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
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
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
“I only want the norco, not the antibiotic”
Today a patient without insurance brought in two separate scripts, one for norco one for antibiotic. After finding out the antibiotic is over 50 dollars, he said he only wanted norco. I told him that we had to fill both, and he replied what if I never showed you the antibiotic? Then he left, likely to another pharmacy to show them just the norco. This got me thinking, how do you prevent patients from skipping out on antibiotics? (Source: Student Doctor Network)
Source: Student Doctor Network - March 26, 2018 Category: Universities & Medical Training Authors: a student Source Type: forums
Exam 1: Hostile Medicaid Alcoholic Wants Vicodin; hates Tramadol
View attachment 229887
Exam concordant for facet mediated pain. Brethalyzer and urine negative for ETOH. No procedures covered by state Medicaid & can't afford cash price. Reached cap for PT. Said acupuncture was "pure BS" and refuses to chiro because "they're all quacks and paralyzed my uncle."
What's your next move? (Source: Student Doctor Network)
Source: Student Doctor Network - February 27, 2018 Category: Universities & Medical Training Authors: drusso Source Type: forums
Post surgical pain treatment in Germany
Nice article on how they treated this woman post surgically without Narcotics. Wouldn't fly here in Amerrrca!!
Opinion | After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea (Source: Student Doctor Network)
Source: Student Doctor Network - January 29, 2018 Category: Universities & Medical Training Authors: chocomorsel Source Type: forums
CII script change
Hey everybody,
Im pretty new to this and am a recent pharmacy grad. I currently am a floater for a chain and I had a question for a CII I filled my first week of practicing that I still debate was the right move or not. So I got a script for norco from a usual patient of the pharmacy it was for norco 10/325, 1 po q 8 hrs prn pain #270 90 day supply, and the patient said she its suppose to be 1 po q6 #360 as what she normally was getting, which was accurate upon checking her profile. So I...
CII script change (Source: Student Doctor Network)
Source: Student Doctor Network - January 9, 2018 Category: Universities & Medical Training Authors: pharmacisttotherescue Source Type: forums
What are your thoughts on opioid prescriptions for kids/adolsecents?
I am just wondering what are your thoughts and experience with seeing these type of prescriptions? As long as the dose matches up with the dosing regiment on say lexicomp, do you question the dose any further? Any particular drugs you deny, besides say codeine/tramadol formulations?
One last question to add, I have looked this up and it seems to be the norm, but i am just wondering to be sure. Have you all seen Percocet/Norco while breast feeding, especially after say c-section or after...
What are your thoughts on opioid prescriptions for kids/adolsecents? (Source: Student Doctor Network)
Source: Student Doctor Network - December 12, 2017 Category: Universities & Medical Training Authors: nsansom15 Source Type: forums
