Analgesics Clinical Case: Management of Debilitating Pain in Left Foot

This clinical case discusses a 57-year-old woman suffering from debilitating pain in her left foot. The proposed medication plan includes Paracetamol, Aspalgin, and Oxycodone. The article also discusses the pharmacology of these drugs and proposes an evidence-based management plan.

Clinical case template
Student’s name Total word count – 1500 words Word
count/
Weighting
Patient summary
information
Client is 57 years old women with debilitating pain in her left foot. Her pain is increasing over time in
18 months and need better treatment and management that can help her to relief from her pain. There
is also need to focus on medication and other medical condition like past of hypertension, lower back
pain, and osteoarthritis in left knee along with headache per week at least once (Gan, (2017).
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Evaluates the client’s
presentation to identify
ALL factors relevant to
the prescription of
medicines
Client social relationship are getting narrow due to her physical health. She is not able to walk and
meet with others due to her worsening pain over time. She is non-smoker but to get some relief from
pain she is consuming alcohol 21/28 units per week which is not good for her health that can lead to
create impact of liver diseases, high blood pressure and cause different cancer. Alcohol enhances the
metabolism and can impact the drug metabolism get delayed and there is not sufficient therapeutic
response on client for health improvement. Her family are far away which creates a condition to take
care of herself. Client is suffering from the chronic pain for longer period of time. She needs relief but
not able to get rid of it. She has used various management but have no response and with time this pain
is getting worse in her left foot. Client has described about the ankle and talo-navicular joints. There is
also pain in the planter to the heel. There is worsening of pes planus which is worsening. Due to such
pain their physician has advised to provide pain reliever which is paracetamol twice a day (500mg).
She is getting weight which is due to not performing any physical activity. Due to weight gain there is
risk of more pressure on foot and increases debilitating pain. There is risk factor of getting obese and
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other health related risk due to more consumption of alcohol. In initial phase her pain was mild and
due to this she was prescribed to take Paracetamol along with use of Orthoses for controlling excessive
pronation to get relief from the pain. With time pain getting worse and lead to moderate pain where
dose has been increased with some addition in medication which was Aspalgin (Aspirin and codeine
phosphate hemihydrate) which allow to assist pain and relief form it. Within 18 months there is no
improvement even after using the management. So client decided to meet podiatric surgeon where
prescribed medication is Oxycodone which is extended release tablet or capsule that provides help to
relieve form pain where other medication is not allowed. This medication can help in relief form sever
pain from which client is suffering (Jimenez, (2018).
Justifies the proposed
medicine(s) prescription
for the client
Client is suffering with increasing level of pain where in the initial phase there was introduction of
paracetamol with use of Orthoses for controlling excessive pronation which was able to manage pain
during mild pain. Paracetamol with oral route have impact on pain and provide relief form mild pain
with its disintegration. This allows drug to work for limited time and allows other dose with proper
time interval that can help to avoid the toxicity within client. It acts as the pain relief and allow body to
handle pain easily (Barakat, (2018). But over time, client pain was getting worse and needed for better
medication where she was prescribed by adding Aaspalgin which is combination of Aspirin and
codeine phosphate hemihydrate. This drug helps to deal with moderate pain and provide relief to client
for longer time period. But over time pain get severe. Client was prescribed Oxycodone from podiatric
surgeon. During this medication, other medication is not allowed for its proper and effective response.
There are contraindications that this should not use during any severe respiratory depression, acute
abdomen, paralytic ileus, delayed gastric emptying, severe bronchial asthma and others (Isola, (2019).
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Analyses the
pharmacology of ALL
the client’s prescribed
medicines and non-
prescription drugs
including alcohol
Paracetamol pharmacology- It is a first line treatment for the pain or pyrexia. This works as an
analgesic which is considered with safety profile with drug interaction sometimes. Oral administration
can produce analgesia within 40 minutes with maximum effect at 1 hour. There is large variation in
bioavailability which can be there on onset and duration of action. It is effective when mediated
through eh activation of descending serotonergic pathways. It has the primary site of action which may
be prostaglandin synthesis inhibition through active metabolite cannabinoid receptors. Prostaglandin H
synthetise is an enzyme which is responsible for arachidonic acid metabolism to unstable PGH. There
are two major forms which are constructive PGHS-1 and inducible PGHS-2. These comprises of two
sites peroxidase and cyclooxygenase site. Paracetamol acts to reducing concentration on lessens
availability of ferryl protoporphyrin radica cation.
Aspalgin pharmacology- Aspirin rapidly observed in upper GIT and disrupts production of
prostaglandins to targeting cyclooxygenase-1 and cyclooxygenase-2. Prostaglandins enhances
sensitivity of pain receptors like histamine or bradykinin. Due to disruption of production along with
prevention of prostaglandins release in inflammation, this can impact on the pain receptors which
prevents symptoms of pain. This allows individual to relief form pain. It prevents the production of
pain causing prostaglandins.
Codeine phosphate hemihydrate- It is a phosphate salt of codeine which is natural occurring
Phenanthrene alkaloid along with opioid agonist with analgesic which can help to relief from severe
pain. Codeine mimics its action of endogenous opioids though binding to receptors of opioids at
various sites within CNS. It results to decreasing the release of nociceptive neurotransmitters like
GABA, acetylcholine, dopamine and nor-adrenaline. It also induces the opening of G-protein coupled
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rectifying potassium channels along with blocking of N-type voltage-gated calcium channels opening
which results in reduced neuronal excitability and hyperpolarization.
Oxycodone pharmacology- It is a semi synthetic opioid which is having an agonist activity on delta
and kappa receptors. It is equivalence about morphine that is 1:2. it have the effect after administration
of one hour and can last for about 12 hours with controlled released formulation. It has metabolite
oxymorphone which is a potent analgesic and noroxycodone that is weak analgesic. This can help in
severe pain and due to having specification of controlled released drug, chewing and broken tablet can
impact its pharmacology.
Alcohol pharmacology- Acute use of alcohol can lead to work as analgesic. Oral ethanol
administration can lead to hypersensitivity and cause chronic constriction injury. They impact the
kappa and mu opioid system. There is chronic inflammatory and neuropathic pain which can lead to
provide into ethanol in chronic pain and provides relief form pain.
Proposes an evidence-
based management plan
for the client including
a simulated prescription
for the proposed
medicine(s)
There is use of capsaicin, lidocaine as a topical medication which allows to decrease the acute pain.
Morphine and Di-morphine Fentanyl which is prescribed to the client to provide better and effective
relief from pain (Clarke, (2018).
Physical exercise- For the management of pain there is need for the physical exercise. There are many
other management strategies like nursing intervention.
Physical Therapy- This can be high helpful in managing pain that can have impact on the individual
and provides relief from acute pain or allow to manage it effectively. Physical therapy can help to
manage pain by reduce the pain and manage strain and restoring body fluid movement.
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Self-management- This is the one in which many physical exercise and stretching can help to manage
acute pain. This can be highly effective to get relief from acute pain for the better and improved health
(Hill, (2018).
Medication- With the help of taking different analgesic can help in managing pain which is cause due
to bilateral internal rotation of limb which causes chronic pain and getting worse with time. There is
different category of drugs like opioid and non-acids which can have different impact and help in
managing pain and provide relief. This medication can be taken for longer time period where body can
get resist or pain can worsen where medication should be improved by taking higher level of analgesic
for acute pain management.
Presents an evidence-
based
review/monitoring plan
for the client
Oxycodone has been prescribed. In this, there is need to monitor that client should not take other
medication because there can chance of contraindication which may include severe respiratory
depression, paralytic ileus, severe bronchial asthma, delayed gastric emptying, acute abdomen pain
and others (Rasooli, (2018). There is need for the documentation which is regarding the progression of
clinical trials. In documentation, there is need to includes all the prescribed mediation, detailed client
health related information and others. Capsaicin, lidocaine is the topical drugs which are prescribed to
provide relief form the severe pain. There is adverse effect like feeling cold or hot, nausea and
vomiting which can be there due to adverse effect. There is also need for time to time analysis along
with getting report of client health. This can help to get correct information about the client’s current
health through regular monitoring. Through regular monitoring it allows to focus on proper delivery of
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current health condition (OMER, (2020).
Reference sources Gan, (2017). Poorly controlled postoperative pain: prevalence, consequences, and prevention. Journal
of pain research, 10, 2287.
Jimenez, (2018). A systematic review of atypical antipsychotics in chronic pain management. The
Clinical journal of pain, 34(6), 585-591.
Isola, (2019). Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling,
and mouth opening after surgical removal of impacted third molars: A randomized, controlled clinical
trial. International journal of oral and maxillofacial surgery, 48(10), 1348-1354.
OMER, (2020). Computational Study on Paracetamol Drug. Journal of Physical Chemistry and
Functional Materials, 3(1), 9-13.
Rasooli, (2018). Hepatoprotective effects of Cichorium intybus against paracetamol induced
hepatotoxicity in broiler. Journal of World Poultry Research, 8(2), 25-30.
Hill, (2018). Oxycodone‐induced tolerance to respiratory depression: reversal by ethanol, pregabalin
and protein kinase C inhibition. British journal of pharmacology, 175(12), 2492-2503.
Clarke, (2018). Opioid weaning and pain management in postsurgical patients at the Toronto General
Hospital Transitional Pain Service. Canadian Journal of Pain, 2(1), 236-247.
Barakat, (2018). Uses of fluoxetine in nociceptive pain management: A literature overview. European
journal of pharmacology, 829, 12-25.
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