Pharmacology _Alagesics Flashcards
Classification of mild pain, moderate pain or severe pain
Analgesics depending on Severity of pain:
Acetaminophen:
- other names?
- which pain level?
- indications for specific pain, such as
Acetaminophen:
- Strength
- Dosage: Adult & Children
- maximum dosage
- Frequency
Strength
- Suspension: 160mg/5ml
- Tablet: 325, 500,600
Dosage and Frequency:
- Children: (<12 years old and <40 kgs
○ 10-15mg/kg/dose every 4 to 6hours
○ Maximum daily dose: 75mg/kg/dose
- Adults:
○ 325 - 1000mg /dose every 4 to 6hours
○ Maximum daily dose: 4g/day
NSAIDS is used for which level of pain?
***Which conditions that absolute contraindicate NSAIDs?
7 pointers
NSAIDs and liver
- severer liver
- alcoholic cirrhosis
- Active hepatitis (Little and Falaces)
- Bleeding disorders - hemophilia A and Von Willebrand disease. (VIII)
Pregnancy and NSAIDs
a) 3rd trimester-……..
b) 1st and 2nd trimester -
- only 3 drugs …. are NTFC
. ……..are considered safe.
- all are contraindicated.
ASA, diflunisal and flurbiprofen - Rest
Pregnancy and NSAIDs
a) 3rd trimester - all are contraindicated.
b) 1st and 2nd trimester - ASA, diflunisal and flurbiprofen are NTFC. rest are considered safe.
***Which conditions that relative contraindicate NSAIDs?
Limit the use of NSADis in cases of: (Pharma = NTFC)
1. MI and Stroke
a) up to 4 days - NTFC
b) 5 days or more - CI (can be LT as well)
- Hypertension (patient on any of the following BAD drugs:
ACE inhibitors, beta blockers and loop diuretics)
a) up to 4 days - NTFC
b) 5 days or more - CI
What is Methotrexate
Manage Patient using Methotrexate to treat Arthritis:
- Methotrexate is indeed a folic acid analog, It works by inhibiting nucleotide synthesis (ADN). This leads to a decrease in DNA synthesis. methotrexate can slow down the growth of rapidly dividing cells.
Pt Management:
- Lower dose of MTX do not need avoid or limit NSAIDs
- Consult physician for any side effects present
Which conditions that absolute contraindicate for ASA only?
- Children with chickenpox, influenza or flu-like illnesses
- Patient on sulfonylureas
- Gout
Ibuprofen:
- Strength
- Dosage: Adult & Children
- maximum dosage
- Frequency
***Naproxen & Naproxen Sodium
- Strength
- Dosage: Initial dose
- Frequency
- Naproxen: 250, 375, 500mg
- Nap. Sod: 220, 275, 550 mg
Suspension: 125 mg/5ml
Maximum: 1250 - 1375 mg (5 tbsx 250)
(Initial 500mg; followed by 250mg every 6-8hrs - Nap)
Ibuprofen for kids?
Acetaminophen for kids?
(Dosesage & Frequency? RMD? Strength?)
Ibuprofen:
Children (<12 years or <40Kgs) - 10mg/kg/dose every 6 to 8 hours
Maximum daily dosage - 40mg/kg/day
Suspension - 100mg / 5ml, 200mg/ 5ml
Acetaminophen:
Children (<12 years or <40Kgs) - 10-15mg/kg/dose every 4 to 6 hours
Maximum daily dosage - 75mg/kg/day
***Suspension:160mg/5ml
Ketorolac:
- Strength
- Dosage: Adult
- maximum dosage *
- Frequency*
Strength :
- Tablet - 10mg
Dosage: Adults - 10mg every 4 to 6 hours (therapy should not go over 5 days: mandatory)
Maximum daily dosage - 40mg/day
Dosage of NSAIDs ( memo)
Dosage Drug Notes
10 Ketorolac No more than 5 days
25-50 Ketoprofen
50-100 Flubiprofen
200 Celebcoxib QD or BID(S: 100,200)
200-400 Etodolac
200-400 Floctafenine flock-tuh-FEH-neen
250-500 Naproxen
200-600 Ibuprofen
Cach nho:
Maxi: ibuprofen
Min: Ketorolac
Half: Etodolac- Floctafenine
Quarter: Flubiprofen
Naproxen 250 -500 => Ketoprofen: 25-50
Frequency of NSAIDs (memo)
Q6-8H
Naproxen
Ketoprofen
Ibuprofen for kid
BID
Diflunisal
BID or QD
Celecoxib
Acetaminophen vs Ibuprofen:
- Adult dose
- Adult Max daily dosage
- Kid dose
- Kid Max daily dosage
- Frequency:
Opioid Contraindications
(compared to NSAIDs contraindication)
1. severe respiratory disease - severe asthma and severe COPD
2. Severe ulcerative colitis and sever Crohn’s disease
3. Concurrent use of alcohol or other CNS depresssants
4. Drug abuses ( cocaine, heroin)
5. Codeine: not under 12 years
6. Meperidine: MAO inhibitors
Specific contraindications of Opioids
- Meperidine,Tramadol: no MAO inhibitors
- Codeine: no under 12 years old
- pt with history of tonsillectomy or adenoidectomy, no codeine under 18
Heroin vs Morphine
Morphine: It is a natural opioid alkaloid and the principal active component of opium.
Heroin: It is a* semi-synthetic opioid* derived** from morphine**. Heroin is created by chemically modifying morphine, and it is a more potent and fast-acting substance.
Natural Opioids (Opiates)
Morphine, Codeine
(From Opium Poppy)
- Semi-synthetic opioid from Codeine
- Semi-synthetic opioid from Morphine
- Semi-synthetic opioid from Thebaine
- Hydrocodone
- Heroin
- Oxycodone
Synthetic Opioids
Fentanyl, Methadone, Meperidine, Tramadol
In case of contraindications to both Opioids and NSAIDs, how to treat severe pain?
Opioids can be used in this case ( relative contraindication)
Ex: Tramadol
Tylenol = ?
Strength of T1? T2? T3? T4?
Frequency?
Daily Max
Dispense: Total tablets max?
Codeine + Acetaminophen Q4-6H
T1: Acetaminophen 300mg, Codeine 8mg
T2: Acetaminophen 300mg, Codeine 15mg
Dispense - no more than 36 tablets.
T3: Acetaminophen 300mg, Codeine 30mg
Dispense - no more than 24 tablets.
T4: Acetaminophen 300mg, Codeine 60mg.
Dispense - no more than 24 tablets.
Percocet?
Strength of Percocet
Acetaminophen 325mg, Oxycodone HCI 2.5mg
Acetaminophen 325mg, Oxycodone HCI 5mg
Acetaminophen 500mg, Oxycodone HCl 5mg
Q4-6H
Tramadol
Strength?
Dose? MRD
Frequency
tablet: 50 mg- 100mg
dose: 50-100mg
Q4-6H
Max: 400 (8 tablets)
