ready for DC to apartment with home health.
Background: You...
Opioid Refugee Squatting in SNF; Refuses Discharge (Source: Student Doctor Network)
Source: Student Doctor Network - September 24, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Fentanyl
fentanyl deaths rising, but "experts say no one is paying close enough attention." fentanyl is 50-100x more potent than morphine, and u add oxycodone to the mix. its amazing how ppl on here are defending these deadly combo.
Fentanyl deaths rising in Central Texas, going untracked (Source: Student Doctor Network)
Source: Student Doctor Network - September 18, 2017 Category: Universities & Medical Training Authors: sosoo Source Type: forums
Delaware Law Exam, Question please help URGENT
Delaware Law states that C2 "may be dispensed up to 100 dosage units or a 31 day supply whatever is the greater." Could you explain this and the whatever is greater part. And what constitutes a dosage unit. As an example, could I fill Oxycodone 3 tabs once daily for #300 tabs. It is a 100 day supply but if 3 tabs are 1 dosage unit then that equal 100 dosage units which is greater than a 31 day supply. Or should I simply be viewing 1 tablet as 1 dosage unit. Several pharmacists have told...
Delaware Law Exam, Question please help URGENT (Source: Student Doctor Network)
Source: Student Doctor Network - July 26, 2017 Category: Universities & Medical Training Authors: viper2ko Source Type: forums
Would you fill these rxs?
Hi everyone,
Would you question/fill these rxs?
Scenario 1: Only medications on file are ambien cr 12.5 mg (#90), norco 10 mg (#180) and soma 350 mg (#120). They are all written by the same doctor.
Scenario 2: Is prescribed soma 250mg and oxycodone 15 mg (#120) from the same doctor, who is a visiting physician (i.e sees patients at their homes.)
Scenario 3: Fills methadone 10 mg (#320)- prn dosing and klonopin 1 mg monthly. They're both written by the same doctor, an internist. (Source: Student Doctor Network)
Source: Student Doctor Network - July 25, 2017 Category: Universities & Medical Training Authors: mimi06bg Source Type: forums
tons of people on Adderall...
So an NP recently quit the private practice I'm at because she was looking for a job with benefits which is fine. Then....I inherited a number of her patients. Almost a good half of them on are Adderall IR as first line treatment. Nearly another half are on some sort of benzo with Xanax being relatively common. The ADHD diagnosis was thrown around pretty loosely, even applied to the guy that smokes pot daily and is getting early oxycodone refills. Interestingly when I called him and told him...
tons of people on Adderall... (Source: Student Doctor Network)
Source: Student Doctor Network - July 14, 2017 Category: Universities & Medical Training Authors: randomdoc1 Source Type: forums
Would you fill this script for cash?
Have a regular pain patient (oxycodone 30 mg #120) whose insurance expired and is not gonna be back up until next month. It's been more than 2 weeks since when they should have gotten their next prescription filled. He's asking if he can pay cash for this month. Would you do it? (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2017 Category: Universities & Medical Training Authors: Sparda29 Source Type: forums
Pharmacy Worst Career Possible
Potential Pharmacy students: Avoid pharmacy "Profession" at all costs:
1.) Retail is a nightmare
2.) Have to work nights and weekends
3.) Have to work holidays
4.) Get treated like garbage on a daily basis
5.) Deal with street drug dealers and legit gang bangers. You are a drug dealer. You are no different than the guy on a street corner selling bags of heroin. Street heroin = oxycodone = same thing.
6.) Working retail you can be terminated at anytime, no job security.
7.) 14 hours...
Pharmacy Worst Career Possible (Source: Student Doctor Network)
Source: Student Doctor Network - February 9, 2017 Category: Universities & Medical Training Authors: diplomat Source Type: forums
Chief Complaint: "My PCP says its a Federal Law I Come See You..."
60 year old with incomplete paraplegia and remote history of methamphetamine use and incarceration for distribution of the same...
Med list: Oxycodone 15 mg QID, Soma, Klonopin, Seroquel, Baclofen, and "high-CBD" cannabis...
Well, at least I'm glad that everyone is compliant with the Federal law these days... (Source: Student Doctor Network)
Source: Student Doctor Network - January 24, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
CII written by resident in hospital that uses Hospital's DEA#
The other day I received an oxycodone 10mg script #360 pills. After putting it in our system, the system flags that the DEA # isn't matching to the prescriber. I checked PMP but couldn't find anything on the patient since the Rx was from another state. When I called the hospital, I found out that the DEA number is active but it belongs to the hospital and that the patient has pancreatic cancer. At that point, I didn't feel comfortable filling the prescription because 1) patient is new to us...
CII written by resident in hospital that uses Hospital's DEA# (Source: Student Doctor Network)
Source: Student Doctor Network - January 7, 2017 Category: Universities & Medical Training Authors: applegirl89 Source Type: forums
What is the law on early fill with dose change?
If a customer turns in a new prescription for same medication of schedule two, oxycodone, early according to last fill. Yet the strength is higher but amount, medicine and dosing schedule is the same. Last one is for 20mg every four. New one is half to whole 30mg every four. Can it be filled? (Source: Student Doctor Network)
Source: Student Doctor Network - July 27, 2016 Category: Universities & Medical Training Authors: FrothDelay Source Type: forums
New Record for Narcotic Dosage
I had a new record for me today, documented on the state controlled substance database and all coming from one clinic. It was only 9000 something pills, which isn't my record, but the fact that almost all of them are oxycodone 30s was.
His daily dose of oxycodone? 1920 mg. That's right, 60 grams a month, all from one provider. Insanity. Not too bad for a young guy that's never been in an IED explosion or some similar event. Where's your pain? Mostly my neck and abdomen, but all over...
New Record for Narcotic Dosage (Source: Student Doctor Network)
Source: Student Doctor Network - June 20, 2016 Category: Universities & Medical Training Authors: The White Coat Investor Source Type: forums
Injured before residency, freaked out and depressed
Think I re-injured an old HIVD problem helping a friend move last week. Currently can't stand for more than a few seconds without experiencing significant pain in the left leg and have to find a place to lie down. Acetaminophen + NSAIDs doesn't help w/ the pain at all and leftover Oxycodone only alleviate the pain partially (pain still significant to the point where I can't stand for long).
I'm an IMG with no health insurance (dumb mistake @@). With Orientation less than 2 weeks away, I am...
Injured before residency, freaked out and depressed (Source: Student Doctor Network)
Source: Student Doctor Network - June 19, 2016 Category: Universities & Medical Training Authors: thrwaway241 Source Type: forums
