Pain Flashcards
FeverAll/Ofirmev
- APAP
- FeverAll - rectal suppository formulation
- Ofirmev - injection
Lorcet/Lortab
- Hydrocodone + APAP
- Also Vicodin and Norco
Endocet
- Oxycodone + APAP
- Percocet
Excedrin Tension HA
APAP + Caffeine
Excedrin Extra Strength
- APAP + ASA + Caffeine
- Also Excedrin Migraine
Midol Complete
APAP + Caffeine + Pyrilamine
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
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
Indocin
- Indomethacin
- High risk for CNS side effects
Vimovo
- Naproxen + esomeprazole
- Naproxen can sometimes be dosed BID
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
Celebrex
- Celecoxib
- CI: Sulfonamide allergy
- Highest COX-2 selectivity
Voltaren
- Diclofenac
- Max of 32 g/d total body
- Patch can be applied BID
- Box Warning: Avoid Arthrotec formulation in childbearing females (contains misoprostol)
Agents with SOME COX-2 Selectivity
- Meloxicam (Mobic)
- Nabumetone
Ascriptin
- ASA + Acetylsalicylic acid
- Also Bufferin or Ecotrin
- All EC/buffered
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
