Pain Medication Flashcards
Codeine (Tylenol#3®)
15-60 mg Q 4 hr, max 360 mg/day
Age <12 lack enzyme to metabolize
Half life is 3-3.5 hours, long term sedation is concern
Tramadol
25-100mg PO depending on the severity, max 300-400 mg/day, half life is 5-6 hours (long), T 1/2 lis 6.3, and 7.4 for metabolite, Onset is longer (1-2 hours)
Synthetic analogue of morphine and codeine.
Active metabolite is very strong.
Not for seizure patients
High incidence of nausea and vomiting
Does not cause dependence, tolerance or addiction.
Fentanyl (Duragesic patch®)
20-50 mcg, 1.5-3 mcg/kg (intraop), onset 30-60 secs
(fast), 1-1.5 hours (fast)
The principle metabolite formed is Norfentanyl is excreted in kidneys, and detected in urine for 72 hours.
Elimination is prolonged due to lungs serving as a large inactive reservior.
Spinal= 5-25 mcg, Epidural=50-100 mcg; 25-100 mcg/hr
Hydrocodone (Lortab®, Vicodin®)
2.5-10 mg hydrocodone with 300 to 750 mg acetaminophen q4-6 hours.
Semi-synthetic opioid, codeine derivative but 8 times more potent,
Most often combined with acetaminophen (Norco, Vicodin, and Lortab)
2nd most commonly abused behind oxycodone.
Primary metabolite is Hydromorphone (Dilaudid)
IV Magnesium or CCB may increase opioid effect.
Hydromorphone (Dilaudid®)
0.2-1 mg IV Q 3-5 mins, 2-8 mg PO
Semisynthetic drug, effective alternative to morphine, 3-5 times potent as morphine, and 8.5 times as potent parentally.
Active metabolite potentiates neurotoxic effects such as allodynia, myoclonus, and seizures.
Epidural= 0.5-1 mg, 0.1-0.2 mg/hr
Methadone (Dolophine®)
Dose is 2.5 to 10 mg PO/IM/SC Q4-12 hours
Synthetic opioid used for opioid addiction, works on mu receptor, has very long half life up to 36 hours
Met by liver by CPY450, be careful with CYP 450 inducers like carbamazepine, antiretroviral agents, and grapefruit juice, also decreased concentration with phenobarbital, phenytoin, MAOIs
Increased concentration with ciprofloxacin, diazepam, ethanol (acute)
Hepatic and renal impairment does not influence clearance of methadone significantly. Excreted in urine primarily, some in bile.
Rarely QT prolongation and bradycardia.
Takes about 10 days to achieve steady state.
Morphine (MSIR® , MsContin®, Kadian®)
1-10 mg (intraop), 5-20 mg (post op), onset 10-20 mins, lasts 4-5 hours.
Oral dose three times IM/IV dose 30-50 mg PO
Active metabolite can cause adverse effects like neurotoxicity, and hyperalgesia
Minimal absorption into CNS (lipid solubility low, high protein binding, and high degree of ionization)
Spinal=0.1-0.3 mg, Epidural=1-5 mg; 0.1-1 mg/hr
Oxycodone (OxyIR®, Percocet®, Percodan®, Oxycontin®)
5 mg, onset 0.5 hours, half life is 3-5 hours (long)
Replaced morphine as the most used opioid
Made alone or with combination with Acetaminophen
CR (controlled released) is oxycontin
Acts on Mu and Kappa
Met by liver
Onset less than 1 hour, half life is 3-4.5 hours
PO most common, but has IV form
Buprenorphine (Subutex, Suboxone)
0.3 mg IM, mostly in IM and PO form, IV not as much. Prolonged action, half life is 20-73 hours.
Semi-synthetic agonist-antagonist opioid, partial mu agonist and kappa antagonist (no dysphoria which are common on other agonist/antagonist, also precipitate withdrawals on pts physically dependent on morphine), weak delta agonist.
Less RD, less immune suppression, reduced constipation, no accumulation in patients with impaired renal function.
Met by liver.
Acetaminophen (Tylenol)
500- 1000mg Q 6 hours, max 3g/24 hours.
Ibuprofen (Motrin)
200-400 mg TID
New research says 800 mg has the same effects as 400mg, NSAID
Celecoxib (Celebrex)
100 mg QD
NSAID
Naproxen (Naprosyn, Anaprox DS, Mediproxen)
220 mg BID
NSAID
Diclofenac (Flector, Cambia, Zipsor)
50 mg BID
NSAID
Pregabalin
300-600 mg
