Diana is a 52-year-old female retired nurse who has been on methadone maintenance for 5 years for prior heroin addiction.

Diana is a 52-year-old female retired nurse who has been on methadone maintenance for 5 years for prior heroin addiction. Her confirmed dose is methadone 80mg po daily. She has herniated discs at L4–L5 and L5–S1. She has failed conservative treatment with physical therapy, chiropractic spinal manipulations, epidural steroid injects, and long-term NSAID use. She presents to the clinic for spinal fusion consultation. However, she is worried about having too much pain and having to take too many pain medications after surgery. What is your plan of care for Diana? Discuss different pain management options, including ways to reduce the risks associated with long-term opioid therapy and opioid use disorder and overdose.

Bridget is 16-year-old female who comes to the clinic for a sports physical with her mom. When her mom leaves the room during the examination, Bridget asks for a prescription for birth control. She requests that you do not tell her mother. Bridget is healthy with no allergies. She is at the 50th percentile for body mass index (BMI). Her blood pressure is 112/68 mm Hg and her examination is normal except for mild acne on her face and upper chest. What is Bridget’s initial treatment plan? What is the legal age in your state when adolescents can self-consent for contraception? What education does she need?

Samuel is an 82-year-old male brought in by his daughter for complaints of low blood sugar. Samuel has a history of type II diabetes well-controlled with glyburide and diet. He was treated last week at an urgent care for a suspected staph infection to his arm with sulfamethoxazole and trimethoprim. He also takes lisinopril, Lipitor, Flomax, Paxil, Coenzyme Q10, and a multivitamin. His daughter also found old prescriptions for alprazolam, atenolol, and terazosin in his medicine cabinet. With what you know about drug-drug interaction in older adults, what could be the cause of his hypoglycemia? What questions do you need to ask the patient and his daughter about safe medication management? What education should be offered to this patient and his family?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

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