Assignment
Noah, a 45-year-old male, presents to your clinic to establish care for his chronic back and leg pain. He appears slightly drowsy. He reports being injured at work approximately 5 years ago, at which time he was started on oxycodone. When asked details about his injury, he appears to have difficulty describing his injury and previous treatments. He does report being on a stable dose of oxycodone for the past few years.
• Additional History
1) He states that he needs the oxycodone to function and that he ran out of his medication one week ago
2) Drinks a beer every night
• HEENT, Neck
1) Eyelids appear heavy, pinpoint pupils, and sclera appears red
• Understand the physiology of the body systems and the pathophysiology of disease process
1) What are the signs and symptoms associated with the disease process?
2) What diagnostics should be performed?
• Confirm Diagnosis
1) Should you treat before you have confirmed a diagnosis? If yes, under what conditions?
2) Have you clearly defined the patient's problem? What are the things you would do to determine the diagnosis?
• Start Pharmacologic/Nonpharmacologic Regimen
1) What do you need to consider when choosing the medication?
2) What are the presenting symptoms? What are the therapeutic objectives? Is there a clear goal with expected outcomes? Did you discuss the goals with the patient?
• Which drug to start?
1) Is there a clinical practice guideline? What is standard practice? What are the patient characteristics? What other drugs is the patient taking?
2) Have you considered the patient's preferences, side effect profile, route of administration, risk vs benefits, effectiveness, price, etc.? Is the medication FDA approved for the problem? Any foreseeable adherence issues?
• Evaluate effectiveness at regular intervals
1) Recommended follow-up?
2) Is the current treatment effective and relevant? Is the diagnosis still applicable? Any medication side effects, including drug interactions?