Question

Case 2: (10 marks) A 27-year-old man with a history epilepsy and is taking Levetiracetam for his epilepsy which is very well managed. He had a road traffic accident, which required an emergent surgery in his lower extremity. Post-surgically, the patient was given tramadol PRN. The clinical pharmacist visited the patient and decided to change his medication to codeine. Answer the following questions: 1) What is the type of pain this patient is suffering from? Provide a justification for your answer. (2 marks) 2) Do you agree with the change that was done by the clinical pharmacist? Provides justification for your answer. 3) The patient informed the nurse the he needs a pain killer, the nurse asked him about the Intensity of the pain, and he rated it as 8 out of 10. The nurse gave him codeine and followed up with him after 1 hour, and the patient is still complaining of pain with the same intensity (8 out of 10). Briefly, explain why this patient is still complaining of the same intensity of pain? 4) What would you o ut for this patient to relief his pain? Provide a jucation for your

Answer 1

ANSWERS :

1. Peripheral neuropathic pain ( PNP)

It is a type of pain originate with nerves in the arms and legs. Peripheral neuropathic pain could be caused during the repair or replacement of joint.

2. Yes, I agree with the decision made by clinical pharmacyst. because Tramadol has been known to cause seizures in abusers and even users who take prescribed doses. As an opioid drug, tramadol stimulates brain receptors and blocks pain. Tramadol induced seizures commonly triggor loss of consiousness , shaking and loss of bladder control.

codeine is a frequently used opioid analgesic, especially when pain control with acetaminophen or nonsteroidal anti-inflammatory drugs fails. Although seizures associated with codein have been exported, pertinent data are very limited.

While administering codeine closely monitor the development of respiratory depression.

3. Normally post operative pain can be controlled with Tramadol injection, but in this case patient have history of taking medication for epilepsy.So in this patient if, tramadol is used there is chance of precipitating seizure.Codeine normally control mild to moderate pain, and its action starts 30 minutes after injection, and peak action develop after 2 hour. Codeine increases tolerance to pain, decreasing discomfort, but the pain is still apparent to the patient.

4. Normally after operation for the pain control we can give twice daily injection of nonsteroidal anti inflammatory drugs ( NSAIDS ), such as inj.Pracetamol, inj.diclofenac can be given. In this case we can combine NSAIDS with opiods for better management of pain. We can give NSAIDS as infusion.

Epidural analgesia is also a choice if pain is still persistent.