Pain Flashcards
How does acetaminophen work and what are its names and dosing?
What to use for acetaminophen overdose?
What to know about NSAIDs in pregnancy?
Inhibition of PG synthesis. Tylenol, Ofirmev, FeverAll. Max dosing is <4000 mg/day. 10-15 mg/kg Q4-6h. BBW hepatotoxicity, >4 grams/day or use of multiple acetaminophen containing products. Watch for severe skin rash and avoid APAP abbreviation.
N-acetylcysteine(NAC), Restores glutathione, oral and IV, rumack-matthew nomogram.
Do not use NSAIDs in the 3rd trimester of pregnancy, NSAIDs can prematurely close the DA. IV NSAIDs (indomethacin, ibuprofen) can be used within 14 days of birth to close a patent ductus arteriosus (PDA).
What are the non-aspirin NSAIDs and how do they work?
What are the side effects to know about the Cox-1 and Cox-2 non selective NSAIDs?
Cox-1 and Cox-2 non selective, all have GI risk, CV risk, and risk in CABG setting. Aspirin is recommended in CABG though. Ibuprofen(motrin,advil), Indomethacin(Indocin),Naproxen(aleve)+esomeprazole(Vimovo), Ketorolac(toradol)(Sprix is nasal spray).
OTC: 200-400 mg, Peds:5-10 mg/kg/dose Q6-8h. High risk for CNS side effects with indomethacin, Naproxen can be dosed BID. Toradol has a max duration of 5 days in adults(combined), watch for acute renal failure, liver failure, Nasal spray of ketorolac is one spray in each nostril if <65 or >50, >65 or <50 is one nostril.
What are the Cox-2 selectivity NSAIDs?
What are the Cox-2 selectivity NSAIDs side effects?
What are the salicylate NSAIDs?
Celecoxib(Celebrex). Lower risk for GI complications, Increased risk of MI/stroke,same renal risk. Diclofenac(voltaren), Meloxicam(mobic), Nabumetone.
Celecoxib is CI’d in a sulfonamide allergy, Highest Cox-2 selectivity. Diclofenac(Arthrotec: avoid in women of childbearing potential). Misoprostol is used to replace the gut protective PG to lower GI risk. Meloxicam and NAbumetone and Etodolac have some COX-2 selectivity.
Aspirin(Bufferin, Ecotrin). Cardioprotection dosing is 81-162 mg daily. Avoid in children and teenagers with any viral infection due to Reye’s syndrome. Dyspepsia,heartburn,bleeding. PPI’s may protect the gut, consider the risks(lower bone density, increased infection risk), Overdose can cause tinnitus, Methyl salicylate is found in bengay.
What is the non acetylated salicylates?
What are the NSAID drug interactions?
What are the opioid boxed warnings?
Magnesium salicylate(Doans).
If using aspirin for cardioprotection and ibuprofen for pain take aspirin one hour before or 8 hours after ibuprofen.
Addiction, abuse, and misuse can lead to death. Respiratory depression, Use with benzos increases the risk of death. Kadian, Embeda, Zohydro, and Nucynta ER:do not consume alcohol, accidental ingestion/exposure can be fatal, Crushing, dissolving, or chewing can lead to a potentially fatal dose.
What to know about Codeine?
What to know about fentanyl?
What to know about hydrocodone?
C2, C3 tablet/capsule combo products. C-V oral solution combination products. Respiratory depression and death have occurred in children following a tonsillectomy and or adenoidectomy. CYP450 2D6 polymorphism, deaths in nursing infants. Use in children younger than 12 or children under 18 after surgery. Constipation side effects.
Duragesic, Sublimaze. C2, actiq is an oral transmucosal lozenge, Apply 1 patch every 3 days. Fentanyl is not used in opioid-naive patients, Morphing 60mg/day or at least 7 days can be converted to a patch. Dispatch of patch in toilet. remifentanil is similar.
C2. Acetaminophen(norco, lorcet, lortab, vicodin), + chlorpheniramine(tussionex, pennkinetic ER). CYP3A4 inhibitors. Hydrocodone ER is C2 also and has CYP3A4 inhibitors BBW.
What to know about hydromorphone?
What to know about methadone?
What to know about meperidine?
Dilaudid, Oral is 2-4 mg q4-6 PRN and IV is 0.2-1 mg Q2-3. Risk of medication error with high potency, opioid-tolerant patients only). Potent, high risk for overdose.
Dolophine, Methadose. Life threatening QT prolongation, variable half-life, lower testosterone.
Demerol, Renal impairment/elderly at risk for CNS toxicity, no longer recommended as an analgesic, short duration, Normeperidine (metabolite) renally cleared, including seizures, serotonergic.
What to know about Morphine?
What to know about Oxycodone?
What to know about Oxymorphone?
MS contin, Kadian, Duramorph.
C2, inhibition of CYP3A4 inhibitors, Oxycontin is CR, + acetaminophen(endocet, percocet).
Opana, Take on an empty stomach, IR opioid naive(5-10 mg Q4-6h PRN.
What is the opioid dosing conversion?
How to treat opioid induced constipation?
What are the centrally acting analgesics?
Morphine 10 IV/IM is 30 oral. Hydromorphone 1.5 IV/IM is 7.5 oral.
PAMORAS, Methylnaltrexone(Relistor), only for those who failed OTC laxatives. Naloxegol. OIC: 24 mcg BIG is Lubiprostone(chloride channel activator).
Tramadol(ultram) +acetaminophen is Ultracet. Works by mu opioid agonists and inhibitors or norepinephrine reuptake.
What to know about tramadol?
What to know about tapentadol?
Who should get a naloxone RX?
Seizure risk, serotonin syndrome, Inhibitors of CYP2D6 or 3A4. <12 or <18 following surgery, requires conversion by CYP2D6 so inhibitors can affect it. C-4
Nucynta, C-2. Increase seizure risk, serotonin syndrome.
history of previous overdose, substance abuse, ultra large doses(>50 mg equivalents), use with benzos, comorbid illness such as respiratory or psychiatric disease.
What are the s/sx of acute opioid overdose?
What to know about naloxone?
What to know about buprenorphine?
extreme sleepiness, slow or shallow breathing, fingernails or lips turning blue or purple, extremely small(pinpoint) pupils, slow heartbeat and/or blood pressure.
Narcan, repeat dosing can be required, acute withdrawal(pain).
C3, Butrans, Belbuca, +naloxone, suboxone, zubsolv. Change patch weekly, disposal is fold sticky sides together and flush. Prescribe for dependance need a DATA 2000 waiver DEA which will start with X.
What to know about Gabapentin?
What to know about Pregablin?
What is the only FDA approved med for trigeminal neuralgia?
Neurontin. Horizont(ER tablet) is for PHN and restless legs syndrome. Somnolence,ataxia, peripheral edema, weight gain.
Lyrica, C-V. Somnolence, mild euphoria, approved for use in fibromyalgia, PHN and neuropathic pain.
Carbamazepine
What to know about baclofen?
What to know about cyclobenzaprine?
What to know about Tizanidine?
Lioresal, All muscle relaxants cause sedation, dizziness, confusion.
Fexmid, Amrix ER, Flexeril. Dry mouth and serotonergic.
Zanaflex, hypotension, dry mouth, weakness, Centrally acting alpha 2-agonist.
What to know about carisoprodol?
What to know about Methocarbamol?
What to know about SNRI’s and TCA’s?
Soma, C-4, Poor Cyp2C19 metabolizers will have increased concentrations.
Robaxin, Robaxin-750. Rarely used is dantrolene(dantrium used for malignant hyperthermia)
Amitriptyline (Elavil), Duloxetine (Cymbalta).
What to know about lidocaine 5% patches?
What to know about Capsaicin 0.025% and 0.075%?
Lidoderm, AAAA up to 12 hours/day, approved for PHN(shingles) pain. Do not apply more than 3 patches at one time of Lidoderm.
Zostrix, Zostrix HP. Wash hands and do not touch genitals, nasal area, mouth or eyes, it will burn sensitive skin.
