Acetaminophen
Tylenol, Paracetamol, Ofirmev (injectable),etc injection- Rx only, Tab( chewable, Disintegrating, ER), caps, gelcap, elixir, solution, suspension, suppository, injection mild pain -HA, ARthritis, fever mod- severe- combined w/ other analgesics preg B(po) /C (inj)500-650mg q 4-6hr prn max. 4g/day, 3g for chronic use children<12yrs:10-15mg q 4-6 hrs prn do not exceed 5 dose in 24hr renal impair- less frequent, liver-2g/day for chronic alcoholics ADR- hepatotoxicity @ excessive. non toxic @ therapeutic DI- carbamazepine, ethanol (>3drinks), isoniazid, phenytoin, warfarin CI- hypersensitivity, severe hep. impair pts note : preferred during pregnant, breastfeeding
Butalbital w/ Caffeine& Acetaminophen
brand; class; OTC; dosage form; indication; Pregnancy; dose; ADR; DI; couseling; note
brand; class; OTC; dosage form; indication; Pregnancy; dose; ADR; DI; couseling; note
brand; class; OTC; dosage form; indication; Pregnancy; dose; ADR; DI; couseling; note
brand; class; OTC; dosage form; indication; Pregnancy; dose; ADR; DI; couseling; note
brand; class; OTC; dosage form; indication; Pregnancy; dose; ADR; DI; couseling; note
Oxycodone
Oxycontin, OxyIR,Roxicodone C II narcotic, cap, oral liquid, concentrate, IR, CR mod-severe pain init 50mg po q 4-6 hr; 10mg ER q 12hr (naive) maintenance- 20-160mg q12h; no max ADR- constipation, n/v, dizziness, xerostomia, pruritus (histamine release); rare/severe- hallucination, hpotension, respiratory/CNS depression MI-CNS depressants, MAO-I, SSRIs CP- drowsiness, avoid, constipation (laxative), discontinuation; combo w/ apap or ibu note : only PO, CR not for acute**death if abuse after crushing SR tablet
Tapentadol
Nucynta, Nucynta ER C II narcotic tab, ER mod-sever pain prg C dose- 50-100 q 4-6 for acute;(max 700 then 600mg);ER 50mg q 12h for chronic (max 500) dec. dose for hepatic impair; not recommend for severe renal & hepatic impair ADR-sedation, hypotension, n/v, constipation,pruritus; rare/severe- S syndrome, seizure, respiratory depression DI- alcohol, CNS depressant, SSRI, MAOI, naloxone (seizure) CP- drowsines, alcohol, discontinuation, no refill note- only po; ER not for acute or postoperative pain; guide @ dispense; ct w/ seizure hx
Tramadol
Ultram, Conzip, Ultracet, Ultram ER, Rybix ODT analgesic Norcotic IR, ER, ODT, ultracet is combo w/ actaminophen mod-severe pain*, neuropathic pain prg C initial 50mg q4-6; main.50-100mg; max 400/day (300 ER); renal&hepatic q 12h ADR-sedation,dizziness, constipation, n/v, somnolence, euphoria/dysphoria rare (hypotension, seizure @ >500mg/day (discontinuation) MI-carbamazepine(dec. level), mao inhibitor, TCA, SSRI (S syndrome), naloxone (seizure) CP- w/ d syndrome, drowsiness NOT CONTROLLED (but abuse pot), caution w/ sz hx
Codeine/Acetaminophen
Capital & codeine, Tylenol2, Tylenol 3, Tylenol 4, Tylenol w/ Codeine tabs- C III; solution- C V Analgesics- nacotic/non-narcotic tabs, oral solution mild-mod*; antitussive prg C dose:Adult- antitussive : 15-30mg q 4-6 hr; pain- 30-60mg q4-6max 4g/ 2g for chronic alcoholics children : 0.5-2mg codeine/kg per dose q 4-6h (5,10,15ml q 6,6,4)renal reduction; hepatic adjust- limit acetaminophen to <2g and avoid if cirrohis pts ADR- constipation, n/v, sedation, dizziness, xerostomia, pruritus rare/severe- hallucination, hypotension, respiratory and cns depression, hepatotoxicity DI- CYP2D6 inhibitors, CNS depressants, ethanol use, Isoniazid, warfarin cp- drowsiness, laxative may b needed, discontinuation, dependence, note : differ in individual metabolism (converting codeine to active metabolite)
Hydrocodone/Acetaminophen
Lorcet, Lortab, Norco, Vicodin, Zydone, etc analgesic- narcotic/non narcotic C III Tab, cap, oral solution moderate pain preg. C Adult max (4g of acetaminophen; 2g for alcoholics) ADR : constipation, n/v, sedation, dizziness,xerostomia, pruritus (histamine release); rare/severe-hallucination, hypotension, respiratory and cns depression, hepatotoxicity (exceeding acet. dose)DI- cns depressant, ehtanol (>3), isoniazid, warfarin, cns depressant CP- drowsiness, discontinuation, alchol, constipation
Hydrocodone/ Ibuprofen
Vicoprofen, Ibudone, Reprexain C II Tablet moderate pain prg. C adult dose : 1 tabs q 4-6 hrmax : 5 tabs / day ADR- constipation, n/v sedation, dizziness, xerostomia, pruritus, dyspepsia (indigestion) ;rare/severe-hypotension, hallucination, respiratory and cns dep. edema, renal impair, GI bleeding (ulcers,etc) increased bp DI- CNS depressant, affect to anticoagulant, antihypertensive, aspirin, cns depressant, Li, MAO inhibitor + SSRI - serotonin synd.CI-asthma, urticaria, allergic rxn to aspirin / nsaids, perioperative pain in CABG surgery
CP- abrupt discontinuation, drowsiness, etc.
Oxycodone/Acetaminophen
Endocet, Percocet, Roxcet, Tylox C II cap, caplet, tablet, oral liquid mod-severe pain initial dose- 1-2 tabs q 4-6 hrs oral solution- 5-10ml q 4-6 h max dose 3g acetaminophen (2g for alcoholic) DI- warfarin, cns depressant, ethanol, isoniazid, CP- drowsiness, constipation, alcohol note: RX should include strength desired*
Celecoxib
Celebrex, NSAIDs (Selective Cox 2 inhibitor) rx only; caps Osteoarthritis*, ankylosing spondylitis, juvenile idiopathic arthritis (JIA), rheumatoid RA, mangement of acute pain (mild), primary dysmenorrehea preg. C/ D (at term) 200mg/day po in bid, increase 400mg in 6 wks (if no effect in 6wks , discontinue) dysmenorrhea- 400mg initial (+200) 1st day, 200mg tid severe renal / hepatic- not recommended; moderate hepatic- reduce 50% ADR : N, GI ulcer (less), hypertension, HA, diarrhea, peripheral edemarare/severe- GI bleeding, perforation,SJ syndrome, MI and stroke, thrombosis, renal toxicity, toxic epidermal necrolysisk dermatitis, hepatitis, liver fx, ARF DI- antacid, corticosteroid, ehtanol, fluconazole, affecting on ACEi, ARB, anticoagulants, aspirin, cyclosporin, diuretic, lithium CI- perioperative after CABG surgery ; hypersensitivity to NSAIDS, celecoxib, sulfonamide, aspirin, other NSAIDs CP- S/Sx of GI bleeding, take w/ food if GI CV risk incresase note- caution w/ fluid retension, CHF, renal insufficiency, HTN, elderly increased risk for GI ulcer, CNSeffect, renal toxicity hypersensitivity to sulfonamides (nonantibiotic sulfonamides)should avoid do not use pts w/ bronchospasm, asthma, rhinitis or urticaria w/ nsaids or aspirin BBW - doesnt inhibit platelet or prolong bleeding time; caution w/ hx of GI; concurrent tx w/ aspirin, anticoagulant, corticosteroids, smoking, alcohol, elderly
NSAIDS in general classA) DI B) MOA C) CP D) note E) ADR F) CI
B) MOA:prostaglandin synthesis inhibited by dec. cox 1& cox 2 activity (inflammation and pain associated to prostaglandin precursors) ADR- n/gastritis, abdominal cramps, gi ulcers, peripheral edema, hypertension, diarrea rare/severe- GI prforation bleeding, renal toxicity, ARF, angioedema, bronchoconstriction, asthma rash, tinnitus, hearing loss DI- corticosteroid(inc. GI SE) ethanol affecting on ACE/ARB; anticoagulant, antiplatelet therapy , BB, digoxin (inc level), diuretic, heparin, warfarin, lithium CI- hypersensitivity to aspirin or NSAIDs, perioperative pain w/ CABG, peptic ulcer disease CP- GI sx, take w/ food if GI upset, abnormal swelling or bleeding, may inc. CV risk (except aspirin) may worsen fluid retention, CHF, renal insufficiency, HTN, may increase risk for MI, thrombosis, stroke, elderly (inc. risk GI, CNS SE, renal SE) ; aspirin triad (bronchial asthma, aspirin intolerance, rhinitis)
Aspirin
Bayer Buffierin, Ecotrin, Excedrin , etcEnteric coated, buffered, chewable, CR, gum suppository preg- no catgory, CI except low dose adult antiplatelet : 50-325mg dailypain& inflammation : 325-650mg q 4-6h max 4g/daypediatric : antipyretic, analgesic: 10-15mg/kg/dose q 4-6h upto 4g/day PO, rectalantiinflammatory- initial 60-90mg/kg per day po renal / hepatic sever impairment- avoid use ADR- Reye's syndrome (children) DI- ginkgo(inc. antiplatelet E), NSAIDS (inc. bleeding) affecting on ACEi, anticoagulants CI- salicylate NSAIDs hypersensitivity, nasal polyps, bleeding disorder (factor deficiency), NO <16yrs for viral infections (chickenpox / flu sx), w/ or w/o fever= Reye's syndrome CP : high dose for short term pain. any bleeding sx, take w/ food or milkstop 1wk prior to surgery (bleeding!)
Diclofenac
Flector, Voltaren, pennsaid, Solaraze NSAIDs ; RX only caps, tab, delayed release enteric tab, ER, topical gel, topical solution , transdrmal patch ophthalmic solutionpreg B for topical gel 3%; C-oral, 1% gel, topical solution, topical patch; D- for PO, topical solution at term (>=30wks) dose analgesia- 50mg po tid, dysmenorrhea 150-200mg; same for RA; instill 1-2 drops; patch- 1 patch daily CI- hypersensitivity to bovine protein rest ADR, counseling for general NSAIDs
Etodolac
Lodine NSAIDs Rx only tab, caps, ER, acute for mild- mod. RA, osteoarthritis preg. C dosing : acute- 200-400 q 6-8 max- 1000mg/day ; RA IR- 400bid or 300 tid, 500 bidwt dosing 400-1000mg daily for children (6-16yr) for juvenile RA Avoid in severe renal impair CP- GI bleeding, take w/ food if GI, abnormal swelling, inc. CV risk