Term
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Definition
-MOA:
Inhibition of cyclooxygenase (COX) enzymes 1 and 2 causing reduction in prostaglandin precursors associated with inflammation and pain.
-Anti-inflammatory and anti-pyretic
-Indications:
Mild to moderate pain, inflammation, and fever.
-Adverse Effects:
Gastrointestinal
Cardiovascular
Renal
Reye’s syndrome
Use caution in certain patient populations.
-Drug Interactions:
Anti-hypertensive agents
Diuretics
Anticoagulants
-Patient Counseling:
Make aware of signs and symptoms of GI bleeding. |
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Term
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Definition
Also indicated for prevention and treatment of MI and acute ischemic stroke/TIA.
Other NSAIDs may diminish cardioprotective effects. |
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Term
| Indomethacin & Ibuprofen (NSAID) |
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Definition
Also utilized for patent ductus arteriosus in infants
Maximum daily dose IBU – 1200 mg to 3200 mg |
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Term
| Ketorolac (IV, IM, PO) (NSAID) |
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Definition
Dose adjustment required for geriatric, renal insufficiency, low body weight
Maximum daily dose
Maximum duration of treatment is 5 days |
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Term
Selective COX-2 Inhibitors(NSAID)
Celecoxib (Celebrex)
Bextra and Vioxx removed from market due to increased risk of heart attack and stroke |
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Definition
Indications: osteoarthritis, rheumatoid arthritis
Lower incidence of gastrointestinal adverse effects |
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Term
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Definition
MOA:
Inhibits CNS prostaglandin synthesis
Indications:
Mild pain
Severe pain in combination
Fever.
Dosing:
Usual dose: 500-650 mg PO Q 4-6H prn
Maximum daily dose: 3 grams
Hepatic dosage adjustment: limit to 2 grams/day
Children: 10-15 mg/kg PO Q 4-6H prn
Children
Pregnancy and breastfeeding.
Adverse Effects:
Hepatotoxicity
Black Box Warnings:
Hepatotoxicity
Contraindications:
Hypersensitivity
Severe hepatic impairment/ Severe active liver disease
Drug Interactions:
Concomitant hepatotoxins
Ethanol.
Patient Counseling:
Maximum daily dose
Warn against inadvertent overdose
Report unresolved pain or fevers. |
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Term
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Definition
MOA:
Inhibits CNS prostaglandin synthesis
Indications:
Mild pain
Severe pain in combination
Fever.
Dosing:
Usual dose: 500-650 mg PO Q 4-6H prn
Maximum daily dose: 3 grams
Hepatic dosage adjustment: limit to 2 grams/day
Children: 10-15 mg/kg PO Q 4-6H prn
Children
Pregnancy and breastfeeding.
Adverse Effects:
Hepatotoxicity
Black Box Warnings:
Hepatotoxicity
Contraindications:
Hypersensitivity
Severe hepatic impairment/ Severe active liver disease
Drug Interactions:
Concomitant hepatotoxins
Ethanol.
Patient Counseling:
Maximum daily dose
Warn against inadvertent overdose
Report unresolved pain or fevers. |
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Term
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Definition
Introduction:
Fioricet
Tabs, caps, oral liquid
MOA:
Butalbital – barbiturate – sensory cortex and motor activity depression, sedation/drowsiness.
Caffeine – increase in cAMP, vasoconstriction, CNS stimulation
Indication: headache
Dosing:
50 mg butalbital/40 mg caffeine/325-750 mg APAP
1-2 tabs/caps (15-30 mL soln) Q4H prn
Maximum daily dose???
Adverse Effects:
Nausea
CNS depression, drowsiness, depression, respiratory depression, nervousness, insomnia, nightmares, hallucinations, tachycardia
Hepatotoxicity
Drug Interactions:
CNS depressants
Alcohol
Patient Counseling:
Contains APAP, avoid inadvertent overdose. |
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Term
Tramadol
(Ultram, Ultram ER, Ultracet) |
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Definition
MOA:
Opioid receptor agonist
Inhibits reuptake of serotonin and norepinephrine
Indications: moderate to severe pain
Dosing:
50 – 100 mg Q4-6H prn
Maximum daily dose 400 mg (300 mg extended-release products)
Adverse Effects:
Nausea, vomiting, constipation
Sedation, somnolence, dizziness, euphoria, dysphoria
Hypotension, seizures, abstinence syndrome with abrupt discontinuation
Drug Interactions:
CNS depressants
Antidepressants may increase risk of seizures and serotonin syndrome
Patient Counseling:
May cause drowsiness
Abrupt discontinuation may result in withdrawal symptoms |
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Term
Narcotics (ALL)
Fentanyl, hydromorphone, methadone, morphine, oxycodone |
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Definition
MOA:
µ opioid receptor agonist activity alteration in perception and response to pain centrally and peripherally
Indications:
Moderate pain, severe pain
Dosing:
Titrate to response.Adverse Effects:
Rash, pruritis
Gastrointestinal
Nausea, vomiting
Constipation
CNS depression
Sedation , dizziness
Respiratory depression.
Black Box Warnings:
High potential for abuse, misuse, and diversion
May cause potentially life-threatening hypoventilation, respiratory depression, and/or death
Contraindications:
Paralytic ileus.Drug Interactions:
CNS depressants
Alcohol
Patient Counseling:
May cause constipation requiring laxatives
May cause drowsiness and impair your ability to operate machinery
Avoid alcohol use
May cause physical or psychological dependence with prolonged use
After prolonged use, abrupt discontinuation may result in abstinence syndrome. |
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Term
Morphine (Kadian, Avinza, MS Contin, Oramorph, Roxanol)
**NARCOTIC** |
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Definition
Dosage forms – immediate and sustained-release tablets, injection, oral solution, suppositories
Patient counseling – do not crush or chew the controlled-release products |
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Term
Oxycodone (OxyContin, OxyIR, Roxycodone)
**NARCOTIC** |
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Definition
Dosage forms: capsules, oral liquid, oral concentrate, immediate and controlled-release tablets
Patient counseling – do not crush or chew the controlled-release products
Deaths due to overdose have been reported due to misuse/abuse after crushing the sustained-release tablets |
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Term
Fentanyl (Duragesic, Actiq, Sublimaze)
**NARCOTIC** |
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Definition
Dosage forms: transdermal patch, buccal tablets, film, lozenges, injection
Dosing:
Transdermal patch 12.5 – 100 mcg/hr Q72 hours
Buccal 200 mcg Q3 hours prn
IV: 1 mcg/kg/hour infusion, 50 – 100 mcg IV prn
Adverse effects
Transdermal patch – skin rash
Patient counseling
Transdermal patch – rotate application site to reduce skin irritation, may take up to 12 hours for onset of effect, never cut patches, discard properly. |
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Term
Hydromorphone (Dilaudid)
**NARCOTIC** |
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Definition
Dosage forms: oral liquid, immediate-release tablets, injection, suppository
1 mg morphine is approximately equal to 0.2 mg hydromorphone |
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Term
Methadone (Methadose, Dolophine)
**NARCOTIC** |
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Definition
Dosage forms: tablets, oral solution, injection
Also indicated in detoxification for opiate addition
Dosing:
Pain – multiple daily doses
Addiction – single daily dose |
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Term
| Narcotic/Non-narcotic Combinations (ALL) |
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Definition
Commonly combined with APAP or ibuprofen as coanalgesics
Codeine/APAP, hydrocodone/APAP, hydrocodone/IBU, oxycodone/APAP
Indications: moderate pain. |
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Term
Codeine/APAP (Tylenol 2, Tylenol 3, Tylenol 4, Tylenol with Codeine)
(Narcotic/Non-narcotic Combinations) |
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Definition
Dosage forms: tablets, elixir
Also used for cough
C-III |
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Term
Hydrocodone/APAP (Vicodin, Lorcet, Lortab)
(Narcotic/Non-narcotic Combinations) |
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Definition
Dosage forms: tablets, elixir, solution
C-III |
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Term
Hydrocodone/IBU (Vicoprofen)
(Narcotic/Non-narcotic Combinations) |
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Definition
Dosage forms: tablets
C-III |
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Term
Oxycodone/APAP (Percocet, Endocet, Roxicet, Tylox)
(Narcotic/Non-narcotic Combinations) |
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Definition
Dosage forms: capsules, tablets, oral liquid
Indicated for moderate or severe pain
C-II |
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