NURS 6630 Week 5 Assignment: De-Prescribing Patient 1: A 36-Year-Old Male on Opioids and Clonazepam Concerns about Remaining on Opioids and Clonazepam

Patient 1: A 36-Year-Old Male on Opioids and Clonazepam

Concerns about Remaining on Opioids and Clonazepam

Some complications connected with the long-term application of opioids and clonazepam are tolerance, dependence, cognitive changes, and overdose. Taking these drugs together only increases the risk of respiratory depression and sedation, which can be fatal. This is because the patient has severe and persistent pain and anxiety, and pain management should not jeopardize their safety.

Patient Education on Risks

The patient’s medical history should be assessed, and the risks of continued use of both medications should be discussed with him. Explaining to him the fact that the use of opioids on a long-term basis creates physical dependence and provides diminished pain control is necessary and that, similarly, long-term use of clonazepam leads to the development of tolerance, dependence, and cognitive impairment (Dowell et al., 2022). Emphasis on the possible interaction between these medications and the risks involved, namely severe sedation and respiratory depression that could lead to a fatal outcome, is also important.

Tapering Clonazepam

The reduction plan is crucial when it comes to tapering off clonazepam in order to avoid unwanted side effects. As suggested by Basit and Kahwaji (2020), the dose should be lowered by 0.25 mg every 2-4 weeks, observing the patient for withdrawal symptoms such as anxiety, insomnia, and irritability. The tapering schedule should be adjusted depending on the patient’s response, particularly if withdrawal symptoms are noted. Along with the tapering plan, other effective approaches, including CBT, could also be employed to address anxiety during the process of the tapering. This can offer help and enhance the particular end result of the patient.

Alternative Medication for Panic Attacks

An SSRI such as sertraline should be prescribed to the patient for panic attacks as this is safer in the long run than benzodiazepines. In contrast to tricyclic antidepressants, SSRIs have no dependence potential or cognitive side effects and can be taken in the long term.

Starting New Medication

Initial side effects can be minimized, and patient compliance can be enhanced by starting at a low dose of 25 mg/day with gradual uptitrations to the effective dose of 50-100 mg/day. These types of patients need periodic follow-up visits to determine the effectiveness and side effects of the treatments.

Legal, Ethical, or Social Consideration

A legal consideration in this context is doing proper consultations and establishing informed consent. The patient needs to comprehend the relative efficacy as well as the potential adverse effects occurring when discontinuing clonazepam and commencing an SSRI. Recording the conversation with the patient and the patient’s consent to the plan of treatment is recommended. Furthermore, the social issue to be concerned with may be the patient’s working capacity and ability to carry out daily activities without the sedation of clonazepam. Such an approach might allow for minimizing adherence-related problems in the transition between treatments and general enhancement of adherence to the new treatment plan.