Pain Management (Pain Meds) Flashcards
Acetaminophen
- Available as oral and rectal
- Weak COX-1 and COX-2 inhibitor in peripheral tissues
- Anti-pyretic
Acetaminophen dosage
Adults: 325-1000mg q4-6
Max daily dose of 4mg/day
Onset 15-30 mins
Acetaminophen SE
- Large doses cause liver toxicity and can be lethal
- Large doses can cause dizziness and disorientation.
- Renal damage can occur even w/ normal dosages.
Aspirin (ASA)
Salicylic acid.
- Irreversibly inhibits COX and platelet aggregation.
- Anti-pyretic
- Anti-inflammatory effects reduce pain
- Decrease thrombosis after CABG
ASA SE
- Gastric Upset, Ulcers
- Hepa, Renal toxicity
- Asthma and rashes
- Salicylism
- Overdoses are a medical emergency
Toxic Levels: acidosis, resp. depression, cardiotoxicity.
Salicylism
Vomiting, tinnitus, decreased hearing, vertigo.
Reversible by reducing dosage.
NSAIDS
- Mild to moderate somatic pain.
- Anti-pyritic
- Inhibits glycogenase (arachnidonic acid –> prostaglandins)
- COX-1 and 2 inhibitors
Prostaglandins
- Activation of inflammatory response
- Elicitation of pain and fever
- contraction and relaxation of smooth muscle
- inhibition of acid synthesis, increased mucous in stomach.
- Increased blood flow to kidneys.
NSAID SE
- GI Upset, ulcers
- Photosensitivity
- Renal: HTN
- Interfere w/ platelet aggregation for 2-4 days.
- CI in pregnant and lactating women
Ibuprofen
Advil, Motrin
200, 400 mg q4 or
600 mg q 6
Maximum 3200mg/day
Naproxen
Aleve
250-500mg q 12
maximum 1000mg/day
Prescription NSAIDS
Naproxen Ketoprofen (orudis) Indomethican Ketorolac (Toradol) - 5 days max Peroxicam (feldine) Meloxicam (Mobic) Ponstel
COX-2 inhibitors
As effective as NSAIDS
Less GI toxicity
Celecoxib (Celebrex)
- onset 3 hrs - good for arthritis
NSAID considerations
Risk for GI toxicity: - age>65 - use of anticoagulant therapy - previous GI bleed - active PUD - use of glucocorticoids Other: - take w/ food - BID instead of TID - Know renal status
Opioids
Severe pain
- exert effects through Mu1, 2 Delta and Kappa receptors. Block them.
- Most profound effect through Mu receptors
- Found in CNS - periaqueductal gray matter
Opioids SE
- N/V, constipation
- hypotension, bradycardia
- sedation, euphoria
- resp. depression
- dependence, tolerance, addiction
Physical Dependence
Body will go into PHYSICAL withdrawals.
Tachy, anxiety etc.
Addiction
Psychological dependence.
Extreme behavioral patterns.
Morphine
IM, IV, oral, rectal, intrathecal.
Severe Pain
Long acting forms for chronic pain
Morphine Dosage
IV: 2-5mg slow push
IM: 10-15mg
Oral varies
Demerol (Meperidine)
IV and IM
Used for severe pain
SE similar to morphine
Dosage: 25-50mg slow IV slow push.
Methadone
- Primarily used in US to treat opioid dependence.
- Extended duration of action and slow onset of action.
- can be used to treat acute pain.
Oxycodone
PO or IV
Used for severe pain
Oxycontin - long-acting
Oxycodone/acetominophen
Percocet or Rixocet 5/325 or 10/325
