Medical News update for 2014:


Controlled Substances:

Acute Pain and Opioids:

Acute Pain can range from headaches, minor traumas, and minor procedures including but not limited to dental, and outpatient procedures.

There have been some recent changes in opioid’s drugs for short-term pain management.  Many people have been taught over the years that opioid’s are the best way to manage the pain that their patients are experiencing; however, with recent changes with hydrocodone combos becoming schedule II drugs new ways have to be brought forth to help patients manage the pain they are experiencing.  Some of the changes that can be made is having patients take acetaminophen or NSAIDs for their acute pain.  Codeine and oxycodone show many of the same pain controlling features to people with acute pain that acetaminophen has shown.  There are other ways to help with acute pain that has nothing to do with pain medication.  These include but are not limited to, adding regular exercise to your daily routine, as well as physical therapy.  A provider will know what is best for you.

Many patients like their opioids over the acetaminophen and NSAIDs drugs because opioids also have a calming effect on people that help with any emotional stress associated with their pain.  There are still many different aspects to acetaminophen and NSAID drugs that can be taken to help patients with their short-term pain.  One aspect that is being taken is having the patients start taking acetaminophen and ibuprofen every 4 to 6 hours as needed, and have the understanding that if they want a higher dose that does not always mean they will have more pain relief.  Please always consult your provider before making any changes to your medications and make sure the changes are in your best interest.

Prescriber’s Letter, Vol 21, No 11, page 61-62; Therapeutic Research Center, Stockton CA,

The schedule II opioids are not the only ones that have had changes come upon them.  Tramadol became a nationally Schedule IV controlled substance as of August 18, 2014.  This opioid has less risk for dependency than many of the other opioids out there but one must still be aware that there is a potential for abuse.  Tramadol in the state of Wyoming can be faxed into a pharmacy, just remember this is the only pain medication in Wyoming that is allowed to be faxed in.  The rest of them have to have a handwritten prescription from a provider.

Prescriber’s Letter, Vol 21, No 8, page 48; Therapeutic Research Center, Stockton CA,


Examples of Benzodiazepines are: Lorazepam (Ativan), Alprazolam (Xanax) and Clonazepam (Klonopin).

New guideline have suggested that providers decrease the amount of benzos that are prescribed to patients due the increase risk of abuse and serious side effects.  With increased risk of abuse comes an increase chance of having car accidents, or even falls which can cause fractures especially in the older adults.  There are some aspects where a benzo maybe needed for long-term diagnoses which will be evaluated by a provider.   

Studies have suggested that many taking a benzo maybe weaned from this class of drug.  Taking a patient off of a benzo it is important to remember that a patient must be tapered off of the drug.  This is typically done by reducing the amount they take by 25% the first week, and 25% the second week, after the first two weeks of tapering off the benzo the provider will continue to bring the dosage down, but only by 10% each week until the patient is off of the benzo all together.  The tapering processes will be specific to each patient to allow them the best recovery.

There are cases in which benzo is needed for a long-term diagnosis, one example is severe anxiety, or sever panic attacks.  When a benzo is needed for the long-term the best one to use is clonazepam which is a long-acting agent. 

Prescriber’s Letter, Vol 21, No 8, page 45; Therapeutic Research Center, Stockton CA,

Pneumococcal Vaccination:

There are two common Pneumococcal Vaccinations that are recommended for people 65 and older to get they are: Pneumovax 23 and Prevnar 13.

The CDC recommends that there are two different vaccinations that should be given to people over the age of 65 to help combat the cold and flu season.  These two vaccinations are Pneumovax 23 and Prevnar 13.  Each one of these covers different serotypes, and when an older adult gets both of them it has shown that they show a better immune response then when just one of them is given.  Unfortunately Medicare B only pays for one Pneumococcal Vaccination every 12 months.  The Prevnar vaccination should be given before the Pneumovax vaccination.  Here a schedule of when is a good time to get both of them in:

Pneumococcal Vaccine Status:

FIRST give:

THEN give:


Prevnar 13

(≥ age 65)

Pneumovax 23

(6 to 12 months after Prevnar 13)

Pneumovax 23

Given AFTER 65th birthday

Prevnar 13

(≥2 months after Pneumovax 23)


Pneumovax 23

Given AFTER 65th birthday

Prevnar 13

(≥ age 65 AND ≥ 1 year after Pneumovax 23)

Pneumovax 23

(6 to 12 months after Prevnar 13 AND 5 years after Pneumovax 23)

Prescriber’s Letter, Vol 21, No 11, page 63; Therapeutic Research Center, Stockton CA,

There are some adults who are younger than 65 who may also be a good candidate for both Pneumococcal Vaccinations.  This includes but is not limited to adults who smoke, or may have chronic conditions that warrant the vaccinations. 

Prescriber’s Letter, Vol 21, No 11, page 63-64; Therapeutic Research Center, Stockton CA,