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     Case Study: Prescribed Drugs with CAMS    

    Case Study: Prescribed Drugs with CAMs
    Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.
    History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.
    Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
    PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.
    Metformin 1000mg ER one tab daily – Type II Diabetes controlled
    Coumadin 5 mg. daily – Hx of DVT – Controlled
    Kava Kava 50 mg. tid – Self-medication for anxiety
    CoQ10 – 200 mg. daily. – Self-medication for unknown reason
    Assignment Directions:
    Provide a diagnosis for the patient and your rationale for the diagnosis
    Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
    Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.
    Provide an education plan for Mr. X
    Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).
    You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting,
    Your writing Assignment should:
    follow the conventions of Standard English (correct grammar, punctuation, etc.);
    be well ordered, logical, and unified, as well as original and insightful;
    display superior content, organization, style, and mechanics; and
    utilize APA 7th edition formatting.


Subject Nursing Pages 5 Style APA


Case Study: Prescribed Drugs with Complementary and Alternative Medicines


Mr. X is likely suffering from mechanical back strain(El Sayed & Callahan, 2020).

Rationale: mechanical back strain from the skiing accident 10 years ago (Alexander & Varacallo, 2020).

  • The injury explains lower back pain, low back stiffness and accessional spasms (El Sayed & Callahan, 2020).
  • The inciting incident was the skiing incident but has been triggered after he moved some boxes during the day of hospitalization.

Treatment Plan

Pharmacologic Intervention

  • First-line pharmacologic intervention: muscle relaxants and nonsteroidal anti-inflammatory drugs (El Sayed & Callahan, 2020).
  • Opioid medications should be avoided since Mr. X’s pain is mild (3-4 out of 10) rather than severe (El Sayed & Callahan, 2020).
  • Second-line medications may include duloxetine and tramadol (El Sayed & Callahan, 2020).

Treatment Plan

Non-Pharmacologic Intervention

  • The first-line non-pharmacologic interventions include acupuncture, spinal manipulation, superficial heat stimulation, and massage (El Sayed & Callahan, 2020).
  • Other important interventions: exercise, yoga, tai-chi, and/or psychotherapy (El Sayed & Callahan, 2020).
  • Multidisciplinary rehabilitation, electromyogram biofeedback, and low-level therapy are also other useful interventions in this case (El Sayed & Callahan, 2020).
  • Exercise and physical therapy on a regular medically-supervised program (Pergolizzi & LeQuang, 2020).
  • STarT Back Screening Test (StarT Back) to identify risk for development of more persistent symptoms such as fear-avoidance, mood disturbances, and/or high level of perceived pain (Pergolizzi & LeQuang, 2020).
  • Consideration for appropriate behavioral interventions, physical therapy, and other interventions for psychological factors (Pergolizzi & LeQuang, 2020).

Over-the-Counter Medications

Interaction with Chronic or Acute Diseases

  • CoEnzymeQ10 may worsen prognosis of deep venous thrombosis (Prescribers’ Digital Reference, 2020).
  • Kava kava helps to relieve stress and anxiety (Carter & Kandola, 2018).
  • Kava may have benefits in management of chronic and acute lower back pain (Bian et al., 2020).

Interactions with other Medications

  • CoEnzymeQ10 should not be taken together with blood thinning medications (Prescribers Digital Reference, 2020).
  • Kava kava may decrease breakdown of ibuprofen and warfarin in the liver (WebMD, 2020).
  • Kava can also decrease the rate of breakdown of tramadol in the liver (WebMD, 2020).

Side Effects

  • CoEnzymeQ10 may cause gastrointestinal discomfort (Prescribers Digital Reference, 2020).
  • Kava kava is hepatotoxic and may cause liver damage (Carter & Kandola, 2018).
  • Kava is associated with significant hepatotoxic risk (Bian et al., 2020).
  • Kava kava may also cause other symptoms such as rash, fatigue, nausea, jaundice, abnormal enzyme levels, and fever (Carter & Kandola, 2018).
  • Education Plan for Mr. X
  • Exercise may improve his ability to self-manage his low back pain (El Sayed & Callahan, 2020).
  • Weight loss and smoking cessation (El Sayed & Callahan, 2020).
  • Maintenance of BMI <25 can contribute to achievement of better outcomes (Casiano, Dydyk & Varacallo, 2020).
  • Drug side effects and potential drug-drug interactions.
  • Reduction of strenuous physical movements may (El Sayed & Callahan, 2020).
  • Physical exercises improved management of non-specific low back pain (Alzahrani et al., 2019).
  • Stretching exercises, ergonomic modifications, and use of appropriate back rest breaks in the workplace (El Sayed & Callahan, 2020).
  • Maintenance of proper posture and avoidance of lifting of heavy objects or weights (El Sayed & Callahan, 2020).


Alexander, C. E., & Varacallo, M. (2020). Lumbosacral radiculopathy. [Updated 2020 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430837/#_NBK430837_pubdet_

Alzahrani, H., Mackey, M., Stamatakis, E., Zadro, J. R., & Shirley, D. (2019). The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies. Scientific Reports, 9, Article number: 8244. https://www.nature.com/articles/s41598-019-44664-8

Bian, T., Corral, P., Wang, Y., Botello, J., Kingston, R., Daniels, T., Salloum, R. G., Johnson, E., Huo, Z., Lu, J., Liu, A. C., & Xing, C. (2020). Kava as a clinical nutrient: promises and challenges. Nutrients, 12, 3044. https://www.mdpi.com/2072-6643/12/10/3044

Carter, A., (Ed.). & Kandola, A. (Dec 17, 2018). Kava kava: benefits and safety concerns. https://www.medicalnewstoday.com/articles/324015 

Casiano, V. E., Dydyk, A. M., & Varacallo, M. (2020). Back pain. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538173/#_NBK538173_pubdet_

El Sayed, M., & Callahan, A. L. (2020). Mechanical back strain. [Updated 2020 Mar 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542314/#_NBK542314_pubdet_

Pergolizzi, J. V., & LeQuang, J. A. (2020). Rehabilitation for low back pain: a narrative review for managing pain and improving function in acute and chronic conditions. Pain and Therapy, 9, 83-96. https://link.springer.com/article/10.1007/s40122-020-00149-5

Prescribers’ Digital Reference. (2020). Ubiquinol, Active Form of CoQl0 (CoQ10) – Full Prescribing Information. https://www.pdr.net/full-prescribing-information/Ubiquinol–Active-Form-of-CoQl0-CoQ10-24289

WebMD. (2020). Kava. https://www.webmd.com/vitamins/ai/ingredientmono-872/kava


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