Ms. Tate Case Summary

Ms. Tate Case Summary
SUBJECTIVE Ms. Tate is seen in her wheelchair after her shower at Glenbridge Nursing Home on
08/17/2017. Ms. Tate at first is conversational and using complete sentences and then later she
struggles for words and ideas and has some fear that they will not let her visit Nancy, who is her
niece by marriage. On a recent visit when she was so desperately ill I stopped her Cymbalta and her
memantine and cut back on her gabapentin. Soon nurses were telling me that she seemed to be much
more uncomfortable and seems confused and yelling out. Gabapentin was increased back to 200 mg
at bedtime and she has improved significantly. She also seemed to have a respiratory infection and
possibly urinary infection and was treated with IV fluids and IV ceftriaxone. I have not received
directives from the family being a nephew to do otherwise. She recovered significantly with the IV
fluids and further with the antibiotics and now seems back to baseline if not better for the absence of
these medications. She actually said today that she felt well, which was very unusual. She said she
slept well last night and had a good breakfast. All are things that perhaps six weeks ago would have
led to long complaints. There have been small wounds on her ... Show more content on
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I feel no thyroid tissue, there is no JVD. I hear no carotids. She does not mention dental issues today
although two months ago this dental technician had told me of plans to have a crown placed. Lung
fields are clear. There is mild dorsal kyphosis. Heart rhythm is regular. An S4 is not heard. No
ectopy is noted. There are good radial pulses, dorsalis pedis and posterior tibials are palpated but
may be slightly diminished. Postphlebitic changes of skin discolorations and a few small scratches
are noted. There are numerous varicose veins. She is conversational, although there is some
delusional thought it is not as intense as it had been at one
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Case Study: Work-Related Injury
DOI: 2/14/2011. The patient is a 52–year–old female clinical nurse who sustained a work–related
injury to her low back from carrying a baby to the mother.
As per the medical report dated 8/13/15, the patient complained of pain in her back. She has had two
prior surgeries on her back, a laminectomy/discectomy in 1996, and an instrumented fusion, single
level, in 2012. She reports that the surgery helped but she still has ongoing sciatica. Her medications
include Percocet, Ibuprofen, Neurontin, Norco, Gabapentin, Valium and Prednisone. Review of
systems is positive for fatigue, depression and joint swelling. Examination is unchanged.
Based on the progress report dated 08/27/15, the patient has consulted with neurosurgery, and
reports that no surgery was ... Show more content on Helpwriting.net ...
Current medications include gabapentin, ibuprofen, Norco and Lunesta.
She was assessed to have lumbar disc herniation L4–L5, status post microdiscectomy, with
recurrence and left L5 lumbar radiculopathy.
The patient has persistent low back pain complaint managed with narcotic and nonnarcotic
medications. She completed neurosurgical reevaluation and is referred to physical medicine and
rehabilitation (PM&R) specialist.
She was given a refill prescription for Ibuprofen 600 mg 1 tablet 3 times daily as needed, ranitidine
150 mg 1 tablet twice daily, gabapentin 600 mg 2 tablets in the morning and afternoon and 1 tablet
at noon and Norco 10/325 mg 1 tablet twice daily as needed.
Treatment plan includes continuation with "MOM" as needed and referral to pain management, Dr.
Salazar who has recommended neurosurgery consultation prior to her treatment which has been
completed. No further follow–up with neurosurgery is recommended.
Current request is for 60 Tablets of Norco 10/325 mg; 60 Tablets of Ranitidine 150 mg with 5
Refills; 90 Tablets of Ibuprofen 600 mg with 5 Refills; and 150 Tablets of Gabapentin 600 mg with
5 Refills between 9/2/2015 and

Anagesia And Sedation In Infants
Newer pharmacologic agents for analgesia and sedation in neonates: Intravenous paracetamol has
been successful in post–operative and mild to moderate pain management in neonates and infants.
Harma et al evaluated the effectiveness of intravenous paracetamol for mild to moderate pain
control in preterm infants. Intravenous paracetamol, a COX–2 enzyme inhibitor, was administered
in standardized dosages to 108 infants with the first dose given prior to 72 hours of life. Controls did
not receive paracetamol; however, both study groups received morphine for pain control when
deemed necessary. Infants in the paracetamol group received significantly fewer morphine dosages
than the control group (p = 0.044) without any signs of hepatic ... Show more content on
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Although not labeled for use in patients under the age of 18 years, recently it has been introduced
into the NICU setting for procedural use, as well as short–term sedation. There are no structured
reviews on the efficacy and safety profile of dexmedetomidine; however, animal studies have
documented its potential neuroprotective effects and minimal respiratory side effects. A study out of
Berlin examined the neuroprotective features of dexmedetomidine in reducing the detrimental
effects of oxygen toxicity. Following single doses of dexmedetomidine at various concentrations,
six–day old rats in the treatment group were exposed to 80% fiO2 for 24 hrs. Hyperoxia–exposed
rats receiving dexmedetomidine pretreatment with a 10 mcg/kg dose one time were found to have
significantly reduced hyperoxia–induced neurodegeneration in various brain regions (p<0.001).
Hyperoxia–exposed rates receiving dexmedetomidine pretreatment in single dosages of 5 mcg/kg
and 10 mcg/kg had significantly decreased expression of IL–1beta protein expression than controls
exposed to hyperoxia without pretreatment (p<0.01 and p<0.001, respectfully). Although these
neuroprotective findings were found in hyperoxia–exposed rats, it was noted that the normoxia–
exposed control group had significantly increased percentage of cells stained positive for DNA
strand breakage when pretreated with one dose 10 mcg/kg dexmedetomidine (p<0.001), raising
concerns for varying safety profiles in different

Essay On Post Operative Risk Management
What pre/peri/post–operative risk management strategies will you utilize with this patient and why?
Female patients diagnosed with anxiety, depression and past chronic pain are at increased risk of
developing chronic post–surgical pain (1). Studies have shown high preoperative anxiety and female
gender are the two major risk factors of developing acute postoperative and post chronic surgical
pain (1). Several strategies can be used to reduce the patient's anxiety and the incidence of
developing acute post–operative chronic pain. At the consultation appointment, the clinician should
address patient's attitudes and concerns, educate the patient on the dental procedure, and identify the
procedures that are likely to cause severe pain (1).
Studies show chronic post–surgical pain is associated with poor surgical technique, increased time
of surgery, and operations with high risk of nerve injury (1). One may consider the use of cone beam
topography to map the inferior alveolar nerve and its proximity to the tooth in question. This patient
should also be treated by an oral surgeon as they are highly trained and efficient in exodontia. The
surgeon should use conservative surgical approach with acceptable exposure, and multimodal
pharmacological analgesic in addition to local anesthesia (1). Also, due to her history of TMJ ...
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NSAIDS inhibits COX–1 and COX–2 which damages the gastrointestinal tract. However, NSAIDs
with selective COX–2 inhibition was much safer for patients with ulcerative colitis as these drugs
presented much lower risk of UC relapse. Studies showed COX–2 selective NSAIDs, Celecoxib and
Etoricoxib, were not associated with relapse of this disease compared to placebo (2). Patients with
diagnosis of UC may also use acetaminophen and aspirin for pain control as no association was
found between the two medications and incidence of ulcerative colitis

How Tinnitus Is Defined As A Symptom A Perception Of Sound
Tinnitus is defined as a symptom a perception of sound which is not relative to any external stimulus
where an individual perceives ringing, bussing and other sounds in varying durations of episodes
which can be continuous, intermittent or pulsatile in a range of frequency and intensities which are
often unable to be masked by external sounds. Tinnitus affects approximately 5–15% of the western
adult population with 1–2% of the population to a debilitating degree (Schlee et al,. 2011).
Tinnitus can be separated into two categories, subjective tinnitus shows no objective sound and is
only heard by the patient, Objective tinnitus is the less common type which can often be heard by an
observer by stethoscope as it is caused by conductions such as turbulence and pulsation of muscle
spasms in body tissues such as middle ear, Eustachian tube or soft palate. Currently, there is no FDA
or EMA approved drugs on the market for this specific purpose. (Langguth and Elgoyhen, 2012)
Many studies have been carried out to find a successful pharmacological treatment for tinnitus but
had critical flaws in their design and methods; Some fail to adopt the correct analytical method to
measure their outcomes which affect their external validity, four studies have been chosen each
addressing different treatments using single or combination of drugs for analysis in their
methodology and experimental design .
A randomized double blind study by (Ciodaro et al,. 2014) has been chosen to illustrate

Arthroplasty Essay
Background: Total knee arthroplasty is associated with moderate to severe postoperative pain and
effective analgesia is essential for postoperative recovery and rehabilitation. The challenge of
analgesic regimes is to obtain adequate pain relief and maximum muscle control to enable the
patient to mobilize and rehabilitate early without troublesome side effects. Local Infiltration
Analgesia (LIA) is widely thought to be effective and is frequently applied as part of a multimodal
pain strategy due to its simplicity and apparent safety in multiple types of surgery. However, the
optimal dose, technique and best composition in perioperative consummated pain medication are not
known.
Objectives: The goal of this prospective randomized clinical trial ... Show more content on
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Results: The four groups were comparable for patient characteristics, preoperative NRS pain scores
and operating time. The mean LOS for the entire cohort was 2.3 nights (1–6), adequate pain relief
was achieved in all patients before discharge. GEE analysis revealed a significant difference
between group A and B (p = 0.021) with group B experiencing higher pain scores post–operatively
than group A. No differences between group A and C (p=0.451) and group A and D were found
(p=0.059). Secondly there was a significant difference between group A and B using rescue
medication found with GEE (p = 0.003) with group B using more medication. No differences
regarding LOS, adverse effects, wound leakage, operating time and destination of discharge were
found between the four groups.
Conclusions: The results of this study show that local infiltration with 300mg (150ml) ropivacaine
might be more effective for pain management than 150mg (75ml) ropivacaine. Furthermore,
alteration in the dose of gabapentin appears not to have influence on the course of pain after TKA.
The percentage of adverse effects seems comparable for all

Gabapentin Versus Lorazepam: Which Drug Is More Effective...
Alcoholism is a long standing health issue, and there has been ongoing research to seek out drugs
that could effectively help to treat alcoholism, acute and long–term. According to an article by
Johnson, Swift, Addolorato, Ciraulo, and Myrick (2005), a challenge has been to identify
medications that not only reduce the rewarding effects of alcohol, but the dependence, post cessation
craving, and the withdrawal craving.
Lorazepam and gabapentin have been used for the detoxification of alcohol dependent patients.
Lorazepam is a type of benzodiazepine, an antianxiety medication. Gabapentin is a type of
anticonvulsant drug originally used to prevent seizures. "Benzodiazepines represent the standard of
care for the treatment of alcohol ... Show more content on Helpwriting.net ...
Research was done to compare gabapentin to lorazepam in the treatment of alcohol withdrawal.
Myrick, Malcolm, Randall, Boyle, Anton, Becker, and Randall (2009) performed a randomized
double–blind treatment on 100 individuals seeking outpatient treatment of alcohol withdrawal with
Clinical Institute Withdrawal Assessment for Alcohol–Revised(CIWA–Ar) ratings ≥10. Subjects
were either given 2 doses of gabapentin, 900 mg tapering to 600 mg or 1200 mg tapering to 800 mg;
or given lorazepam, 6 mg tapering to 4 mg for 4 days. Severity of withdrawal from alcohol was
measured by the CIWA–Ar on days 1–4 of treatment and days 5, 7, and 12 post treatment. Verbal
reports and breath alcohol levels were measurements of alcohol use. Results showed that CIWA–Ar
scores reduced in all groups overtime. High–dose gabapentin statistically did the best but was
clinically similar to lorazepam. Lorazepam patients had higher probabilities of drinking on day 2
(the first day the dosage decreased), as well as the second day off the medication. Gabapentin
treated groups were less likely to have craving, anxiety and sedation compared to the lorazepam
treated groups. Overall, the gabapentin treated group had a less probability of drinking and was well
tolerated. Some limitations to the study were that the participants selected had mild to moderate
withdrawal severity and were in better general health than patients presenting the ED or hospitals.
Also, no placebo group was

Symptoms And Treatment Of Migraine
Pharmacological Treatment of Migraine
Chronic migraine is a significant disorder as approximately 2 percent of the world's population
suffers from it. "In 2010 the World Health Organization ranked migraine as the 19th leading cause
of medical–related disability in high–income countries." (Young, 2014) Preventive treatments are
often given to patients with frequent migraine, which is considered to be more than four headache
days per month. Many migraine patients are prescribed medicines as a preventive treatment and a
majority of drugs used as migraine preventatives are actually medications developed to treat other
disorders such as certain antihypertensives, antidepressants, seizure medications, and even Botox.
(Young, 2014) My client, AB, has chronic migraine and also takes daily medications for migraine
that are often used to treat other disorders.
Patient Demographics and History
Upon interviewing, my client AB disclosed that she has chronic migraine headaches. My client is a
38 year old single white female, classified as middle class, who is a master–level student. AB has
full–time employment in an office and customer service setting. She stated that she has experienced
migraines since she was an adolescent. AB is taking three different medications including:
gabapentin, 300 mg via capsules am/pm four times a day, Citalopram, 40mg tablets once by mouth
each morning, and Tramadol 50 mg 1–2 pills every 4–6 hours for acute pain.
According to AB's history, she states she

The Sexual Dysfunction Problem for Men
Premature ejaculation (PE) is a frequent and under–treated problem for males and their sexual
partners. PE is the most common sexual dysfunction problem for men, with an estimated 14–30% of
males ages 18 years and older reporting PE globally. However, the prevalence of PE is difficult to
determine because of the ambiguity surrounding the definition of clinically relevant PE as well as
the reluctance of sufferers to report their condition . Yet, most previously published clinical trials use
the DSM–IV–TR definition of PE, defined as : A. Persistent or recurrent pattern of ejaculation
occurring during partnered sexual activity within approximately 1 minute following vaginal
penetration and before the individual wishes it (Note: Although the diagnosis of PE may apply to
individuals engaged in non–vaginal sexual activities, specific duration criteria have not been
established for these activities) B. The symptom in Criterion A must have been present for at least 6
months and must be experienced on almost all or (approximately 75%–100%) all occasions of
sexual activity (in identified situational contexts or, if generalized, in all contexts) C. The symptom
in Criteria A causes clinically significant distress in the individual. D. The sexual dysfunction is not
better explained by a nonsexual mental disorder or as a consequence of severe relationship distress
or other significant stressors and is not attributable to the effects of a substance/medication or
another medical

Gabapentin Essay
Gabapentin Toxicity Gabapentin is an analogue of GABA that is rapidly absorbed and penetrate the
blood–brain barrier (1). It was initially developed to act on the postsynaptic GABA receptors in the
central nervous system (2). It is an antiepileptic medication used increasingly to treat neuropathies
as it is highly lipid and water soluble. Gabapentin has a half–life of 5 to 7 hours in healthy persons
and its excreted by solely the kidneys (3). It could be used in different dosage forms e.g. oral, IV and
topical formulations. Nowadays, compounded dosage forms of gabapentin are commonly used
topically for pain management as topical 5% gabapentin reduction in nociception was similar to SQ
gabapentin (100 mg/kg) according to Bryson et al (4). The most common adverse events reported
were mainly CNS–related and that included somnolence (24.4%), dizziness (20.3%) and ... Show
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Despite gabapentin overwhelming use, multiple case reports of gabapentin overdose have
consistently claimed gabapentin lack of serious toxicity after oral ingestion of 860–1022 mg/kg (2,
6,7). In addition, a case series of 20 patients who had ingested different doses of gabapentin in a
range between 50 mg to 35 g developed no or minimal toxicity (8). However, severe dizziness,
lethargy, and altered mental status were reported after single recommended dose of 300 mg in a 57–
year–old woman with ESRD. Her symptoms resolved dramatically after a single session of
hemodialysis (9). In another case report, a 46–year–old woman with ESRD was intubated after
taking multiple gabapentin doses without intervening with hemodialysis. Therefore, she had a single
hemodialysis session which led to rapid clinical improvement (10). A case of 31–year–old epileptic
man developed coma and shock secondary to valproic acid and

Pain Informative Speech
Hello Mr. Lopez, your doctor has prescribed you Oxycodone 5–325 and Gabapentin for neuropathy
pain. The order states to take Gabapentin with pain; however, if the pain is severe take the
Oxycodone 5–325.With the pain medications, it can cause adverse reactions such as cognitive
changes. With these medications you may have vision, memory, mood or hearing changes. These
effects can lead to falls (Tabloski, p.133, 2014). Therefore, it is important to take these medications
while you are sitting down. Also, with these medications do not do strenuous activities, drive or try
to climb any steps.This will help prevent falls, if you are aware of the adverse effects. With these
medications you will have pharmacokinetic changes. Pharmacokinetic changes

Informatic Cancer Case Write Up
DOI: 9/18/2000. Patient is a 59–year–old female technician who sustained a work–related injury due
to being jostled and jolted in the back of a golf cart which ran over a pothole. As per OMNI, she was
diagnosed with post cervical protrusions, facet syndromes with headaches, lumbar facet syndrome
and status post right shoulder repair/resection.
Urine drug screen obtained on 05/02/16 showed positive for hydrocodone, norhydrocodone,
Zolpidem, gabapentin, meprobamate and caffeine.
Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with
medications and 10/10 without medications. Current medications include Ambien 10mg; Maxalt–
MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg. ... Show
Quality of sleep is fair. Activity level has remained the same.
On examination of the cervical spine, there is tenderness and tight muscle band is noted on both the
sides of the paravertebral muscles. There is pain with extension and palpation of right facets.
Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90
degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin's test, Neer's test,
Shoulder crossover test, Empty Cans test, Lift–off test, and Apprehension test is positive. On
palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Essay on bipolar disorder
Bipolar Disorder also known as Manic Depressive Illness involves outstanding mood swings. The
individual has periods of depression, and periods when they feel either unusually good or pressured
and irritable. It affects 1–2% of the population. Genetics plays a significant role. About 15% of
children with one bipolar parent develop the disorder.
Treatments include medication, supportive psychotherapy and occasionally ECT. Medications
include lithium, anticonvulsant drugs (carbamazepine (Tegretol), valproate (Depakote), gabapentin
(Neurontin) and lamotrigine Lamictal), antidepressants (such as bupropion (Wellbutrin)or sertraline
(Zoloft)), neuroleptics (e.g. haloperidol) and benzodiazepines (e.g. lorazepam) Treatment choices
depend on the ... Show more content on Helpwriting.net ...
It is most often used when medication doesn't work or is unsafe.
Lithium is a top choice for acute mania and for maintenance in 'classic' bipolar disorder. Because of
its narrow therapeutic range, blood levels must be monitored; also heart and kidney function (EKG,
blood and urine tests). Medications such as diuretics, that block its excretion require caution.
Anticonvulsants have an edge with rapid–cycling and mixed mood states (e.g. depression with
racing thoughts). Except for gabapentin (Neurontin) and lamotrigine (Lamictal), they require blood
tests. Carbamazepine (Tegretol) is monitored with blood levels; also CBC, platelets and liver
function tests. Valproate (Depakote) requires CBC, platelet count and liver function tests; blood
levels may be helpful. Lamotrigine (Lamictal) requires caution because of its association with a rare
but dangerous skin rash (exfoliative dermatitis); risk can be minimized by starting with low doses
and increasing gradually. Use lower doses with medications that slow lamotrigine metabolism (e.g.
valproate). Gabapentin is generally safe and does not require blood tests.
It is not unusual for patients to need more than one mood stabilizing medication for best results.
Because bipolar disorders are generally recurrent, maintenance treatment is usually needed. This is
especially true when there have been multiple episodes, a clear family history of bipolar disorder or
symptom onset before age 18. Effective maintenance

Tylenol's Case Summary
DOI: 1/4/1999. The patient is a 66–year–old male delivery person who reports bilateral wrist and
pain, right greater than left, from continuous twisting of nozzles. As per OMNI, the patient was
initially diagnosed with lumbar spinal stenosis, bilateral carpal tunnel syndrome, upper extremity
tendinitis, depression, gastritis and sleep disorder. Per progress notes dated 11/23/15, the patient
presents for follow–up of his chronic pain. He was started on Gabapentin at his last visit, and he
states that with the 300 mg dosage, he began to see some improvement. He continues to 3–4 tablets
of Tylenol#4 dosage and frequency. Based on the progress report dated 02/ 24/16, the patient
presents for follow–up of his chronic forearm pain. He had been

Gabapentin Case Study
Achieve satisfactory benefit in epilepsy through Gabapentin
How to Buy Gabapentin Pills Online, Buy Neurontin (Gabapentin) online, for antiepileptic
treatment purchase Gabapentin Online, Buy Gabapentin Online without prescription, get Gabapentin
coupon code
Gabapentin became a routine drug therapy for me because of manic disorder. I had panic attacks too.
When I consulted the doctor, he made the necessary investigations and explained me that the best
way to stay mentally calm and healthy is to take Gabapentin. I started taking 2700 mg per day in
three divided doses. It helped me in getting rid of the panic attacks. I could even sleep properly
because of this medicine. Gabapentin is responsible for increasing the gamma amino butyric acid
levels in the brain indirectly. It does not bind to plasma proteins and therefore remains unchanged. It
does not undergo any metabolism and is removed as it is, from the body in the form of urine. You
can take this medicine with or without food as food does not affect its absorption. Gabapentin is
available for purchase from online pharmacy stores for antiepileptic treatment. It is legal to buy
Gabapentin online even without prescription.
The indications of Gabapentin are as follows.
1. Hypnotic agent because of its sedative properties
2. Used in panic ... Show more content on Helpwriting.net ...
It has no noteworthy hepatic cytochrome P450 or pharmacodynamic interactions. Antacids that
contain Aluminium Hydroxide and Magnesium Hydroxide decrease the absorption of Gabapentin by
20 percent if they are taken simultaneously. If they are taken two hours before taking Gabapentin,
there is no effect on its absorption. Gabapentin can cause false positive result with the Ames N–
Multistix SG dipstick test that is done to check proteins in urine. When the patient is undergoing
renal dialysis or has kidney disorders, the drug should be used

Cancer Case Studies
DOI: 10/14/2009. Patient is a 44–year–old female hospital medical records clerk who sustained a
work–related injury after tripping over garbage can and fell on her right knee on 02/07/2010.
Per office visit notes dated 12/10/2015, the patient's current medications are Cymbalta 60 mg,
Ultram ER 200 mg, Doxepin 3.3% cream, Gabapentin 600 mg, Ketamine HCL 5% cream, and
phendimetrazine 35 mg.
Based on the visit note dated 01/08/16, the patient presents for a follow up visit. She is status post
right L4–5 and L5–S1 radiofrequency ablation performed on 9/30/15 with 10–12% relief. She notes
her pain is back to baseline.
She reports that she continues to have pain and swelling in her right knee but is also now getting
swelling in the left side. ... Show more content on Helpwriting.net ...
Diagnoses are lumbosacral region intervertebral disc displacement, intervertebral disc displacement,
lumbosacral radiculopathy and sacroiliitis.
The IW notes that her current dosages are not working. She does find Cymbalta beneficial with her
anxiety and depression but not much improvement with gabapentin and Ultram ER. She has trialed
several other opiates in the past at much higher dosages and she would like to trial them again for
pain control.
MD will not continue to escalate her pain medications. IW was advised going on a drug holiday but
she defers it for now. She states that Ultram ER is helping her some and would like to continue it at
this time. Ultram will be gradually increased from 50mg 1 tablet twice daily to 200mg 1 tablet daily.
MD will no longer continue escalate dosages.
She was given a prescription for Cymbalta for pain, anxiety and chronic musculoskleteal pain and
Ultram for around the clock pain relief. Neurontin was dispensed.
She will follow up in 4–5

Ebola Cellular Entry Summary
In the fall of 2014, an outbreak of Ebola virus in West Africa spread to the United States. Panic
overtook regions of the country and led to the search for uncovering the molecular biology of the
disease and for finding a suitable treatment against the virus. Yasuteru Sakurai and colleagues
discussed Ebola's dependence on host calcium signaling proteins in their scientific journal article,
"Two–pore channels control Ebola virus host cell entry and are drug targets for disease treatment".
In the article, the authors hypothesized that two–pore channels are good drug targets against Ebola
because they help regulate entry into the host cell. They examined the mechanism of the calcium
signals, the calcium channels activated by that mechanism, the effect of inhibiting those channels,
and a drug that could potentially be an effective therapy. ... Show more content on Helpwriting.net
...
While investigating potential calcium channels responsible for entry, Sakurai and colleagues
questioned if blocking L–type channels inhibited infection. After discovering that gabapentin, an
inhibitor of a fifth class of L–type channels, had no effect on infectivity, they studied NAADP, an
intracellular mobilizing agent that stimulates calcium channels to release calcium from endosomes.
Unlike gabapentin, other inhibitors in the study decreased infectivity and blocked NAADP–
stimulated calcium release. The effect of these other inhibitors, like tetrandrine, on infection and
NAADP activity, the inhibition of NAADP by Ned19, and the subsequent blocking of viral infection
due to Ned19 supported the role of NAADP in Ebola

Symptoms And Treatment Of Chronic Pain
This is a 61–year–old male with a 7/20/2011 date of injury, who fell at work and sustained injury to
his left shoulder, left knee, cervical spine and lumbar spine.
Diagnoses include chronic intractable low back and neck pain secondary to lumbosacral
degenerative disc disease. Left shoulder pain s/p arthroscopy, chronic left knee pain, chronic pain
syndrome, severe neuropathic pain, depression, history of drug abuse, and chronic daily headaches.
12/14/15 Progress Report described a follow–up visit. The patient reported worsening left knee pain
X 3weeks after doing housework on his knees. He heard a pop upon standing. Since then, he is
having pain with weight bearing and feeling of instability/buckling. The patient has persistent back
pain ... Show more content on Helpwriting.net ...
The patient denies aberrant behaviors. Objective Findings: He has difficulty getting up from seated
to standing position. He has an antalgic gait and uses a cane. There was pain with palpation of
medial knee and with varus stress to medial knee. Motor strength was 5/5. Cervical and lumbar
ROM is limited. Sensations are intact. Treatment plan included SCS and medications. The goal is to
decrease the use of narcotics and medications in general. Follow–up is in one month. UDS and
CURES reports were reviewed.
09/21/15 Progress Report indicated that the patient is maintaining usual medications for chronic
pain syndrome. He is awaiting evaluation with the spine surgeon for SCS placement and/or
injections under fluoroscopy. He had this done a couple of years ago. Current medications: Norco,
Butrans, Gabapentin, and Cymbalta. The medications help control his pain. 1. Butrans Patch 20mcg
1 patch q 5 days #5, and 2. Norco 5/325mg 1 tab 4 x daily #120,
08/27/15 UDS Report showed that the patient has been consistent with Butrans and Norco.
06/30/15 Progress Report noted that the patient stated that Butrans in only authorized for 20 days.
Since, he is running out of his Butrans patch, it is affecting his ability to do his ADLs and aid in
ambulation. He reported that he has been using his Butrans patch for 10 days now, instead of 5 days.
This is a change of circumference. The patient is feeling miserable. The pain was 7–8/10–scale level
and he has not been

Inguinal Herni A Case Study
DOI: 10/8/2015. The patient is a 32–year–old male field technician who sustained a work–related
injury to her stomach, groin and right leg from tripping and falling on wooden gate. As per OMNI
notes, the patient is diagnosed with unilateral inguinal hernia. He had surgery for right inguinal
hernia repair on 12/8/15.
Per medical report dated 8/19/16, the patent presents for new patient evaluation for groin pain. The
patient states that right after his surgery in 12/2015, he started with right groin pain, initially only
with movement or sex and later spontaneously. The patient states that his pain is every day,
intermittent, worse with movement, sex, bowel movement, and flexion of the right hip. It is mildly
relieved with ice pack and tramadol. He was initially on gabapentin which was helping but the
patient discontinued it due to a lot of headaches. The patient was also seen by pain/anesthesiologist
for compression neuropathy and underwent a right ilioinguinal and iliohypogastric nerve blocks as
well as right genitofemoral nerve blocks on 7/20/16. ... Show more content on Helpwriting.net ...
He says that pain is currently persistent and he is unable to perform his activities for the job since it
entails a lot of heavy lifting. The patient notes allergies for Reglan; ondasetron; and Compazine.
Physical examination notes that the patient abdomen is soft, nontender, non–distended, tender to
palpation in bilateral groin area, which is more in the right. Assessment and plan notes that the
patient has tissue pain rather than neurologic issues. The provider notes that it could be related to the
plug. An addendum was also noted that the exam findings and dermatomal mapping is consistent
with mesh issue. The provider recommends that open operation, plug removal and neurectomy is

Upper Back Pain Case Study
DOI: 8/12/2010. Patient is a 64–year–old male shredder maintenance who sustained injury to his
cervical and thoracic spine when he lost control of an air gun and fell about 6 feet from the top of
the machine hood.
Based on the progress report dated 11/18/16, the patient presents with chronic neck and upper back
pain. Patient reports persistent neck pain and stiffness.
His pain is made worse with standing or walking for longer than 15 minutes. His pain is made better
with resting and medication. He received authorization to fill his Ultram prescription obtained at his
previous visit. He reports that use of the medication helps to reduce his pain by 30%, which
improves his ability to move around. He reports decreased pain and improved function with use of
the medication. He is utilizing for Prilosec for gastrointestinal protection, with good benefit. He
reports ... Show more content on Helpwriting.net ...
Current medications include tramadol–acetaminophen 37.5–325 mg 1 tablet twice daily, Prilosec Dr
20 mg 1 capsule daily, simvastatin 20 mg once daily and terazosin 1 mg capsule at bedtime.
Diagnoses include other spondylosis of the cervical region, other intervertebral disc displacement of
the lumbar region, chronic pain syndrome and other spondylosis, thoracic region.
He was given a prescription for gabapentin 300mg 1 capsule at bedtime #30 to help with nerve pain
and difficulty sleeping, tramadol–acetaminophen 37.5–325 mg 1 tablet twice daily # 60.00 and
Prilosec Dr 20 Mg 1 capsule daily #30.
Preliminary urine testing on 09/20/16 was negative for all substances, as he was not able to obtain
his medication at that time. A DEA CURES report on 9/20/16 was consistent. He has a signed pain
medication contract in his chart. He does not demonstrate any aberrant behavior
Current request is for 30 Capsules of Gabapentin 300 mg; 30 Capsules of Prilosec 20 mg; and 60
Tablets of Tramadol/Acetaminophen 37.5/325 mg between 11/28/2016 and

A Patient's Case Summary
DOI: 5/28/2014. The patient is a 47–year–old male applicator/driver who sustained a work–related
injury while we was walking on grower's road and fell. As per progress report on 9/17/15, the
patient's current medications include Omeprazole, Naproxen and Gabapentin which decreases his
pain about 60% and helps to control the pain and numbness in his left leg. Based on the progress
report dated 02/18/16, the patient reports that since his last visit, his lower back symptoms are
persistent and unchanged. He rates his low back pain at 5/10 on the pain scale. His pain can increase
up to a 6–7/10. He says he experiences cramps throughout his whole body when he sneezes. He
denies radiation of pain, numbness, or tingling to the bilateral lower extremities except for
numbness in the left great toe. His pain is exacerbated by bending and prolonged walking. ... Show
He says he experiences radiating numbness to his bilateral index fingers. He rates this pain at 9/10
on the pain scale. He says he continues to walk for exercise at home. He says he walks for
approximately 45 minutes three times a week. He gets 4–6 hours of interrupted sleeps a night due to
his pain. He says that he continues working with modified duty. Treatment history includes 24 PT
visits, lumbar epidural injection in 10/2014 which helped by 50% and on 01/23/15 with 50% relief
and 8 visits of chiropractic treatment. The following medicatiosn were discontinued: Advil and
Tylenol with insufficient relief; –Relafen and Flexeril, which helped somewhat decrease his
pain;and

Pregabalin Essay
The gabapentinoids, gabapentin and pregabalin are increasingly prescribed for a variety of
conditions by medical practitioners from family physicians, neurologists, rheumatologists,
orthopaedic surgeons, and others. The indications may vary according to the countries these
medications are marketed in. Some of the indications include neuropathic pain, fibromyalgia,
generalised anxiety disorder, epilepsy and so on.1 Gabapentinoids are analogues of gamma–
aminobutyric acid (GABA). They bind to the α2δ subunit of the calcium channels on neurons. Both
of them have a relatively benign side effect profile, lack significant drug interactions, are not liver
metabolized, and are renally excreted. Pregabalin has quicker absorption and higher absolute
bioavailability compared to gabapentin.1 Despite their good safety profile, it is important to
appreciate that the gabapentinoids have potential for abuse. Pregabalin is classified under Schedule
V of the Controlled Substance Act in the United States, which is an indication of its potential for
abuse. Gabapentinoids are not considered as controlled drugs in Singapore. ... Show more content
on Helpwriting.net ...
63.1% of misuers obtain their medications from health services and 57.8% from family or
acquaintances.4 Studies in Germany and Ireland showed that urine samples of patients with opiate
addiction were positive for pregabalin in 12.1% and 7% respectively. None of these patients had a
medical indication of pregabalin.5,6 In a questionnaire–based survey amongst substance abusers,
22% of participants indicated that they had abused gabapentinoids. 38% of the gabapentinoids
abusers did so to enhance the "high" from

Postoperative Pain Essay
Postoperative pain prevention and treatment continues to be a major challenge in postoperative care
and plays an important role in getting the patient to move and feel better. Although opioid drugs are
commonly used in postoperative pain management, they are accompanied by side effects such as
nausea, vomiting, drowsiness, itching and urinary retention, leading to restriction of their use. (1)
Other methods such as epidural analgesia are effective, but require extra work and are associated
with serious complications. NSAIDs are also used for postoperative analgesia, but may be
accompanied by damage to the gastrointestinal mucosa, bleeding, renal toxicity, allergic reactions
and heart failure. Selective cyclooxygenase–2 NSAIDs have pro–thrombotic properties, and an
increased ... Show more content on Helpwriting.net ...
(3) Some of these drugs are gabapentin and pregabalin, which are anti–seizure, anti–hyperalgesic
and anti–anxiety drugs. Both bond to α2–δ–1 subunit of voltage–dependent calcium channels, which
are widely found in the central nervous system. Pregabalin is structurally similar to gabapentin and
produces a greater analgesic effect than gabapentin in the case of neuropathic pain, diabetic
peripheral neuropathy (4) and postherpetic neuralgia (5) in animal models. Due to higher
bioavailability (90% vs. 33%–66%), more rapid absorption, and a linear increase in blood
concentration with increase in dose, pregabalin is preferred over gabapentin. Gabapentin and
recently pregabalin have been used in many studies to control postoperative pain. (6) However, the
effects of these drugs on pain control are compared in limited studies. In this study, the effect of
pregabalin and gabapentin on postoperative pain in patients undergoing laparoscopic
cholecystectomy have been evaluated and compared with the
placebo

Case Conceptualization Paper
Mr. Gillespie is a 21 year old male who presented to the ED after an intentional overdose on 20
600mg of Gabapentin. Per documentation from ED staff Mr. Gillespie reported he became angry at
his grandmother tonight and tried to "prove a point." Mr. Gillespe reported to staff threatened to
overdose on his on pills, however dumped them in the toilet. He expressed after making threats to
overdose on his prescribed Celexa did not phase his grandmother, he proceeded to take her
Gabapentin. Per documentation Mr. Gillespe has been living with grandmother for 2 weeks and
before that was living with his mother in Cary. At the time of the assessment Mr. Gillespie was calm
and cooperative. He denies current suicidal ideation, homicidal ideation, and symptoms of
psychosis. He appears guarded during the assessment. He reports tonight his grandmother and he got
into an argument over him getting a job. He reports his grandmother informed him he has to be out
by Friday. Mr. Gillespe denies history of self harm. He ... Show more content on Helpwriting.net ...
Gillespie grandmother, (Carol), was contacted. She reports her grandson has anger issues. She
reports 2 months ago he went to a mental health facility in Cary for frequent reports of suicidal
ideation. Carol states, "All I said tonight, I talked to one of the guys at the store about hiring him and
he got smart with me." Carol reports after he threaten to take his pills, he took mine and walked
away with them. She also states, "He told me, I'm going to kill myself, just like your father did."
Carol reports she informed her grandson he need to get a job by Friday or he would have to leave
because she could not afford to continue to take care of him. She reports yesterday finding him
attempting to take some of her Gabapentin. Mr. Gillespe reports taking 10 600mg of Gabapentin
before to get high. He states, "I have taken 10 600mg of Gabapentin to get high and it did not touch
me, so I was confident 20 wouldn't do much." He admits to taking his grandmother

Muscle Guarding Case
DOI: 03/08/2011. Patient is a 48–year–old male route sales representative who sustained an alleged
work–related injury to his back, neck, lower extremity and abdomen which affected his psychiatric
state while performing his duty. Per progress report dated 03/04/16, the patient complains of pain of
pain in the neck and lower back. Current medication is for Norco and Gabapentin. Based on the
medical report dated 04/01/16, the patient complains of pain in the neck with radiation to bilateral
upper extremities and pain to the lower back with radiation to the lower extremities with
tingling/numbness and weakness. He rates his pain 8–9/10. He describes the pain as burning, sharp–
shooting, numbness, stabbing, deep–pressure, tightness and spasms. ... Show more content on
Helpwriting.net ...
He was given a refill prescription for gabapentin 600 mg, 1 tablet orally, 3 times a day for 30 days, #
120 and hydrocodone/APAP tablet, 10/325 mg 1 tablet 4 times a day for 30 days #120. The patient
continues on stable doses of medications in a responsible and compliant fashion. The IW was
encouraged to stay active and engage in a regimental home exercise program. Treatment plan
includes acupuncture, UDS to ensure compliance with Norco, surgical consultation, and follow–up
in 4

Dr. Fieser's Case Summary
DOI: 09/17/2012. This is a 32–year–old male truck loader who fractured his lower left leg when he
fell off a truck as it pulled away. Patient is diagnosed with closed left tibia and fibula fracture. He is
status post open treatment of left tibia fracture with intramedullary nailing on 09/24/2012.
Based on the progress report dated 04/05/16 by Dr. Fieser, the patient complains of pain in the left
knee, left ankle and left foot, associated with numbness and tingling in the left leg/foot, as well as
weakness in the left leg. He describes the pain as sharp, cutting, throbbing, dull, aching, pressure–
like, cramping, shooting and shocking with muscle pain and pins–and–needles sensation.
Patient rates his pain with medications as 2.5/10 and without

Wound Case Studies
DOI: 1/14/2016. Patient is a 47 year old male senior information technology field services who
sustained injury when his vehicle went off road. He had a transmetatarsal amputation of left foot
with failed flap, status post further surgical excision debridement twice a week removing necrotic
tissue.
Based on the progress report dated 08/26/16 by Dr. Boparai, the patient presents for left foot pain,
rated as 2.5/10 with medications and 10/10 without medications. Quality of sleep is good. Activity
level has remained the same. Patient is going to hyperbaric oxygen treatment daily and wound care
clinic weekly for left foot amputation due to frost bite/gangrene.
Patient reports improved pain.
Patient has an appointment for surgical debridement on 09/03/16. ... Show more content on
Helpwriting.net ...
There is no edema present or no change in skin color or temperature when compared to the right
foot, except for the area of the open wound.
The patient is assisted by a left knee scooter.
Current medications include OxyContin 20 mg 1 tablet every 12 hours, Aspirin 325 mg, clopidogrel
75 mg, gabapentin 600 mg, lisinopril 10 mg and Percocet 7.5/325 mg 1tablet every 4 hours.
IW was diagnosed with pain in the left ankle and joints of left foot.
He was advised to continue with OxyContin 20mg every 12 hours #120, Percocet 10/25mg #180 as
patient is having surgery on 09/03 for left foot debridement, and gabapentin 600mg three times daily
for neuropathic pain.
There is no need for a sympathetic ganglion block as there is no evidence of complex regional pain
syndrome.
Of note, CURES report reviewed 8/26/16 showed no aberrant behavior noted.
Urine drug screen performed on 8/17/16 revealed positive for ethanol (ETOH) and Percocet. IW was
informed that he is to refrain from ETOH otherwise, his pain medications will be tapered as adverse
effects including death may

The Chemical Structure Of Pregabalin
Introduction Pregabalin, trade name Lyrica, approved for its anticonvulsant properties and to relieve
pain in those who suffer from diabetic neuropathy. The chemical structure of pregabalin is
structurally analogous to γ–aminobutyric acid (GABA), an inhibitory neurotransmitter found in the
central nervous system and functions by binding to α2δ voltage–gated calcium ion channel in
presynaptic, inhibiting the release of neurotransmitters, most notably GABA. By decreasing the
amount of the inhibitory neurotransmitter GABA in synaptic terminals, epileptic seizures can be
controlled and prevented.1
Each drug displays its own properties when introduced to the body and all traits must be evaluated
to observe effectiveness and side effects that may occur. Pregabalin, although structurally and
functionally similar to gabapentin (trade name Neurontin), has been shown to be more potent and
exhibits linear kinetic properties, unlike gabapentin. Some factors that contribute to its success are
that it has a bioavailability of 90%, 98% is excreted in urine unchanged, thus no or few side
reactions occur, and it is able to pass through the blood–brain barrier. Beneficial effects of taking
pregabalin can be observed in as little as 2 days of administration, unlike most other central nervous
system drugs, which typically take effect.1
Pregabalin is prescribed to treat conditions such as epilepsy and diabetic neuropathy. In addition,
pregabalin has been approved for the treatment of

Thorexic Osteopathy Case Studies
258986 Hugh Harrell DOI: 11/01/2007. This is a 45–year–old male network administrator who
sustained an injury to his back and shoulder while moving servers in the data room. The patient was
subsequently diagnosed with other intervertebral disc displacement, lumbar region; other cervical
disc displacement, mid–cervical region, and postlaminectomy syndrome, not elsewhere classified.
MRI of lumbar spine dated 5/3/10 (no official report) revealed mild lower lumbar spondylosis;
moderate bilateral facet arthropathy at L5–S1 mildly narrows the bilateral neural foramina at this
level; and mild congenital spinal canal stenosis from L2–L3 to L4–L5. MRI of cervical spine
without contrast dated 12/6/13 (no official report) revealed status post anterior fusion from C5
through C7; C4–C5, disc osteophyte complex with central disc protrusion which extends 3 mm
dorsally, as well as facet arthrosis; C3–C4, disc osteophyte complex with facet arthrosis, mild canal
narrowing and mild to moderate bilateral neural foraminal narrowing; C5–C6, status post anterior
fusion; and C7–T1, sic osteophyte complex and facet arthrosis with minimal canal narrowing ...
Show more content on Helpwriting.net ...
Prescription is given for Nucynta 50 mg, gabapentin 600 mg, and Pantoprozole–protonix 20 mg.
Treatment plan includes waiting for the diagnostic studies requested by Dr. Tay and response for
physical therapy request. Regarding medication management of pain, prescription refills for
gabapentin and pantoprazole were given. Nucynta prescription is given for trial for efficacy and
tolerance since tramadol was not tolerated. UDS is positive for "THC" and no other substances.
Patient has a medicinal marijuana card. Patient is scheduled for a follow up in 4 weeks. Patient is
permanent and stationary. There is non–certification for the Pantoprazole–Protonix 20 mg as per
affiliated

Gabapentin: A Case Study Of Dental History
In this case, it is very important to consider her medical and psychological history as well as the
dental history and how she describes her past experiences when formulating a plan for treatment.
This patient is at risk of developing a similar chronic condition after these extractions. According to
Shipton, there are several risk factors that can lead to chronic pain development that this patient is
positive for: female gender, younger age, pain before surgery, pre–operative anxiety/fear,
depression/anxiety, and stress. Additionally, the patient has a history of ulcerative colitis or
inflammatory bowel disease, which is a chronic pain and hypersensitivity condition and also
increases her risk for developing chronic pain postoperatively because ... Show more content on
Helpwriting.net ...
Shipton advises to use the least painful surgical approach possible. Profound anesthesia should be
obtained and along with the use of nitrous oxide. Also, whether or not the patient was positive for
myofascial pain preoperatively, it will be important to avoid overstretching the muscles by taking
breaks as needed, supporting the jaw and avoiding extreme pushing or pulling. Atraumatic
extraction without laying a flap is advisable. The extraction site should be debrided very well and
may be packed with gelfoam. Any sutures placed should be tension–free and nothing should be able
to irritate the tongue. Before the procedure is terminated, I would administer a long acting local
anesthetic, Bupivicaine with epinephrine, as a nerve block so that she will remain anesthetized for
several hours (5–7 hours) (Buvanendran & Kroin,

Business Ethics
Business Research Ethics
"Ethics are norms or standards of behavior that guide moral and choices about our behavior and our
relationship with others" (Cooper & Schindler, 2011, p.). When a business conducts a research, the
business uses ethics to guarantee that no individual will be hurt or suffers from the consequences
from the research. When a business is planning a research, some of the ethics a business must
consider are to: protect the rights of the individual, follow the ethical standards, and to ensure that
the information that is acquire is ethical. The purpose of the research is not to allow any type of
physical harm, discomfort, pain, embarrassment, and the loss of privacy (Cooper & Schindler,
2011). According to "Copper ... Show more content on Helpwriting.net ...
Without requiring drug companies to publish all of their safety data, these companies can submit
information that only provides only what seems to be positive data and hide the negative data.
"Pharmaceutical companies can manipulate their own trial data to manufacture good results"
(Benson, 2010).
In a legal case against Neurontin, Pfizer and Parke–Davis used some strategies to cover up some
unfavorable findings from their research. When their strategies were uncovered in 2008, Pfizer and
Parke–Davis detained reports where it proved that there was no evidence of the drug's efficacy, their
negative data was reinterpreted, and the grouping of negative and positive studies to counterbalance
the results. According to "Ramirez de Arellano" (2009), "In some cases, legitimate researchers saw
their findings rewritten and recast to, in the words of one of company's medical writer, to make [the
overall picture] sound better than it looks on the graphs." Pfizer and Parke–Davis were skewing
information on off–label uses of Neurontin. They manipulated their data to support their findings,
and failed to report any negative outcome from their findings. When pharmaceutical companies
skew or manipulate their findings on a drug, people who take Neurontin for off–label uses are
endangering their lives. The FDA does not approve Neurontin for off–label uses because Pfizer and
Parke–Davis cannot prove the

Evidence-Based Treatment of Hot Flashes Related to Cancer...
Hot flashes are one of the many side effects of cancer treatment. A hot flash is defined as "a
subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and a
subsequent drop in core temperature" (Kaplan, Mahon, Cope, Keating, Hill & Jacobson, 2011).
Another description of a hot flash is a "sudden sensation of intense warmth that begins in the chest
region and rises to the neck and face" (Loprinzi, Barton & Rhodes, 2001). Hot flashes are difficult to
measure because they are a subjective experience. Electronic monitoring devices have been used to
assess skin temperature and objectively measure hot flashes (Carpenter, 2005). Hot flashes cause
discomfort and can affect a patient's quality of life, especially when associated with night sweats,
sleep disruption, and mood swings (Loprinzi, Barton & Rhodes, 2001). There are certain types of
cancer treatments that cause hot flashes in patients. Cancer treatments that target estrogen and
testosterone production cause more incidences of hot flashes than other cancer treatments (Kaplan et
al., 2011). The side effects of these types of cancer therapies include hormone–deprivation
symptoms, one of which can be hot flashes (Kaplan et al., 2011). These treatments are used for
breast cancer in women and prostate cancer in men (Kaplan et al., 2011). Premenopausal women
who undergo treatment for cancer may also experience hot flashes. This is because "about 80% of
premenopausal women who receive

Few Animal Studies Have Proved That Gabapentin Has A...
Few animal studies have proved that gabapentin has a potential to activate a serotonin receptor
(5HT3) at the spinal level and also attenuate the function of microglial cells[6]. In some parts of the
brain such as periaqueductal grey (PAG) and anterior cingulated cortex, gabapentin has been shown
to elevate the level of GABA, a major inhibitory neurotransmitter, which might serve as an
explanation of its' efficacy in partial management of seizure[14]. Although gabapentin is approved
to be used as an add–on treatment of focal epilepsies in 6 years and older patients and as
monotherapy in patients older than 12 years of age, it seems to show no efficacy when used in a
management of generalized tonic–clonic seizures, generalized absence ... Show more content on
Helpwriting.net ...
Due to an effect of gabapentin at the level of hypothalamus to regulate the temperature, it can also
be used as an effective non–hormonal therapy for hot flashes, a bothersome problem of menopause.
It is shown to be more efficacy if used in patients with hot flashes that associated with sleep
interference [17]. Study shows that a bioavailability of gabapentin is low and it is dose–dependent.
The bioavailability of 300 mg is around 60% and decreasing to less than 30% if the dosage is 1600
mg 3 times a day [4; 11]. It has low protein binding property and it is eliminated unchanged in the
urine, which means it will not change into toxic metabolite or intermediate that can be harmful to
the body. Gabapentin has a short half life of 5 to 9 hours, but with renal impairment, it will
increase[4]. A dose adjustment is required in patient who has creatinine clearance of 60 ml/min and
in the elderly because of reduced renal function that has been thought to be decreased around 1%
per year after the age of 40[4; 16]. A number needed to treat (NNT) of gabapentin is 6.3 and its
number needed to harm (NNH) is 25.6, therefore it is considered a safe drug [6]. The ceiling effect
has been reported to be 100 mg/kg in one study and 30–300 mg/kg in another study following oral
administration [13]. The pharmacokinetic of absorption of gabapentin is not linear unlike other
newer anti–seizure medications. The explanation for this event is because gabapentin absorption
depends on

Medical Case Analysis: Low Back Injury
DOI: 08/20/2012. This is a 59–year–old female sales associate who sustained a low back injury
when she was bending down to put some shoes away in the stockroom. Patient was diagnosed with
L3–4 spondylolisthesis, multilevel disc protrusion at L3–S1, radiculopathy and bilateral left knee
sprain/strain.
Per progress report dated 7/2/15, the patient reports continued symptoms of back pain, mid back
pain and bilateral leg pain since the industrial injury. Subsequently, she had severe back pain and left
lower extremity pain, numbness and weakness with compensatory changes to the right side as well.
The treatments were discussed including medications, physical therapy, modification of activities
and pain medications. Surgical options were also discussed

Double Blind Study: The Effects Of Gabapentin
A randomized double blind study by (Ciodaro et al., 2014) has been chosen to illustrate the effects
of lidocaine, an amide type local anaesthetic in combination with gabapentin, an Antiepileptic in the
treatment of tinnitus in patients with chronic idiopathic non–pulsatile unilateral tinnitus. This study
is an example where a study fails to address the full pharmacological characteristics of the drug of
interest and the the possible interactions caused by the drugs the participating individuals may have
been exposed to before the trial. This study involves 74 participants each randomly separated into 3
groups of 24 each. (Group 1: Gabapentin + 40mg in 1 ml Intradermal lidocaine injection, Group 2:
Gabapentin + intra dermal saline injection, ... Show more content on Helpwriting.net ...
429 participants were randomly allocated into 4 groups to receive different doses of Neramexane of
25mg per day(n=112) , 50mg per day (n=108), 75 mg per day (n=102) or the placebo (n=116) for 16
weeks and followed up after 4 weeks of no active treatment. The evaluations of the outcomes of
treatment were done to assess both perceptual aspects of tinnitus by measuring the audiometric and
psychoacoustic characteristics with pure tone audiometry, tinnitus matching and minimal masking
levels as well as the subjective tinnitus severity by THI. Moreover, the effect of treatment was not
only self assessed by the participants, but also assessed by the physicians with Global Impression of
tinnitus severity (CGI–S) scale which allows a reduction of self–assessment bias and a more
accurate measurement of the effect of the

Speech '40mg Dosage Of The Cymbalta'
Good afternoon Dr. Hogans: I have increased to the 40mg dosage of the Cymbalta and am seeing
greater progress during my work hardening sessions with Michael Caruso. He mentioned this
afternoon that the restriction in my shoulder had eased slightly and I was gaining greater mobility.
However, I am experiencing many of the side effects that we knew might be occur such as a change
in consciousness and having to read a document a couple times for comprehension, trouble
remaining asleep, feeling lightheaded and very fatigued, and decreased appetite. To combat the
symptoms, I tried switching to taking the Cymbalta and Gabapentin in the morning and Topamax
and Hydroxyzine in the evening; however, I ended up being asleep until the middle

Skewed Research Essay
Skewed Research
RES/351
In today's society we have found that the best way to find what works for individuals and businesses
alike is done through business research. This is not always done in ethical manners though. Some
companies tend to ask questions that are inappropriate while others changed the information they
have been given to make their product look more appealing. This paper will focus on skewing the
research results in the service of selling the drug Neurontin. Neurontin is a brand name for the drug
gabapentin and it is manufactured by Pfizer and Parke–Davis (Ramirez de Arellano, 2009). The drug
has been approved by the FDA to use in treating neurological conditions such as epilepsy. There
have been a large ... Show more content on Helpwriting.net ...
During the studies done on Neurontin 20 clinical trials were identified and only 12 of those reported
in publications, in which 8 of those published trials had different primary outcomes reported than
was in the original research protocol (Ramirez de Arellano, 2009). These differences included
changing the primary outcome, not distinguishing between the primary and the secondary outcomes,
and not reporting all of the primary outcomes. There was 21 primary outcomes for the research and
out of those 21 protocols there was 6 not reported and 4 were put as secondary outcomes instead of
primary. The changes made in the published reports were done to make Neurontin look favorable for
the unapproved indications. In the Neurontin situation of skewing the research done for the
medication, affects the people that use the drug along with others that take any medication. It makes
the doctors look as if they do not know what they are doing when they prescribe the medication and
leaves individuals in an untrusting state to try something new to treat their ailments. It also makes
the scientists that develop the drug look bad. Another thing this does is undermines individuals' trust
in published studies and the entire decision–making process. The organization is affected by this
unethical

Neck Pain Case Study
DOI: 5/6/2012. The patient is a 34–year–old female registered nurse who sustained a work–related
injury when she felt a pop in her left shoulder due to turning a patient who weighed 250 pounds in a
hospital bed. As per OMNI, the patient is status post left shoulder surgery on 10/19/12.
According to the progress report on 10/15/15, the patient is still having neck and left–sided upper
extremity complaints. She has some complaints on the right side, as well. The patient's hip seems to
be causing her mild complaints only. She has not been able to get back to work. On examination, the
patient has negative Spurling's and foraminal compression tests on her right side; she only had neck
pain with that. Her foraminal compression test on the left side

Radiculopathy: Case Study
DOI: 2/15/2014. Patient is a 61–year–old female clinical specialist who sustained injury to her back
and left knee when she was involved in a motor vehicular accident. Per OMNI, she was initially
diagnosed with grade 1 L4–5 lumbar spondylolisthesis with left paracentral disc protrusion and left
L5 radiculopathy. Based on the progress report dated 03/12/15 by Dr. Esposito, the patient has
reached a plateau state. She has had no major flare–ups since the last evaluation. She is still taking
Norco 10/325 mg on occasion twice a week for flare–up. She is also taking gabapentin 600 mg
twice a day as well as Aleve. She has backache with left leg radicular symptoms. The patient was
treated with nonsteroidal anti–inflammatories and oral

Ms. Tate Case Summary

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Ms. Tate Case Summary