Someone explain to me
I do a procedure, say an L5-S1 intralaminar epidural, and patient says they got 80% relief, but they are here for their legacy monthly refill of ms contin 15mg BID and morphine IR 15 QID for their 8/10 pain. Don't worry... It's under 90 OME so that means that it is okay. They are getting their alprazolam from their psychiatrist, I'm not the one writing it, so it's obviously okay. It makes no sense. There are only a few cases where the medication management doesn't essentially seem like I'm...
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Source: Student Doctor Network - February 5, 2024 Category: Universities & Medical Training Authors: OuttaLuckMove Tags: Pain Medicine Source Type: forums
Patients with multiple controlled substances.
I'm seeing this constantly now, patients on 2-3 controlled substances at once by the same prescriber.
e.g. Xanax 2 mg TID, Adderall 20 mg BID, Suboxone 8-2 mg BID
I've been tempted to just tell patients I will only prescribe only 1 controlled substance at once.
How do you handle transfers or new patients with these regimens? (Source: Student Doctor Network)
Source: Student Doctor Network - January 16, 2024 Category: Universities & Medical Training Authors: littlefred Tags: Psychiatry Source Type: forums
Benzos in animals..
Gettings,
Pharmacist here. We have an owner who gets Xanax 2 mg # 30 tabs approximately every 45 days for anxiety for her dog.
I have a concern about legitimacy of this prescription, especially it being relatively high dose of Xanax. My question is, can this kind of dose be justified in rare circumstances? How often if ever do you guys prescribe benzos in your practice?
Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - August 6, 2023 Category: Universities & Medical Training Authors: Chrish Tags: Veterinary Source Type: forums
Medication high scores
Let's have some fun. What are the highest prescribed doses of medication you've ever seen, both indicated and not indicated? Let's keep to outpatient and also things you know a pharmacy actually filled. I've had catatonic and manic inpatients on elephant doses of benzos but that's different.
Here are some of mine:
Risperidone 8mg bid. An antipsychotic was indicated, but... Not that much.
Adderall IR 30mg qid. Suspect pt was diverting, shocked someone was filling it.
Xanax 2mg qid. Pt...
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Source: Student Doctor Network - June 28, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Legal age for driver
Have a patient who really needs Xanax for her procedure. Single mom.
Her only driver is her 17 year old son. Has license but not 18 yet.
any legal concerns? (Source: Student Doctor Network)
Source: Student Doctor Network - May 11, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Tired of this
Here’s the med list for my consult today:
Diazepam 10 mg daily
Xanax 0.5 mg qid
Hydrocodone 7.5 mg qid
Ambien 10 mg at hs
So sick of dealing with this (Source: Student Doctor Network)
Source: Student Doctor Network - May 9, 2023 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry 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
Patient with worsening anxiety and abusing xanax from their PCP.
Long story short, woman with anxiety sees me for follow up. She had been getting xanax 1mg TID from her PCP but last visit she had told me she weaned herself down to half a tablet a day. This is a telehealth visit (which i generally prefer in person but oh well) and I ask her how many she has left and apparently she only has 9 tablets left, despite filling the medication 30 days prior for 90 tablets. I call her out that it would be impossible to have 9 tablets left if she was only using...
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Source: Student Doctor Network - November 11, 2022 Category: Universities & Medical Training Authors: annoyedpsychiatrist Tags: Psychiatry Source Type: forums
half life , duration, dosing interval
I'm really confused about this.
alprazolam half life is roughly 12 hours, and the dosing interval is 3 times daily.
so I think its duration is 8 hours
another drug fludiazepam half life is roughly 23 hours, and the dosing interval is still 3 times daily
its duration is also 8 hours ?
for bzd drugs, it is hard to find complete data about their duration of action, the half-life and the dosing interval
question is how do I consider a drug is long acting or not ?
the previous example...
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Source: Student Doctor Network - October 29, 2022 Category: Universities & Medical Training Authors: zongsheng0621 Tags: Pharmacy Source Type: forums
Is xanax contraindicated in Asthma / Copd exacerbation
Is there any data that restricts the use of low dose xanax (0.5mg) in mild asthma exacerbations (not requiring o2) Can they still take to help them sleep. Is it a complete contraindication? (Source: Student Doctor Network)
Source: Student Doctor Network - September 18, 2022 Category: Universities & Medical Training Authors: Cadet133 Tags: Pulmonary / Critical Care Medicine Source Type: forums
Switching patient from xanax to trazodone?
I have a patient who has been on xanax for years, been on 0.5 mg at bedtime for the past year. She states that it helps her with sleep, but she wants off the medication due to cognitive concerns and concerns for addiction. I told her to cut it to 0.25 mg at bedtime, with a plan to slowly switch to trazodone. Anyone have experience with this or advice? (Source: Student Doctor Network)
Source: Student Doctor Network - April 25, 2022 Category: Universities & Medical Training Authors: StayOnTop Tags: Psychiatry Source Type: forums
Benzo vs other options for anxiety
Question for the psychiatrists here from a pain physician.
All the national guidelines I’ve read about anxiety management, state that virtually no one should be prescribed chronic daily benzodiazepines for anxiety, (particularly short acting agents such as Xanax), and definitely not tid or qid dosing. Some papers do mention a small supply for rescue benzo doses to be used 3-5 times a month max.
Everything else should be used instead of benzos, so psychotherapy, multiple SSRI, buspirone...
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Source: Student Doctor Network - April 17, 2022 Category: Universities & Medical Training Authors: bedrock Tags: Psychiatry 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
How would you help this other type of this patient?
Never mind. Changed my mind about posting this here in any detail. Basically, though, the question is what to do about a patient who is being transitioned from xanax to a longer acting benzo but also has a lot of care seeking/care rejecting behaviors and is not stable from an anxiety standpoint. (Source: Student Doctor Network)
Source: Student Doctor Network - December 12, 2021 Category: Universities & Medical Training Authors: throwaway2222 Tags: Psychiatry Source Type: forums
Homeless psych dispo -WWYD?
Had a case recently with a homeless guy coming to the ED after being release from jail the same day asking for help because of a panic attack. He definitely was cogent and coherent enough that I didn’t think he was exhibiting any emergent toxidrome or withdrawal.
So I give him a rx for a couple Xanax because he supposedly lost his after his car was stolen while he was in jail. I give him some lorazepam in the ED. I offer to have him stay overnight in the lobby for the social worker to see...
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Source: Student Doctor Network - January 23, 2021 Category: Universities & Medical Training Authors: pandahunter Tags: Emergency Medicine Source Type: forums
