Case+3

===This wiki is the being used as a housing location for these case scenarios. Each student is to answer each of the case scenarios and turn in for grading as per the course syllabus. ===

===Sam Smith is a 25 year old who is new to your practice. He presents with a vague complaint of pain that he associates with a cleaning he had last week at another dental office. You attempt to complete a medical history review and learn that he has had problems with chronic pain since a work related injury about three years ago. He takes no medications and states that NSAIDs do not “touch the pain” he is experiencing. He also tells you that acetaminophen and codeine is not very effective. He would like you to review what was done to him at the other dental office and hopefully the dentist can prescribe Vicodin for the pain. ===

Questions
===1. What are some of the red flags associated with this individual? Some red flags associated with Sam Smith is that he has come into our dental office with a vague complaint and is very specific about what medication he is wanting. Also, upon filling out a medical history form we find out that he has a work related injury in which he is in chronic pain. Another red flag is that he has been to different dentists within the last few days which is considered doctor shopping. He states that all non-narcotic drugs "don't touch the pain" such as NSAIDs and tylenol. A big red flag is that he is specific about the type of medication he wants acetaminophen and hydrocodone (vicodin). A concern of ours is that he didn't return to the dentists office in which he had his original treatment in order to follow up with the pain he is associating it with. === === **2. What is hydrocodone and how effective is it in treating or managing dental pain?** Hydrocodone is derived from two of the natural occurring opioids codeine and thebaine. Hydrocodone is a semi-synthetic opioid. Hydrocodone is an orally active narcotic analgesic and antitussive. It relieves pain by binding to the opioid receptors in the brain and spinal cord. Hydrocodone is found in Vicodin and has a chance of addiction and toxicity. This drug is used for severe pain conditions. === === **3****. What should be recommended to this patient?** We would recommend that the patient return to the office that he previously received dental treatment for the pain he is experiencing from the treatment. Also we would recommend that he follow up with his primary care doctor for management of the chronic pain. Also we would communicate with the office about his visit and request for narcotics. ===

**4. What are the pharmacologic effects of opioid analgesics?**
=== Opioids are added to nonopioids in order to control moderate to severe pain that doesn’t respond to the nonopioids alone. Opioids have no ceiling effect on their analgesic effect. Side effects are the only dosing limitation. Addiction and tolerance can occur in most all patients when taken for a prolonged period of time. However, in dentistry the duration is short (generally 7 days or less) so the addiction and tolerance is rarely seen. Pharmacologically opioid analgesics clinically show sedation, drowsiness and lethargy, cognitive impairment, depression of the respiration being a main cause of death from opioid overdose. Opioids are used for cough suppression by suppressing the "cough center". Also seen as an unpleasant side effect is nausea and vomiting due to stimulation of receptors called chemoreceptor trigger zone. Diarrhea is seen as a side effect due to the direct action on the intestines. Opioids also can release histamine causing an itching or severe allergic reactions including branchoconstriction. Also effecting white blood cell function and immune function. ===