You are a new FNP in a restricted state and you have your DEA license and state

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You are a new FNP in a restricted state and you have your DEA license and state furnishing for schedule II-V controlled substances. You are working at a busy family practice group and you have a patient, ML, that is establishing care for the first time with your practice, and comes to you with the following scenario:
ML is a 54 y.o. Hispanic female with hx of chronic shoulder and back pain that began 10 years ago when she was in a boating accident
She lives in both US and Mexico, making regular visits across the border; lately, she has stayed in US due to Covid border crossing constraints, living with her daughter’s family
She had rotator cuff surgery in 2011 and reports to you that due to a long operation and poor positioning, she has suffered from not only pain, but also chronic numbness and tingling in her R shoulder
As “la abuela” (grandma) she is the primary caregiver of the children and homemaker for her family and her pain is exacerbated with housework, and especially with the prolonged carrying of her grandchildren; one of which is 10 m.o.
Currently, her med list is as follows
Losartan 50 mg BID for HTN
Gabapentin 300 mg po BID for pain
Atorvastatin 40 mg daily for cholesterol
Diazepam 5 mg po up to TID prn pain
Norco 5/325 mg – takes up to two, sometimes up to 4-5x a day, prn pain
She is a smoker, only smokes outside the house, and drinks 2-3 cans of beer on the weekends, but more on family celebrations
Denies recreational drugs and denies past overdoses
Recently moved to CA more permanently to stay to take care of children during Covid/school closures
She asks you to refill all her meds for 6 months like her doctor in Mexico did so she doesn’t have to make another co-pay and come back and see you so often; it’s hard for her to get an appointment, and with Covid her daughter has to take off of work to watch the kids just so she can come to you by bus since there is only one family car
Here VS are 135/75, 80, 97.5, 20 and PE unremarkable other than R shoulder exam with pain with ROM, but full ROM, no tenderness, otherwise normal, back exam including SLR are normal/neg

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