HuBio 564: Principles of Pharmacology II
Case Study 5
A 16 year old high school sophomore comes to your office complaining of low back pain of about a week's duration beginning shortly after he began baseball practice this spring. He mostly treats his pain with Tylenol but in the last few days, he has been taking some pain medicine that his girlfriend got from her parent's medicine chest (about 16 in the last 2 days). The label says it is hydrocodone 5mg with acetaminophen 500 mg (Vicodin).
1. He wonders if you'd give him a prescription for more. Is this a reasonable choice for him? Based on the WHO analgesic ladder what pain relievers would you suggest?
2. Is there a daily maximum of Vicodin you would prescribe for most patients? Why? What are the toxicity risks with this formulation?
He says that he's also having trouble with seasonal allergies and his parents give him Nyquil for those.
3. Describe the reasons why mixing Vicodin with Nyquil is a bad idea.
4. What are the most likely adverse reactions for this patient if he took a short course (a week) of ibuprofen for his pain?
The patient's otherwise healthy father has also developed low back pain during the last week duration except his pain "shoots down [his] leg and into his foot."
5. What is this type of pain called and what is the likely pathological cause?
6. How would you treat this case of acute low back pain? Would you treat the father's pain differently if his pain was accompanied by leg weakness?
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