Wirach Case Study

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SUBJECTIVE INFORMATION: Wirach is a 61 year old male that suffers from migraine headaches that is focused in the occipital area. Today he was seen by myself Kareen Wong (Pharmacy student) and Anna Rogers (Clinical Pharmacist) for a medication review. When asked about his current list of medications, he is currently taking propranolol for heart palpitations, venlafaxine for depression, lorazepam for sleep, ranitidine for heart burn and senokot for constipation. In addition, he is on amlodipine, fosinopril, and hydrochlorothiazide for hypertension, and atorvastatin for dyslipidemia. For the past nine to ten years, he has been taking lorazepam 3 mg PO at bedtime to help with sleep. Currently, his sleep latency is around 1.5 hours, and sleeps…show more content…
Jovey had challenged him to trial Suboxone to see if he was experiencing medication overuse headaches from his Oxyneo. During that time, he would supplement with four tablets of either Tylenol or Advil to help with his headaches on a daily basis. In addition, he has trialed carbamazepine, amitriptyline, topiramate, botox injections, and nasal sprays in the past for migraine prophylaxis. He mentioned he was uncertain the duration of each trial of medications, but he may have been on one medication for two weeks and switched to another one afterwards in a follow up appointment if the medication had shown no efficacy for pain…show more content…
Currently, he is prescribed Percocet with a maximum of eight tablets daily. He takes 1.5 tablets every six hours to help for his migraine headaches. His Percocet would start to decrease his pain after 30-45 minutes of ingestion, and the pain decreases for four hours. He mentioned that his pain never actually goes away. This medication was initiated three weeks ago. In addition, he had also tried marijuana oil, however he experienced side effects including memory loss and loss of recall on topics of conversation. He would supplement with Tylenol #1 for his pain management as he was trialing cannabis oil. When asked about his goals for his current medication management, he had mentioned that he wanted to decrease his medication load, especially opioids, as he knows that it effects his stomach, liver, and kidneys. However, he frequently mentioned to the pain relief he gets from his Percocets and that his opioid is what has helped him function over the past years he has had his migraines. In addition, he had mentioned that he does not use the medication to get high, and that he needed it for pain. In the past, he was told by his own daughter that she saw him as a junkie at one

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