Acute Pain Flashcards
1
Q
APAP
A
- Tylenol, Ofirmev
- Max Dose: 4g from all sources
- Boxed Warnings: Severe hepatotoxicity (>4g)
- SE: severe skin rash (Rare)
- Ethanol use: consuming >= 3 drinks per day can increase liver damage risk
- Hepatic impairment: use with caution if patient has impairment of acute liver disease
2
Q
APAP + Geriatrics
A
-Some recommend a max dose of 3g per day
3
Q
Mild Pain Options
A
- APAP
- COXIBs
- NSAIDs
- Local/regional anesthesia
4
Q
Moderate Pain Options
A
-Low dose opioids \+ -APAP -COXIBs -NSAIDs -Local or regional anesthesia
5
Q
Severe Pain Options
A
-Higher dose of opioids \+ -Low doses of opioids \+ -APAP -COXIBs -NSAIDs -Local or regional anesthesia
6
Q
Chronic Liver Disease/Cirrhosis + APAP
A
- Use with caution and consider dose adjustment
- Limited data exists, but =<2 or 3g/day is usually well tolerated in these patients
- Patients not actively drinking alcohol
7
Q
NSAIDs + Kidneys
A
- Coadministration with certain drugs increase kidney injury risk
- Includes ACE-I, ARBs, antirheumatics (Methotrexate), Diuretics, and Lithium
8
Q
NSAIDs + CV Risk
A
- Risk of adverse CV effects
- Consider baseline ASCVD risk
- High NSAID doses are associated with higher CV risk
- COX-2 selective agents don’t seem to have a significant CV risk factor
9
Q
COX-2 Selective NSAIDs
A
- Lower risk for complications
- Increased risk of MI/stroke
- Same risk for renal complications
10
Q
Bleed Risk + NSAIDs
A
- Coadministration of certain drugs increase bleed risk
- Includes anticoagulants, antiplatelets, corticosteroids, SSRI, SNRI, TCA, and herbals
11
Q
Ketorlac
A
- Toradol
- Pain management (acute, moderately severe) in patients >= 50 kg
12
Q
Multimodal Analgesia
A
- APAP
- Gabapentin/pregabalin
- Ketamine
- NSAIDs
- Skeletal muscle relaxants
- Steroids
13
Q
Methocarbamol Warnings/SE
A
- Considerations: half-life is prolonged in older adults and has increased risk of drowsiness/dizziness (Beers List)
- Warning: caution with other CNS depressants (increased CNS depression)
- SE: dizziness, drowsiness, HA, insomnia, metallic taste, N/V
14
Q
Antispasmodic Agents
A
- Cyclobenzaprine
- Metaxalone
- Methocarbamol
15
Q
Antispasticity Agents
A
- Baclofen
- Dantrolene