-
GI bleeding risd
NSAIDs and oral corticosteroids
-
Mild Pain
- Non-opioids
- Aspirin
- Acetaminophen
- NSAIDs
-
Moderate pain
- NSAIDs
- Acetaminophen + codine, hydrocodone, or oxycodone
- NSAID or anticonvulsant (pregabalin, etc)
-
Severe pain
- Oxycodone, Morphine, Methadone, Fentanyl
- adjuvants (NSAIDs, anticonvulsants)
- Topical
- ALL MEDS AROUND THE CLOCK
- sustained release, immediate for break-through
-
Skeletal muscle relaxants
Acute pain only
-
Corticosterioid side effects
- Immunosuppression/infection
- Adrenal suppression
- GI bleed/ulceration
- Fluid retention/wt gain
- Electrolyte changes
- Glucose intolerance
- Heart failure risk
- RESERVED FOR SERIOUS INFLAMMATORY STATES
-
Anti-epileptics
- (eg. pregabalin)
- adjuvant for neuropathy:
- Diabetic neuropathy
- Fibromyalgia
- Post herpetic neuralgia
- Trigeminal neuralgia
-
NSAID Risks
- Na+ and water retention
- GI bleeding risk
- -60yr +
- -peptic ulcer history
- -concomitant corticosteroid/duplicate NSAID
- -aspirin, warfarin
- -hemophilia
- -SSRIs, alcohol, oral biphosphonates
-
hydroxychloroquine (Plaquenil) use and risk
SLE/Lupus symptoms
RETINOPATHY RISK
-
fentanyl (Duragesic, Sublimaze)
- Q72H
- Cover with immediate release initial 18 hrs q3H and prn
-
Opioid side effects
- Nausea and vomiting
- Itching
- Sedation
- Constipation - no tolerance developed
- softener + stimulant (docusate + senna)
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