Discussion Response – Patient Using Norco Medications Diazepam Medications for Shoulder Pain

Discussion Response – Patient Using Norco Medications Diazepam Medications for Shoulder Pain

Thank you for sharing your post! I agree with you on the concerns In the management of the case patient. She is on high amounts of Norco medications in an attempt to relieve her shoulder pain, which is an issue of concern. Alongside Norco’s medications, she is on Diazepam medications. The higher amounts of these medications have higher chances of causing mortality. It has a combination of an opioid and a non-opioid component. These are hydrocodone and acetaminophen, respectively (Seago et al., 2016). Hydrocodone has a side effect of slowed breathing and, therefore, has to be used with precautions (Molassiotis et al., 2017). High doses of the Norco medication may stop the breathing process, reducing oxygen circulation in the body. However, this patient, who increases her dose intake without a doctor’s prescription, is at risk of respiratory distress. Apart from respiratory distress, the patient is likely to undergo liver and kidney failure because of the drugs administered orally. Respiratory distress is more likely to lead to death and systemic failure. This endangers the patient’s health more.

When using Norco, one is advised not to drink alcohol since it can lead to serious side effects threatening the patient’s health. This worsens her condition more despite the hypertension case. Drug-drug interaction is likely to be experienced by this patient. Administration of a benzodiazepine (diazepam) and hydrocodone is likely to cause sedation. Therefore, it is better to educate the patient on the harm she is causing herself. The dangers of alcohol intake while taking the prescribed drugs. It is also important to encourage her on other alternative pain treatment options. They include physical therapy, massage, and psychotherapy. More awareness should be created on the risks of taking an overdose on one’s health. Majoring in the effects such as kidney and liver failures and her hypertension worsening. Since she is also a primary caregiver to her grandchildren, it is better to modify her activities to minimize more injury caused on her shoulder.

References

Molassiotis, A., Smith, J. A., Mazzone, P., Blackhall, F., Irwin, R. S., Adams, T. M., … & Weir, K. (2017). Symptomatic treatment of cough among adult patients with lung Cancer: CHEST guideline and expert panel report. Chest, 151(4), 861-874.

Seago, S., Hayek, A., Pruszynski, J., & Newman, M. G. (2016, July). Change in prescription habits after federal rescheduling of hydrocodone combination products. In Baylor University Medical Center Proceedings (Vol. 29, No. 3, pp. 268-270). Taylor & Francis.

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Discussion Response – Patient Using Norco Medications Diazepam Medications for Shoulder Pain

ML is a 54-year-old grandmother who has a few issues that I would be concerned with. ML’s current medication regimen appears to be appropriate except for the possible high amount of Norco she is taking for her shoulder pain, along with the use of Diazepam. The combination of opioids and benzodiazepines is concerning not only for possible dependence but also for the risk of accidental respiratory depression and death associated with their use together (Kang et al., 2020). I would use the National Institute on Drug Abuse Modified Alcohol, Smoking, and Substance Involvement Screening Test (NMASSIST), which consists of an easy 10 questions that can be administered by a provider (Lindley et al., 2019). Ethically I would be inclined to screen her for opioid dependence and inquire into who is prescribing her these medications in such high quantities.

Norco Medications Diazepam Medications for Shoulder Pain

One pain contract I would use is developed by the American Academy of Family Physicians. Opioid Medication for Chronic Pain Agreement has ten places for the patient to initial, including the name of the medication, pharmacy name, phone number, and signatures by patient and provider (Chronic Pain Management Toolkit, 2021). I would first ask ML to honestly tell me where she is getting prescribed her medications and how often. I would then use the CURES database to search for any prescriptions written for ML to collaborate on her story and ensure her safety.

Current California laws regarding the number of drugs dispensed and how many refills prevent providers from refilling a controlled substance more than six months from the original prescription, no more than five refills not exceeding 120 day’s supply of schedule III or IV drugs such as Valium, and no refills for any schedule II substance like Norco (California Legislative Information, 2021). According to state law, ML’s atorvastatin, losartan, and gabapentin would be able to be called into a pharmacy over the phone. A Schedule II controlled substance such as Norco would need a written or electronic prescription to be delivered to the pharmacy. Oral prescriptions are not allowed for Schedule II controlled substances in California (Preuss, 2021). All prescriptions require the patient’s legal name, date of birth, home address, phone number, drug name and dose, quantity prescribed, refills, instructions of administration, prescriber name, DEA number, and NPI number. Also, California law requires the date and origin of the prescription, a watermark printed on the backside of the prescription stating “California Security Prescription, chemical void protection on paper, checkboxes for simple selection of the quantity of medication, no substitute check box and a unique serialized number prescribed by the Department of Justice.

After prescribing a controlled substance, I would go to the CURES registry to file a report of the quantity of Norco prescribed no later than one day after the prescription so that if she tried to get another prescription filled, other providers would be able to see when she had last been prescribed (State of California Department of Justine, 2021). California is a restricted state for advanced practice registered nurses regarding the practice and prescribing of controlled substances. Attached is the Board of Registered Nursing policy for a nurse practitioner to follow when furnishing an order for scheduled and controlled substances.

In summary, patient ML would need education on opioid dependence, smoking cessation, and alternative pain control methods such as massage, physical therapy, and meditation. I would educate her about the risks of liver failure, drinking alcohol, taking medications with acetaminophen, and exploring different ways she could care for her family without exacerbating her shoulder injury

Reference

Health and Safety Code. (2021). California Legislative Information. Retrieved July 8, 2021, from https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=11200.&article=4.&highlight=true&keyword=controled+substance+refills

Lindley, B., Cox, N., & Cochran, G. (2019). Screening tools for detecting problematic opioid use and potential application to community pharmacy practice: a review. Integrated pharmacy research & practice, 8, 85–96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649304/

Kang, M., Galuska, M., Ghassemzadeh, S. (2020). Benzodiazepine Toxicity. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482238/

Kenny, B., & Preuss, C. (2021). Pharmacy Prescription Requirements. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538424/

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