Pain Management Flashcards
Ofirmev
Acetaminophen IV
Narcan
- Indication
- Form
Naloxone
- I: management of opioid overdose
- Form: IV
MSIR
Morphine IR
Embeda
- Caution:
ER morphine and naltrexone embed
- Caution: avoid EtOH => speeds the release of morphine, which can lead to respiratory depression
Dilaudid
- Potency compares to morphine
- Forms
Hydromorphone
- More potent than morphine with decrease histamine release and no active metabolites.
- An option to morphine for pts w/ renal impairment
- Forms: IM/SC/IV/PO/Suppository
Exalgo
- Form
- Frequency
Hydromorphine OROS ER
- PO QD
- Break into clumps if crushed or turns into a thick gel if mixed with liquid to defer pt from abuse
Zohydro
- Form
- Frequency
Hydrocodone ER
- Do not crush/chew
- PO BID
Roxicodone
Oxycodone
OxyContin
- Frequency
Oxycodone
- PO Q12H
Oxecta
- Special about this drug
Oxycodone IR
- Discourage abusers: breaks into chunks instead of a powder if crushed, turns into gel if mixed w/ liquid, and contains Na laurel sulfate, which irritates the nose if it’s snorted.
Opana
- Form:
- Frequency
Oxymorphone ER
- F: IV, IM, SC, PO
- Q12H
Demerol
- Avoid
- DDI
- Forms
- Max dose:
Meperidine
- Avoid in renal insufficiency: increase chance of sz
- DDI: MAOIs
- Forms: IV/IM/SC/PO/Syrup
- Max: 600mg/d due to SZ
Fentanyl
- Potency
- Safe in which population
- Duration of action
- DDI
Fentanyl
- 100x potent than morphine. Has insignificant histamine release. Decrease sedation and constipation
- Safe for pt w/ renal failure
- Has quick onset and short duration of action
- CYP3A4 substrate
Sublimaze
Fentanyl injection IV/IM
Lazanda
- Indication
- # s of spray in bottle:
Fentany nasal spray
- Indication: breakthrough pain
- each bottle contains 8 sprays
Actiq
Fentanyl lozenges - dissolves slowly in mouth
Abstral
Fentanyl SL tab
Subsys
Fentanyl SL srpay
Fentora
- Direction to take:
Fentanyl buccal tab:
- Buccal: place b/w the cheek and gums. Leave it there until it dissolves
Onsolis
Fentanyl buccal soluble film
Duragesic
- Form
- Frequency
- Dispose
Fentanyl Patch
- F: Q3D or Q72H
- Dispose: fold and flush down the toilet
- Remove prior to MRI
Diskets
- Indication
- High dose: 40mg
- high dose can cause:
Methadone
Indication
- Severe pain in opioid tolerance pts: 5, 10mg tab
- Opioid dependence: 40mg for detox and maintenance tx of opioid addicted pts. Not FDA approved for pain
High dose:
- Arrhythmia, respiratory depression
- QT Prolongation
Vicodin
- Max
Hydrocodone/APAP 5/300
- Max 8 tabs
Vicodin ES
- Max
Hydrocodone/APAP 7.5/300
- Max: 6 tabs
Vicodin HP
- Max
Hydrocodone/APAP 10/300
- Max 6 tabs
Norco
Hydrocodone/APAP 5/325, 7.5/325, 10/325
Vicoprofen
Hydrocodone/ibuprofen 7.5/200
Tylenol + Codiene
#1: #2 #3 #4
- Black box
- Indication
#1: 300/7.5 #2: 300/15 #3: 300/30 #4: 300/60
- Black box: do not use in kids after a tonsillectomy due to some deaths and serious ADEs
- Codeine is a prodrug that converts into morphine by 2D6
- Indication: mild to moderate pain
Roxicet
Oxycodone + APAP: 5/325mg Q6H
Percocet
Endocet
Oxycodone + APAP: Q4-6H
5/7.5/10 plus 325 mg
- CS II
Xartermis XR
Oxycodone + APAP: Q12H
- Same as percocet/endocet
Percodan
Endodan
Oxycodone + ASA: Q6H
- 88/325mg
- 44/325
Butrans
- MOA
- Form and frequency
- Indication
- CS
Buprenorphine transdermal system
- MOA: partial opioid agonist and antagonist
- F: Patch change once a week
- Indication: mod to severe pain
Do not give w/ other opioid - CS: III
Subutex
- Indication
- DEA
- CS
Buprenorphine
- Pain given 3-4x/d
- Opioid addiction
- Tx of opioid dependence
- DEA # starts with X is required to dispense to treatment of opioid addiction. If rx for pain, do not need DEA w/ X
- CS III
Fioricet with codeine
- Indication
- Max
APAP + butalbital + caffeine + codeine
325/50/40/30
- Indication: Tension or muscle contraction HA
- Max: 6 tabs/d
Fiorinal with codeine
- Indication
- Max
- CS:
ASA + butalbital + caffeine + codeine
325/50/40/30
- Indication: Tension or muscle contraction HA
- Max: 6 tabs/d
- CS III
Vivitrol
- Form
- Indication
- Dose
Naltrexone ER
- Form: IM
- Indication:
Treat and prevent replace after detox
EtOH dependence - Dose: 380mg ONCE a month IM injection
Utram
- Indication
- Max dose
- SEs
- DDI
Tramadol
- Indication: mod to severe pain
- Max dose: 400mg/d in health pt; 300mg in elderly
SEs:
- Dizziness, GI upset, *constipation
- *Somnolence
- Seizure
DDI
- MOAIs, SSRIs, SNRIs = may cause serotonin syndrome
Ultracet
- Duration of use
- 5 Tramadol + 325 APAP
- For short term 5 days
Nucynta
- Indication
- Max dose
- CS
- SE
Tapentadol => similar to Tramadol
- Indication: mod to severe pain in > 18 y.o
- Max dose: 600mg/day
- CS: II
SEs
- Resp depression
- CNS depression
- Serotonin syndrome
- Increase risk of SZ
MS Contin
- Frequency
- Form
Morphine
- Q8-12H
- CR tab - don’t break or chew
15, 30, 60, 100, 200mg
Oramorph
- Frequency
- Form
Morphine
- Q8-12H
- CR tab - don’t break or chew
Avinza
- Frequency
Morphine ER
- 24H: Opened and sprinkled on applesauce
Kadian
- Frequency
Morphine ER
- 12- 24H: Opened and sprinkled on applesauce
Embeda
- Frequency
- Avoid
Morphine ER
- 12-24H: morphine pellets with an inner core of naltrexone
- Avoid w/ EtOH = speed the release of morphine = CNS depression
Roxanol
Morphine Soln
RMS
Morphine suppository
Lorcet
- Dose
hydrocodone/APAP
- 10/650mg
Percolone
Oxycodone
Xartemis XR
- Dose
Oxycodone + APAP
- Dose: 2 tab Q12H
Pethidine
- Avoid
Meperidine
- Avoid in renal insufficiency: increase chance of sz
Dolophine
- Indication
- High dose can cause
Methadone
Indication
- Severe pain: in opioid tolerance pts: 5, 10mg tab
- Opioid dependence: 40mg for detox and maintenance tx of opioid addicted pts. Not FDA approved for pain
High dose:
- Arrhythmia, respiratory depression
Buprenex
- MOA
- Indication
- CS
Buprenorphine injection
- MOA: partial opioid agonist and antagonist. Do not give w/ other opioid
- Mod to severe pain
- CS: III
Suboxone
- Form
- Dose/Indication
- CS Category
Buprenophine/naloxone
- Form: film
- Dose/Indication
Pain: given 3-4x/day
Opioid addiction: QD
DEA # starts with X is required to dispense to treatment of opioid addiction. If rx for pain, do not need DEA w/ X
- CS III
Zubsolv
- Form
- Dose/Indication
- CS Category
Buprenorphine/Naloxone
- F: SL TAB
- Dose/Indication
Pain: given 3-4x/day
Opioid addiction: QD
DEA # starts with X is required to dispense to treatment of opioid addiction. If rx for pain, do not need DEA w/ X
- CS III
Ultram
- Max dose:
- SEs
Tramadol
- Max: 400mg/d due to seizure
Age > 75: max 300mg/day - SEs: Anticholinergic, SZ, sedation
Ryzolt
- Frequency:
Tramadol
- Frequency: QD
Ultracet
Tramadol + APAP
ReVia
- Form:
- Indication
Naltrexone
- Form: PO QD
- Indication:
Treat and prevent replace after detox
EtOH dependence
Depade
- Form:
- Indication
Naltrexone
- Form: PO QD
- Indication:
Treat and prevent replace after detox
EtOH dependence
Hysingla
- Form
- Frequency
Hydrocodone
- ER
- PO QD
Targiniq
- Frequency
Oxycodone + Naloxone ER
- PO Q12H
Bunavail
- Form
- Dose/Indication
Buprenorphine + naloxone
- Form: Buccal film
- Dose/Indication
Pain: given 3-4x/day
Opioid addiction: QD
Evzio
- Indication
- Form
Naloxone
- I: management of opioid overdose
- Form: SC/IM auto-injector
Relistor
- Form
- Indication
Methylnaltrexone
- Form: SC
- I: tx for opioid-induced constipation
Movantik
- Form
- Indication:
- CS
Naloxegol
- Form: SC
- I: tx for opioid-induced constipation
- CS: II
Campal
- Indication
- Dose/frequency
Acamprosate
- I: Tx of EtOH dependance or alcoholism
Decrease craving - Dose: 666mg PO TID
Antabuse
- Indication
- Frequency
Disulfiram
- I: Tx of EtOH dependance or alcoholism
- D: PO QD
Gralise
- Indication
Gabapentin ER QD
- I: post-herpetic neuralgia
