Would you fill these rxs?

[mimi06bg]

Hi everyone,
Would you question/fill these rxs?

Scenario 1: Only medications on file are ambien cr 12.5 mg (#90), norco 10 mg (#180) and soma 350 mg (#120). They are all written by the same doctor.

Scenario 2: Is prescribed soma 250mg and oxycodone 15 mg (#120) from the same doctor, who is a visiting physician (i.e sees patients at their homes.)

Scenario 3: Fills methadone 10 mg (#320)- prn dosing and klonopin 1 mg monthly. They're both written by the same doctor, an internist.

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[zelman]

Hi everyone,
Would you question/fill these rxs?

Scenario 1: Only medications on file are ambien cr 12.5 mg (#90), norco 10 mg (#180) and soma 350 mg (#120). They are all written by the same doctor.

Scenario 2: Is prescribed soma 250mg and oxycodone 15 mg (#120) from the same doctor, who is a visiting physician (i.e sees patients at their homes.)

Scenario 3: Fills methadone 10 mg (#320)- prn dosing and klonopin 1 mg monthly. They're both written by the same doctor, an internist.

I question all opiate/soma combos, so I would talk to the doc and document the conversation about #1&2. I'd be fine with #3 as long as it is documented that the methadone is for pain.

 

[steveysmith54]

Are they all for fibromyalgia

 

[zelman]

Are they all for fibromyalgia

No, it's "chronic non-malignant pain syndrome"

 

[Bosno]

I question all opiate/soma combos, so I would talk to the doc and document the conversation about #1&2. I'd be fine with #3 as long as it is documented that the methadone is for pain.

I've never seen anyone taking Methadone for pain PRN. If they are in enough pain to be taking methadone for pain, they should be taking it scheduled. Otherwise, they should probably be on oxycodone or morphine PRN or something.

But then again, I work in hospital, so maybe I don't see as much.

 

[mimi06bg]

The methadone is for chronic low back pain, but I haven't seen it used PRN before. Shouldn't this be a concern considering methadone's long half life? Also, wouldn't it be appropriate the patient be referred to a pain management specialist?

 

[radio frequency]

The methadone is for chronic low back pain, but I haven't seen it used PRN before. Shouldn't this be a concern considering methadone's long half life? Also, wouldn't it be appropriate the patient be referred to a pain management specialist?

The PRN is very possibly a mistake or a misunderstanding of kinetics on the part of the prescriber. I would call for clarification and possibly educate if necessary. I've called on this one before and it turned out the prescriber was trying to duplicate the patient's home regimen and wasn't familiar with methadone at all.

 

[Dred Pirate]

Methadone prn is never (somebody jump in that is a pain expert) - it is a horrible prn med - you have to build levels, long acting, etc etc. It is a horrible drug to try to get high off of, but the time you take enough to get high, you often kill yourself.

The other - very situation dependent - call MD, are they respectable, or just a pill mill?

 

[Rouelle]

So the #320 methadone 10 has no frequency whatsoever? Just prn pain? If there was a frequency AND I ascertained that it was a former heroin addict who now has cancer (or something similar), I might do it. Otherwise, not a chance on that one. Especially if it's new. Due diligence, due diligence, due diligence

 

[mimi06bg]

So the #320 methadone 10 has no frequency whatsoever? Just prn pain? If there was a frequency AND I ascertained that it was a former heroin addict who now has cancer (or something similar), I might do it. Otherwise, not a chance on that one. Especially if it's new. Due diligence, due diligence, due diligence

Well, it's 2 tabs q4-6h prn pain (chronic low back pain). The patient is new to me, but has been on the medication for several years now...