adjuvant analgesia Flashcards
Bone pain description
- Progressive worsening, achy pain, worse with weight bearing and at night
- tender over bone
- joint pain
alternative to meds for bone pain
radiation especially if pain is better with steroids
Drug classes for adjuvant bone pain
- NSAIDS
- Bisphosphonates
- Steroids
Bone Pain NSAIDS
- Diclofenac 1.3% patch BID
- Ibuprofen 400-800mg PO q6h
- Ketorolac 30mg PO/SC/IV q6h
bisphosphonates in bone pain
- pamidronate 60-90mg in 500-1000ml of NS IV over 4-6h
- Zoledronic Acid 4mg IV q4wk
Steroids in bone pain
dexamethasone 2-10mg po/sc qd
Visceral pain description
Colicky, cramping, abdominal pain or bladder spasms
Visceral pain alternatives to medications
Paracentesis for ascites, nerve blocks, opioids are generally less effective
Visceral pain medication classes for adjuvants
- Anticholinergics
- steroids
- benzodiazepines
- prokinetic
- antisecretory agent
Anticholinergics for visceral pain
- glycopyttolate 0.4mg po/sc q4hr
- B&O suppositry max 4/day
- scopolamine 1-2TD patch q3 day
- hyoscyamine 0.125mg PO/SL q4-8hr
- Oxybutynin 5-10mg po q8hr
Steroids for visceral pain
dexamethasone 2-10mg po/sc qd-BID
Benzos for visceral pain
Lorazepam 0.5-1mg PO/SC q4-8h
Prokinetic agents for visceral pain
metoclopramide 5-10mg PO/SC q4hr
Antisecretory agent for visceral pain
octreotide 100mg SC/IV q8hr
Neuropathic pain description
continuous burning, tingling, pain on light touch, shooting or stabbing pain
Med classes for Neuropathic pain
- TCA
- Antidepressants
- anticonvulsants
- Anesthetic
- SNRI
- Other
TCA for neuropathic pain
- amitriptyline 10-150mg po qhs
- Imipramine 10-150mg PO qhs
- Nortriptyline 10-50mg PO qhs
- Desipramine 10-150mg PO qhs
- Doxepin 10-50mg PO qhs
Antidepressants for neuropathic pain
trazadone 25-150mg PO qhs
Anticonvulsants in neuropathic pain
- gabapentin 100-300mg PO q8h
- pregabalin 25-50mg PO q8hr
- Valproate 250mg PO/IV q8-12hr
- carbamazepine 200mg PO q12h (monitor)
- lamotrigine 100-200mg PO q12hr
- Topiramate 100-200mg PO q12h
- Clonazepam 0.5mg PO BID
- Phenytoin 300-400mg PO qd
Anesthetic for neuropathic pain
- ketamine
- mexiletine 150mg BID-TID
- Lidocaine Sc/IV/5% TD
- Lidocaine/prilocaine (EMLA) topical
SNRI for neuropathic pain
- venlafaxine XR 37.5mg PO qd
- Duloxetine 30-60mg PO qd
Other meds for neuropathic pain
- Clonidine 0.1-0.3mg PO BID
- Baclofen 5-20mg PO TID
- Capsaicin 0.025 or 0.075% cream topical QID
Ketamine
Brief in adjuvant
- dissociateive anesthetic with analgesic prop in subanesthetic doses
- Head/neck cancer pain
- neuropathic pain
Ketamine receptors
- NMDA antagonist
- Calcium and Na channels
- noradrenergic and serotonergic reuptake inhibition
- mu, kappa, and delta like effects
Ketamine solubility
Lipid and water
allows PO, PR,SC,IM, IV, intranasal, and transdermal dosing
metabolism of ketamine
extensive first pass metabolismto norketamine, active metabolite with analgesic properties
ketamine onset of action
IV/IM 1-5 min
SC 15-30min
PO 30min
Half life of ketamine
ketamine 1-3h
Norketamine 12hr
Duration of action of ketamine
IV/IM/SC 20-45min, PO 4-12hr
PO:IV ratio of ketamine
1:1
