Pain

Question 1

acetaminophen

Answer 1

Tylenol, FeverAll (rectal suppository), Ofirmev (IV; 10 mg/mL in 100 mL vials)

Question 2

acetaminophen: safe use

Answer 2

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

Question 3

acetaminophen pediatric (<12 yrs) dose

Answer 3

10-15 mg/kg Q4-6 hr
Max: 5 doses/day
Infant and children’s suspension (use measuring device): 160 mg/5mL

Question 4

acetaminophen + hydrocodone

Answer 4

Lorcet, Lortab, Norco, Vicodin

Question 5

acetaminophen + oxycodone

Answer 5

Endocet, Percocet

Question 6

acetaminophen + codeine

Answer 6

Tylenol #2, #3, #4

Question 7

acetaminophen + tramadol

Answer 7

Ultracet

Question 8

acetaminophen + caffeine

Answer 8

Excedrin Tension Headache

Question 9

acetaminophen + aspirin + caffeine

Answer 9

Excedrin Extra Strength, Excedrin Migraine, Goody’s Powder

Question 10

acetaminophen + caffeine/pyrilamine

Answer 10

Midol

Question 11

acetaminophen + butalbital/caffeine

Answer 11

Fioricet

Question 12

acetaminophen + diphenhydramine

Answer 12

Tylenol PM

Question 13

acetaminophen + ibuprofen

Answer 13

Advil Dual Action

Question 14

acetaminophen overdose

Answer 14

antidote is N-acetylcysteine (NAC). Can be given IV or PO

Question 15

Non-selective NSAIDS like aspirin block…

Answer 15

COX1 and COX-2. Blocking Cox-1 decreases the formation of thromboxane (TxA2), which is required for both platelet activation and aggregation.

Question 16

Rx, non-aspirin NSAIDs required MedGuide due to risk of:

Answer 16

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)

Question 17

Side effects of all NSAIDs:

Answer 17

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

Question 18

Which IV NSAIDS can be used within 14 days of birth to close a patent ductus arteriosus?

Answer 18

1) indomethacin (Indocin)

2) ibuprofen (NeoProfen)

Question 19

Non-selective NSAIDs:

Answer 19

1) ibuprofen
2) indomethacin
3) naproxen
4) ketorolac
5) piroxicam
6) sulindac

Question 20

COX-2 selective NSAIDs:

Answer 20

1) celecoxib
2) diclofenac
3) meloxicam
4) nabumetone
5) etodolac

Question 21

ibuprofen (Advil, Motrin; Caldolor IV)

Answer 21

OTC:
200-400 mg Q4-6hrs; (max 1.2 g/day)
400-800 mg Q6-8hrs; (max 3.2 g/day)

Question 22

ibuprofen: pediatric dosing

Answer 22

5-10 mg/kg/dose Q6-8hrs (max: 40 mg/kg/day)

Question 23

indomethacin (Indocin, Tivorbex)

Answer 23

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)

Question 24

naproxen (OTC: Aleve, Rx: Naprelan, Naprosyn)

Answer 24

200 mg (220 mg naproxen sodium) Q8-12 hours
Max: 3 tabs in 24 hours (can take 2 tabs with first dose)

Question 25

naproxen + esomeprazole (Vimovo)

Answer 25

Used to protect GI tract

Question 26

ketorolac (Toradol, Sprix)

Answer 26

Oral: 10-20 mg x 1, then 10 mg Q4-6hr PRN