Acute Pain - More Drugs - Exam 2

Question 1

Ibuprofen starting dose:

ceiling effect dose:

Answer 1

• 200mg TID
• 400mg = ceiling effect

Question 2

Celecoxib Starting dose:

Answer 2

100mg daily

Question 3

Tylenol starting dose:

Answer 3

500-1000mg q 4-6h

Question 4

Naproxen starting dose:

Answer 4

220mg BID

Question 5

Diclofenac starting dose

Answer 5

• 50mg BID

Question 6

MOA anti-depressants (TCAs) for pain:

What type of pain are they used for?

Answer 6

• MOA: increase transmission in spinal cord to reduce pain signals
• nerve pain: DM/chronic

Question 8

How long do TCA/anti-depressants take to have effect?

Answer 8

5-10 days

Question 9

TCA/anti-depressant

SE:

Answer 9

• dizziness
• drowsiness
• decreased appetite
• dry mouth
• strung out

Question 10

What types of pain are anti-convulsants used for?

Answer 10

• acute surgical pain
• nerve pain

Question 11

What are 4 examples of anticonvulsants used for pain?

Answer 11

1. Gabapentin (Neurontin)
2. Phenytoin (Dilantin)
3. Carbamazepine (Tegretol)
4. Topiramate (Topamax)

Question 12

Gabapentin dose:

Answer 12

• 100mg - 300mg BID/TID
• pre-op dosing

Question 13

SE of anticonvulsants for pain:

Answer 13

• dizziness, drowsiness
• HA
• wt gain

Question 14

What are the indications for skeletal muscle relaxants in pain control?

Answer 14

1. muscle pain
2. tension HA
3. lower back pain

Question 15

What are 5 skel. muscle relaxants available for pain

Answer 15

1. Baclofen (Lioresal)
2. Carisoprodol (Soma)
3. Cyclobenzaprine (Flexeril)
4. Methocarbamol (Robaxin)
5. Tizanidine (Zanaflex)

Question 16

what is there a high incidence of w/ Soma?

Answer 16

• OD

Question 17

What are SE associated w/ skel. muscle relaxants?

Answer 17

• dizziness
• drowsiness
• dry mouth
• constipation

Question 18

What are available OTC topicals?

Answer 18

• capsaicin cream
• menthol - methyl salicylate cream (Bengay)
• lidoderm 5% patch
• compounded (ibuprofen & ketamine) (ketamine, precedex, ibuprofen)

Question 19

What are the 3 types of dosing for opioids?

Answer 19

• initial: opioid naive for acute pain
• up-titration: need more in PACU
• max dose: not really a max (acute, persistent, cancer, end of life pain)

Question 20

Opioid conversion

Morphine IV:PO

Answer 20

• IV: 10mg
• PO: 30mg

Question 21

Opioid conversion

Dilaudid IV:PO

Answer 21

• IV: 1.5mg
• PO: 7.5mg

Question 22

Opioid conversion

oxycodone IV:PO

Answer 22

• IV: —
• PO: 20-30mg

Question 23

opioid conversion

codeine IV:PO

Answer 23

• IV: 130mg
• PO: 200mg

Question 24

opioid conversion

hydrocodone IV:PO

Answer 24

• IV: —
• PO: 30mg

Question 25

# opioid conversion methadone IV:PO

Answer 25

* IV: 1.5-2.5mg * PO: 3-5mg

Question 26

# opioid conversion fentanyl IV:PO

Answer 26

* IV: 0.1mg * PO: ---

Question 27

# PCA dosing: Morphine (1mg/mL) bolus: lockout: cont:

Answer 27

* bolus: 0.5-2.5mg * lockout 6-10min * cont: 1-2mg/hr

Question 28

# PCA dosing Fentanyl (0.01mg/mL) bolus dose: lockout: cont:

Answer 28

* bolus: 20-50mcg * lockout: 5-10min * cont: 10-100mcg/hr

Question 29

# PCA dosing Hydromorphone (0.2mg/mL) bolus dose: lockout: cont:

Answer 29

* bolus: 0.05-0.25mg * lockout: 10-20min * cont: 0.2-0.4mg/hr

Question 30

# PCA dosing Alfentanil (0.1mg/mL) bolus: lockout:

Answer 30

* bolus: 0.1-0.2mg * lockout: 5-10min

Question 31

# PCA dosing Methadone (1mg/mL) bolus: lockout:

Answer 31

* bolus: 0.5-1.5mg * lockout: 10-30min

Question 32

# PCA dosing Oxymorphone (0.25mg/mL) bolus: lockout:

Answer 32

* bolus: 0.2-0.4mg * lockout: 8-10min

Question 33

# PCA dosing Sufentanil (0.002mg/mL) bolus: lockout: cont:

Answer 33

* bolus: 2-5mcg * lockout: 4-10min * cont: 2-8mcg/hr

Question 34

# PCA dosing (agonist/antagonist) Buprenorphine (0.03mg/mL) bolus: lockout:

Answer 34

* bolus: 0.03-0.1mg * lockout: 8-20min

Question 35

# PCA dosing (agonist/antagonist) Nalbuphine (1mg/mL) bolus: lockout:

Answer 35

* bolus: 1-5mg * lockout: 5-15min

Question 36

# PCA dosing (agonist/antagonist) Pentazocine (10mg/mL) bolus: lockout;

Answer 36

* bolus: 5-30mg * lockout: 5-15min

Question 37

# Neuraxial Doses Fentanyl (2mcg/mL) intrathecal: epidural single: epidural infusion:

Answer 37

* intrathecal: 5-25mcg * epidural single: 50-100mcg * infusion: 25-100mcg/h

Question 38

# Neuraxial doses Sufentanil SA: epi single: epi infusion:

Answer 38

* SA: 2-10mcg * epi single: 10-50mcg * infusion: 10-20mcg/h

Question 39

# Neuraxial Doses Alfentanil SA: epi single: epi infusion:

Answer 39

* SA: --- * epi single: 0.5-1mg * infusion: 0.2mg/h

Question 40

# Neuraxial Doses Morphine SA: epi single: epi infusion:

Answer 40

* SA: 0.1-0.3mg * epi single: 1-5mg * infusion: 0.1-1mg/h

Question 41

# Neuraxial Doses Hydromorphone SA: epi single: epi infusion:

Answer 41

* SA: --- * epi single: 0.5-1mg * 0.1-0.2mg/h

Question 42

# Neuraxial Doses ER morphine SA: epi single: epi infusion:

Answer 42

* SA: not recommended * epi single: 5-15mg * infusion: not recommended

Question 43

# Neuraxial doses - LA Bupivacaine SA: epi single: epi infusion:

Answer 43

SA: 5-15mg epi single: 25-150mg infusion: 1-25mg/h

Question 44

# Nueraxial Doses - LA Ropivacaine SA: epi single: epi infusion:

Answer 44

* SA: not recommended * epi single: 25-200mg * infusion: 6-20mg/h

Question 45

# Neuraxial Doses - Adjuvant Clonidine SA: epi single: epi infusion:

Answer 45

* SA: not recommended * epi single: 100-900mcg * infusion: 10-50mcg/h