Question

Ashish Roshan, a 32-year-old man, arrives for first-time visit with complaints of hip pain. His girlfriend, Ana, is with him. One year ago, Ashish had a displaced left femoral neck fracture requiring total hip arthroplasty. Post-surgery, he has had chronic hip pain. For a while, his pain was managed by his orthopedist, originally with oxycodone and more recently with ibuprofen. Ashish complains that now his primary care physician will not refill his oxycodone prescription. He states that only the oxycodone relieves his pain. Reviewing his medical records from his PCP, you see that a recent extensive reevaluation of his hip pain was negative. Ashish states that he will run out of his 30-day supply of oxycodone within just 14 days. Ana says that he doesn’t seem to have any personality anymore and is always worried about taking his next pill. Ashish asks about starting on Suboxone instead. Ana also asks you to explain how these medications work. Questions From your perspective as Ashish’s psychiatric nurse practitioner, answer the following questions in a paper no longer than two double-spaced pages (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references. What is oxycodone? What medication class is it? How should you discuss his possible addiction with Ashish? What is buprenorphine/naloxone? How would it work to help Ashish transition off opiates? What brands and formulations of buprenorphine/naloxone are available? What are the signs of opiate withdrawal? How long after the last dose will withdrawal symptoms start? What further education and referrals can you provide for Ashish and Ana?

Answer 1

Oxycodone

Oxycodone is a opioid medication used to treat pain.

Class: opioid

Mechanism is to hyperpolarisation of neuron results decrease excitability so it is used for dependence and addiction

Naloxone is a opioid antagonist

Narcan and Evizia are the brands

Formulation: available as nasal spray and prefilled syringe

Opioid withdrawal symptoms

• Muscle aches
• lacrimination
• Dyspnea
• Insomnia
• Running nose
• irritability
• Diaphoresis
• Hypertension
• Blurred vision
• Nausea and vomiting
• Abdominal cramps

The symptoms begin after 24hour of drug stops

Education

• Be calm and take rest
• Teach nonpharmacological pain management
• Follow relaxation techniques
• Advice diversional therapies
• Introduce vocational training
• Refer to the deaddiction counselling centres if persists.