- APAP - FeverAll - rectal suppository formulation - Ofirmev - injection

- Hydrocodone + APAP - Also Vicodin and Norco

- N-acetylcysteine, antidote for APAP overdose - Glutathione precursor, increases glutathione - Administered IV or PO - Rumack-Matthew nomogram used to determine likelihood of hepatotoxicity and if NAC is needed

- Ibuprofen - Also Advil and Motrin B - Max of 3.2 g/d - 200-400 mg for adult dosing Q4-6H - Limit self-treatment <10 days

- Indomethacin - High risk for CNS side effects

- Naproxen + esomeprazole - Naproxen can sometimes be dosed BID

- Ketorolac - Oral and NS formulation - Max of 5 days duration combined for lifetime - Warning: acute renal and hepatic failure - Prime NS 5 times before use

- Celecoxib - CI: Sulfonamide allergy - Highest COX-2 selectivity

- Diclofenac - Max of 32 g/d total body - Patch can be applied BID - Box Warning: Avoid Arthrotec formulation in childbearing females (contains misoprostol)

- ASA + Acetylsalicylic acid - Also Bufferin or Ecotrin - All EC/buffered

Pain Flashcards by Rachel Crusius

FeverAll/Ofirmev

APAP
FeverAll - rectal suppository formulation
Ofirmev - injection

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Lorcet/Lortab

Hydrocodone + APAP

- Also Vicodin and Norco

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Endocet

Oxycodone + APAP

- Percocet

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Excedrin Tension HA

APAP + Caffeine

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Excedrin Extra Strength

APAP + ASA + Caffeine

- Also Excedrin Migraine

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Midol Complete

APAP + Caffeine + Pyrilamine

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NAC

N-acetylcysteine, antidote for APAP overdose
Glutathione precursor, increases glutathione
Administered IV or PO
Rumack-Matthew nomogram used to determine likelihood of hepatotoxicity and if NAC is needed

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Cadalor

Ibuprofen
Also Advil and Motrin B
Max of 3.2 g/d
200-400 mg for adult dosing Q4-6H
Limit self-treatment <10 days

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Indocin

Indomethacin

- High risk for CNS side effects

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Vimovo

Naproxen + esomeprazole

- Naproxen can sometimes be dosed BID

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Toradol

Ketorolac
Oral and NS formulation
Max of 5 days duration combined for lifetime
Warning: acute renal and hepatic failure
Prime NS 5 times before use

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Celebrex

Celecoxib
CI: Sulfonamide allergy
Highest COX-2 selectivity

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Voltaren

Diclofenac
Max of 32 g/d total body
Patch can be applied BID
Box Warning: Avoid Arthrotec formulation in childbearing females (contains misoprostol)

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Agents with SOME COX-2 Selectivity

Meloxicam (Mobic)

- Nabumetone

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Ascriptin

ASA + Acetylsalicylic acid
Also Bufferin or Ecotrin
All EC/buffered

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Excedrin

APAP + ASA + Caffeine

-Also Excedrin Migraine

Yosprala

-ASA + Omeprazole

Doan’s Extra Strength

Magnesium Salicylate

- Non-acetylated salicylates

Salicylate NSAID Information

Salicylate overdose can cause tinnitus
Methyl salicylate is popular OTC topical in BenGay, IcyHot, and Salonpas
Take ASA 1 hour before or 8 hours after ibuprofen if being used together
NSAIDs in general can increase the levels of lithium

Opioids with Alcohol Boxed Warning

Kadian
Nucynta ER
Oxymorphone ER
Zohydro ER

Codeine Classes

CII: Codeine tablet
CIII: tablet/capsule combination products
CV: oral solution combination products

Codeine Information

Risk of respiratory depression and death in ultra-rapid metabolized of CYP2D6 polymorphism
Don’t use in kids < 12 or kids < 18 following tonsillectomy/adenoidectomy
SE: Constipation

Sublimaze

Fentanyl, Duragesic is also a brand name
Actiq: transmucosal lozenge on stick (lollipop)
1 patch Q72H

Fentanyl Information

CYP3A4i
SE: Application site redness/erythema
Only potential to use in patients on 60 mg or morphine or more for at least 7 days
Similar drug is remifentanil (IV)
Apply to hairless skin (cut hair if necessary)
Only cover w/ permitted adhesives: Bioclusive, Tegaderm

Dilaudid

- Hydromorphone - Oral: 2-4 mg Q4-6H PRN - IV: 0.2-1 mg Q2-3H PRN

Hydromorphone Information

- Boxed Warning: Medication error with high potency (use in opioid tolerant ONLY) - High risk for overdose

Dolophine

- Methadone - Box Warning: QT prolongation (life-threatening) - Variable half-life - Decreases testosterone and can cause sexual dysfxn - Major CYP3A4 substrate (avoid with inhibitors)

Demerol

- Meperidine - Warning: renal impairment/elderly at risk for CNS toxicity - No longer recommended as an analgesic - Short duration - Metabolite is renally cleared and can accumulate/induce seizures - Serotonergic, increased 5HT syndrome risk

Kadian

- Morphine - ER formulation, MS Contin is another one - Injection: Duramorph, Infumorph - SE: Pruritus - Diphenhydramine can be used to prevent histamine-induced pruritis

Roxicodone

- Oxycodone - IR formulation - CR: OxyContin, Endocet or Percocet is + APAP - Box warning: CYP3A4i - SE: Pruritus

Opana

- Oxymorphone | - Take on an empty stomach!

IV/IM Opioid Conversions

Morphine 10 mg : Hydromorphone 1.5 mg

Oral Opioid Conversions

Morphine 30 mg : Hydromorphone 7.5 mg : Oxycodone 20 mg

Opioid Allergy

Tend to Cross-React: - Codeine - Hydrocodone - Oxycodone - Morphine - Hydromorphone - Oxymorphone - Buprenorphine - Heroin