Exam 5 (final) - Rogers Flashcards
what the CDC practice guidelines include
outpts >18
acute pain (<1 month)
subacute pain (1-3 months)
chronic pain (>3 month)
what the CDC practice guidelines do NOT include
management of pain related to sickle cell disease
management of cancer related pain
palliative care
end of life care
WHO analgesic ladder
- non opioid +/- adjuvant analgesic
- opioid for mild-moderate pain +non opioid +/- adjuvant analgesic
- opioid for moderate-severe pain +non opioid +/- adjuvant analgesic
adjuvant options
gabapentanoids
SNRIs
TCAs
muscle relaxants
anti-epileptics
topical agents
pediatric acetaminophen dosing
10-15mg/kg po q4h prn
-max of 75mg/kg/day or 3-4g/day
pediatric dosing of aspirin
avoid (Reye’s Syndrome)
ibuprofen adult dosing
200-800mg PO q6-8h PRN
-max of 3200mg/day
ibuprofen pediatric dosing
> 6months: 5-10mg/kg po q4-6h prn
-max 40mg/kg/day or 2400mg/day, whichever is less
adult dosing diclofenac (Voltaren)
50mg po q8h
2-4g applied topically 4 times/day
naproxen (Aleve or Naprosyn) adult dosing
220-500mg po q6-12h
-max of 1000mg/day
ketorolac (Toradol) adult dosing
15-30mg IV/IM q6h prn
10mg po q6h prn
ketorolac (Toradol) peds dosing
0.5mg/kg/dose IV/IM q6h prn
max duration of ketorolac (Toradol)
5 days (parenteral and oral)
-reason is increased risk of GI bleed
celecoxib (Celebrex) adult dosing
200mg po BID
gabapentin (Neurontin) and pregabalin (Lyrica) uses
fibromyalgia
neuropathies
post-op pain
adult dosing for gabapentin (Neurontin) and pregabalin (Lyrica)
gaba: 100-300mg po TID
-max of 3600mg/day
pregaba: 75mg po BID
-max of 600mg/day
gabapentin (Neurontin) and pregabalin (Lyrica) side effects
sedation
dizziness
peripheral edema
gabapentin (Neurontin) and pregabalin (Lyrica) clinical pearls
titrate doses up to reduce sedation
use in combo with other analgesics to reduce sedation
renal dose adjustments
SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) uses
fibromyalgia
neuropathy
SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) dosing
V(E): 37.5-75mg po daily
-max of 225mg/day
D(C): 30mg po daily for 1 week, then increase to 60mg daily
-max of 60mg/day
SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) side effects
N
HA
HTN
sedation
weakness
SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) clinical pearls
start low and titrate up to minimize SE
renal dose adjustments:
-CrCl<30: avoid duloxetine and use low dose of venlafaxine
TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) uses
fibromyalgia
neuropathy
migraine prophylaxis
TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) dosage forms
tablet (ami)
capsule (nor)
oral solution (nor)
TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) dosing
both: 10mg po QHS
-max of 150mg/day
TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) side effects
anticholinergic SEs
sedation
TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) clinical pearls
last line for fibromyalgia and neuropathy due to SE
muscle relaxants class includes:
cyclobenzaprine (Amrix, Fexmid)
baclofen (Lioresal)
methocarbamol (Robaxin)
carisoprodol (Soma)
tizanidine (Zanaflex)
muscle relaxants clinical pearls
short term use only (<3 weeks)
carisoprodol is C-IV due to abuse potential
muscle relaxants SE
sedation/drowsiness
dizziness
dry mouth
vision changes
anti-epileptics: carbamazepine (Tegretol) use
neuropathic pain
anti-epileptics: carbamazepine (Tegretol) clinical pearls
increased risk of hypersensitivity rxn if pt has HLA-B*1502 allele
auto-induction of hepatic enzymes (levels will fall over first few weeks of use)