CASE LEARNING OBJECTIVES
Identify the typical signs and symptoms of withdrawal associated with the use of opioids
Determine the appropriate treatment measures to produce a desired outcome following an episode of opiate withdrawal
Determine when a patient meets criteria for substance dependence
Choose specific pharmacotherapeutic options based on patient-specific factors
"I hurt my knee playing with the kids yesterday. I'm in a lot of pain."
History of Present Illness
RG is a 44-year-old man who presents to the emergency department (ED) on a Sunday afternoon complaining of knee pain. The patient states that he was playing with his girlfriend's children yesterday and accidentally stepped into a hole in the yard and "twisted" his right knee. Per the patient, he tried acetaminophen but it did not work for him. He rates his pain as a 9 on a 10 point scale. The patient states that he has had problems with this knee before and is concerned that he may have triggered an old injury. He offers that he has had prior success with both oxycodone and hydromorphone for a similar injury.
Generalized anxiety disorder (GAD) × 6 years
Patient was adopted and does not have any health-related information regarding his birth family
The patient is divorced and lives with his girlfriend and her two children. He is currently employed as an insurance agent.
Social drinker; denies tobacco or illicit substance use.
Allergies/Intolerances/Adverse Drug Events
Patient states that he has anaphylaxis to all NSAIDs
Sertraline 50 mg PO daily
Lorazepam 2 mg PO q 6 h prn
Zolpidem 15 mg PO q hs prn
Overall physical health good; (+) mild abdominal cramping; (−) chest pain, shortness of breath; (+) depression, anxiety
Patient is a well-developed, 44-year-old male who appears to be in mild distress and is moderately agitated.
BP 152/93 mm Hg, P 93, RR 18, T 37.5°C, pain score = 9
Weight 164.6 lb (74.8 kg)
(+) Rhinorrhea, lacrimation, dilated pupils