Mr. K. is a 62-year-old man who lives alone. He was admitted 4 days ago to an extended-care facility on his third postoperative day from a right total knee replacement for care and rehabilitation until he can safely care for himself at home. He is prescribed hydrocodone with acetaminophen (Vicodin) for pain control. The prescription reads: “Vicodin (5 mg hydrocodone; 300 mg acetaminophen) one to two tablets every 4 to 6 hours as needed for pain.” He tells you that overall, his pain is not bad except when he comes back from physical therapy. Then it is “really roaring.” He also says he tries to take the drug just at that time so that he does not become addicted.
- What type of pain is he having?
- How will you know the severity of “really roaring” pain?
- What specific type of drug is Vicodin?
- What type of change(s) could be made in drug delivery with the current prescription to help relieve his pain more effectively?
- What will you tell him about his potential for addiction?
- If he were to receive two Vicodin tablets every 4 hours around the clock, what would be his total dose of acetaminophen for the day?
Full Answer Section
Assessing Pain Severity
Assessing pain severity is crucial for effective pain management. While Mr. K. describes his pain as "really roaring," it is important to quantify the severity using a standardized pain scale. The Numeric Rating Scale (NRS) is a commonly used pain scale that ranges from 0 (no pain) to 10 (worst imaginable pain). By asking Mr. K. to rate his pain on the NRS, you can get a more objective assessment of the severity of his "really roaring" pain.
Type of Drug
Vicodin is a combination analgesic containing two active ingredients: hydrocodone, an opioid analgesic, and acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID). Hydrocodone works by binding to opioid receptors in the central nervous system (CNS), reducing pain perception. Acetaminophen reduces pain and inflammation by inhibiting the activity of cyclooxygenase (COX) enzymes.
Modifying Drug Delivery
To help Mr. K. manage his pain more effectively, consider the following changes to the current prescription:
- Adjust Timing of Dosing: Instead of taking the medication only when the pain is severe, consider a scheduled dosing regimen, such as every 4 hours, even if the pain is not severe. This will help maintain a steady blood level of the medication and prevent the pain from spiking before the next dose is due.
- Increase Dose: If the pain is still severe even with scheduled dosing, consider increasing the dose to two tablets per dose. Monitor Mr. K. closely for potential side effects, such as drowsiness and dizziness, and adjust the dose accordingly.
- Consider Alternative Pain Management Strategies: In addition to medication, consider incorporating non-pharmacological pain management strategies, such as ice, heat, physical therapy, and relaxation techniques. These can help reduce pain and improve overall well-being.
- Monitor for Medication Tolerance: Be mindful of the potential for medication tolerance, where the body becomes less responsive to the medication over time. If the medication is no longer providing adequate pain relief, consult with a healthcare provider to reassess the pain management plan.