Classes of Pain Medication

Question 2

What are the classes of medications used in acute pain control?

Answer 2

-Acetaminophen
-NSAIDs
-Opioids
Pregabalin/Gabapentin (CNS depressors)
-SNRIs
-Lidoderm patches

Question 3

When should we discontinue tyelenol?

Answer 3

When there is abject liver failure.

Question 4

If a pt has acute cholecystitis and has a bump in their liver enzymes, what do we do with their tyelenol?

Answer 4

For the love of Goodness, do not discontinue the tyelenol because the liver enzymes will correct with treatment of the condition.

Question 5

What is the max dose of tyeleno that we should try before escalating to another class of pain medication?

Answer 5

3-4 g of Tyelenol per day.

Question 6

What are contraindications to NSAIDs?

Answer 6

GI bleeding, diagnosis of inflammatory bowel disease (IUD), pelvic ulcer disease (PUD), or AKI or CKD.

Question 7

What class of drug does ketorolac fall under?

Answer 7

NSAID.

Question 8

Which NSAID is most preferred for oral administration?

What about IV?

Answer 8

Oral is Ibuprofen.

IV-administered preferred NSAID is Ketorolac.

Question 9

What is the best way to schedule standing NSAID and Tyelenol?

Answer 9

Alternate them.

Question 10

What is the maximal dose of ibuprofen to give before adding on another agent?

Answer 10

2400 mg per day.

Question 11

What is the starting dose for ketorolac in a normal person?

How often do we give it?

Answer 11

15 mg.

Every 6 hours in a normal person.

Question 12

What is the starting dose and frequency of ketorolac in an elderly pt or someone with questionable renal function?

Answer 12

7.5 mg every 6 hours.

Question 13

What is the max dose of ketorolac before adding on another agent?

Answer 13

10-12 mg.

Question 14

What other non-analgesic medication might we add on if we schedule an NSAID?

Answer 14

Give them PPI or H2 receptor blocker.

Question 15

Generally, what steps do we take to escalate pain medication within the same class?

Answer 15

-We increase the frequency of the same dose first.

-Next, we increase the dose itself.

-Repeat till we reach the max dose and then escalate to another class.

Question 16

What drug class do we add after trying the maximal dose of tyelenol and NSAIDs?

Answer 16

Opioids -

*there’s nothing special about them, okay. Just pick two favorites and prescribe from there! (oral vs IV)

Question 17

What is my preferred opioid to prescribe orally?

Answer 17

Oxycodone.

That’s it. Nothing fancy. :/

Question 18

What is my preferred IV opioid to prescribe?

Answer 18

Hydromorphone.

Hydro = water, think that water can go through an IV.
;)

Question 19

What is the starting dose of Oxycodone?

How frequently do we give Oxycodone?

Answer 19

5-10 mg

Every 4 hours as needed. (Do we ask them if they need it every time or just schedule?)

Question 20

What is the starting dose of hydromorphone?

How frequently do we give it?

Answer 20

0.5-1.0 mg

Every four hours as needed.

Question 21

If a pt is frail and old, what starting doses do we give of oxycodone and hydromorphone?

Answer 21

Oxycodone: 2.5-5.0 mg q 4hrs prn.

Hydromorphone: 0.25-0.5 mg q 4hrs prn.

*Just half it… Nothing complicated.

Question 22

What about morphine?

What is an annoying side effect of it?

Answer 22

-Avoid it unless the pt tolerated it well in the past.

Nausea and hypotension because of histamine release as result.

Question 23

When should we start pregabalin or gabapentin?

Is it useful in acute pain?

Answer 23

Give pregabalin/gabapentin if the pt has it as their home medication or if they have neuropathic pain.

Pregabalin and gabapentin are useless for acute pain. They take days to work?

Question 24

When should we offer SNRIs?

Answer 24

Only give SNRIs if they have it on their home regimen.

Question 25

When to give lidocaine patches?

Answer 25

Localized pain, 12 hours on, followed by 12 hours off.

Question 26

What do we do if pts have their own opiate regimen from home?

Answer 26

We continue their same home regimen in the hospital.

*It does not matter if we feel that it is excessive.