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Medication Prescription

1. Pain Management:

   • Medication: Morphine sulfate (immediate-release)
   • Dosage: Consider a low starting dose, e.g., 2.5 to 5 mg orally or intravenously, due to the increased sensitivity to opioids in elderly patients and potential for renal clearance reduction. Adjust the dose based on pain severity and patient response.
   • Frequency: PRN (as needed), with clear instructions on the maximum daily dosage to prevent overdose.
   • Indication: To manage pain pre and post-surgery as needed.

2. Antiemetic Prophylaxis:

   • Medication: Ondansetron
   • Dosage: 4 mg IV
   • Frequency: Single dose to be taken 30 minutes before surgery.
   • Indication: Prevention of nausea and vomiting associated with opioid use and postoperative nausea and vomiting (PONV).

Considerations:

• Drug Interactions: Review the potential interactions between the new prescriptions, Methotrexate, Folic acid, and Amlodipine. For instance, morphine should be used cautiously due to potential sedation and respiratory depression, particularly in the elderly.
• Renal Function: Ensure the patient's renal function is assessed, as morphine and its metabolites are renally excreted and may accumulate in patients with renal impairment.
• Monitoring: Plan for close monitoring of respiratory rate, blood pressure, pain level, and signs of opioid-induced side effects, especially given the patient's age and potential for altered pharmacokinetics.
• Postoperative Pain Management: Ensure there is a plan in place for assessing and managing pain postoperatively, considering the patient's ability to communicate his pain level effectively.
• Allergies: Confirm no known allergies to the prescribed medications.

Instructions for the Patient/Nursing Staff:

• Administer the antiemetic 30 minutes before the surgery to ensure optimal effectiveness.
• Provide morphine PRN as needed for pain, with strict guidelines on when to administer (e.g., pain score above a certain threshold) and the maximum allowable dose.
• Educate the nursing staff about monitoring vital signs and potential side effects related to morphine administration, including sedation, respiratory depression, and constipation, and the signs of opioid overdose.