Mar 2/17 (1400hr) Clinical Pharmacy Note RE: Pain
ID: 46 yo male admitted with traumatic brain injury and fractures on face and both legs from falling 12ft off a tree
S/O:
- v/s: 37.1, HR 90, BP 105/60, RR 21
- RASS -1 to 0, BPS 5/12, NRS 10/10 (patient regularly banging (not agitated) on side of bed to ask for more pain medication)
- Ongoing, non-resolving shooting, burning and aching pain to neck and both legs
- Current pain meds:
- Dilaudid 0.1-0.5mg IV Q5min PRN (received >20 doses so far today)
- Dilaudid 1mg OG Q4H regular (started today)
- Acetaminophen 975mg OG Q6H reg
- Previous PRN dilaudid IV doses (total daily doses) – Feb 28: 5.8mg, Mar 1: 6.4mg
A:
- Ongoing pain (likely combination of neuropathic and nociceptive) is not being adequately managed
- Current regularly scheduled dilaudid OG (total daily dose: 6mg equivalent to 3mg IV) is not adequate in managing pain
- Pregabalin is effective in managing neuropathic pain and would help decrease requirements for opioids
- No significant drug interactions with pregabalin
P: Suggest
- ↑ Dilaudid to 2mg OG Q4H reg (total daily PO dose = 12mg equivalent to 6mg IV)
- Start pregabalin 75mg OG BID
- Monitor pain (BPS, NRS) Q4H and use of PRN dilaudid IV daily
- Monitor for AEs of pregabalin: drowsiness, dizziness, headache, dry mouth, constipation, peripheral edema
- Monitor for AEs of dilaudid: drowsiness, dry mouth, nausea, vomiting, constipation, urinary retention, pruritus
