Pain Flashcards
acetaminophen
Tylenol, FeverAll (rectal suppository), Ofirmev (IV; 10 mg/mL in 100 mL vials)
acetaminophen: safe use
Max daily dose <4,000 mg/day from all sources
Max of 325 mg per Rx dosing unit in combo products
Dosing ranges depending on the formulation
BBW: Severe hepatoxicity
Counsel patients to avoid or limit alcohol
Warning: Severe skin reactions, use cautiously in renal impairment
acetaminophen pediatric (<12 yrs) dose
10-15 mg/kg Q4-6 hr
Max: 5 doses/day
Infant and children’s suspension (use measuring device): 160 mg/5mL
acetaminophen + hydrocodone
Lorcet, Lortab, Norco, Vicodin
acetaminophen + oxycodone
Endocet, Percocet
acetaminophen + codeine
Tylenol #2, #3, #4
acetaminophen + tramadol
Ultracet
acetaminophen + caffeine
Excedrin Tension Headache
acetaminophen + aspirin + caffeine
Excedrin Extra Strength, Excedrin Migraine, Goody’s Powder
acetaminophen + caffeine/pyrilamine
Midol
acetaminophen + butalbital/caffeine
Fioricet
acetaminophen + diphenhydramine
Tylenol PM
acetaminophen + ibuprofen
Advil Dual Action
acetaminophen overdose
antidote is N-acetylcysteine (NAC). Can be given IV or PO
Non-selective NSAIDS like aspirin block…
COX1 and COX-2. Blocking Cox-1 decreases the formation of thromboxane (TxA2), which is required for both platelet activation and aggregation.
Rx, non-aspirin NSAIDs required MedGuide due to risk of:
1) GI risk
2) CV risk: avoid use in patients with CV disease or risk factors (except aspirin)
3) NSAIDS are C/I after Coronary Artery Bypass Graft (except aspirin)
Side effects of all NSAIDs:
1) can decrease renal clearance (use cautiously in renal failure)
2) can increase BP (avoid in patients with uncontrolled HTN)
3) can cause premature closure of the ductus arteriosus (avoid in 3rd trimester ≥ 30 weeks)
4) nausea (especially salicylates, take with food)
4) photosensitivity
Which IV NSAIDS can be used within 14 days of birth to close a patent ductus arteriosus?
1) indomethacin (Indocin)
2) ibuprofen (NeoProfen)
Non-selective NSAIDs:
1) ibuprofen
2) indomethacin
3) naproxen
4) ketorolac
5) piroxicam
6) sulindac
COX-2 selective NSAIDs:
1) celecoxib
2) diclofenac
3) meloxicam
4) nabumetone
5) etodolac
ibuprofen (Advil, Motrin; Caldolor IV)
OTC:
200-400 mg Q4-6hrs; (max 1.2 g/day)
400-800 mg Q6-8hrs; (max 3.2 g/day)
ibuprofen: pediatric dosing
5-10 mg/kg/dose Q6-8hrs (max: 40 mg/kg/day)
indomethacin (Indocin, Tivorbex)
IR: 25-50 mg BID-TID
CR: 75 mg daily BID
Tivorbex micronized: 20 mg TID or 40 mg BID-TID
Old drug, better choices for gout now. **High risk for CNS side effects (avoid in psych conditions)
naproxen (OTC: Aleve, Rx: Naprelan, Naprosyn)
200 mg (220 mg naproxen sodium) Q8-12 hours Max: 3 tabs in 24 hours (can take 2 tabs with first dose)
naproxen + esomeprazole (Vimovo)
Used to protect GI tract
ketorolac (Toradol, Sprix)
Oral: 10-20 mg x 1, then 10 mg Q4-6hr PRN
