Pain

Question 1

FeverAll/Ofirmev

Answer 1

• APAP
• FeverAll - rectal suppository formulation
• Ofirmev - injection

Question 2

Lorcet/Lortab

Answer 2

• Hydrocodone + APAP

- Also Vicodin and Norco

Question 3

Endocet

Answer 3

• Oxycodone + APAP

- Percocet

Question 4

Excedrin Tension HA

Answer 4

APAP + Caffeine

Question 5

Excedrin Extra Strength

Answer 5

• APAP + ASA + Caffeine

- Also Excedrin Migraine

Question 6

Midol Complete

Answer 6

APAP + Caffeine + Pyrilamine

Question 7

NAC

Answer 7

• N-acetylcysteine, antidote for APAP overdose
• Glutathione precursor, increases glutathione
• Administered IV or PO
• Rumack-Matthew nomogram used to determine likelihood of hepatotoxicity and if NAC is needed

Question 8

Cadalor

Answer 8

• Ibuprofen
• Also Advil and Motrin B
• Max of 3.2 g/d
• 200-400 mg for adult dosing Q4-6H
• Limit self-treatment <10 days

Question 9

Indocin

Answer 9

• Indomethacin

- High risk for CNS side effects

Question 10

Vimovo

Answer 10

• Naproxen + esomeprazole

- Naproxen can sometimes be dosed BID

Question 11

Toradol

Answer 11

• Ketorolac
• Oral and NS formulation
• Max of 5 days duration combined for lifetime
• Warning: acute renal and hepatic failure
• Prime NS 5 times before use

Question 12

Celebrex

Answer 12

• Celecoxib
• CI: Sulfonamide allergy
• Highest COX-2 selectivity

Question 13

Voltaren

Answer 13

• Diclofenac
• Max of 32 g/d total body
• Patch can be applied BID
• Box Warning: Avoid Arthrotec formulation in childbearing females (contains misoprostol)

Question 14

Agents with SOME COX-2 Selectivity

Answer 14

• Meloxicam (Mobic)

- Nabumetone

Question 15

Ascriptin

Answer 15

• ASA + Acetylsalicylic acid
• Also Bufferin or Ecotrin
• All EC/buffered

Question 16

Excedrin

Answer 16

APAP + ASA + Caffeine

-Also Excedrin Migraine

Question 17

Yosprala

Answer 17

-ASA + Omeprazole

Question 18

Doan’s Extra Strength

Answer 18

• Magnesium Salicylate

- Non-acetylated salicylates

Question 19

Salicylate NSAID Information

Answer 19

• Salicylate overdose can cause tinnitus
• Methyl salicylate is popular OTC topical in BenGay, IcyHot, and Salonpas
• Take ASA 1 hour before or 8 hours after ibuprofen if being used together
• NSAIDs in general can increase the levels of lithium

Question 20

Opioids with Alcohol Boxed Warning

Answer 20

• Kadian
• Nucynta ER
• Oxymorphone ER
• Zohydro ER

Question 21

Codeine Classes

Answer 21

• CII: Codeine tablet
• CIII: tablet/capsule combination products
• CV: oral solution combination products

Question 22

Codeine Information

Answer 22

• Risk of respiratory depression and death in ultra-rapid metabolized of CYP2D6 polymorphism
• Don’t use in kids < 12 or kids < 18 following tonsillectomy/adenoidectomy
• SE: Constipation

Question 23

Sublimaze

Answer 23

• Fentanyl, Duragesic is also a brand name
• Actiq: transmucosal lozenge on stick (lollipop)
• 1 patch Q72H

Question 24

Fentanyl Information

Answer 24

• CYP3A4i
• SE: Application site redness/erythema
• Only potential to use in patients on 60 mg or morphine or more for at least 7 days
• Similar drug is remifentanil (IV)
• Apply to hairless skin (cut hair if necessary)
• Only cover w/ permitted adhesives: Bioclusive, Tegaderm

Question 25

Dilaudid

Answer 25

- Hydromorphone - Oral: 2-4 mg Q4-6H PRN - IV: 0.2-1 mg Q2-3H PRN

Question 26

Hydromorphone Information

Answer 26

- Boxed Warning: Medication error with high potency (use in opioid tolerant ONLY) - High risk for overdose

Question 27

Dolophine

Answer 27

- Methadone - Box Warning: QT prolongation (life-threatening) - Variable half-life - Decreases testosterone and can cause sexual dysfxn - Major CYP3A4 substrate (avoid with inhibitors)

Question 28

Demerol

Answer 28

- Meperidine - Warning: renal impairment/elderly at risk for CNS toxicity - No longer recommended as an analgesic - Short duration - Metabolite is renally cleared and can accumulate/induce seizures - Serotonergic, increased 5HT syndrome risk

Question 29

Kadian

Answer 29

- Morphine - ER formulation, MS Contin is another one - Injection: Duramorph, Infumorph - SE: Pruritus - Diphenhydramine can be used to prevent histamine-induced pruritis

Question 30

Roxicodone

Answer 30

- Oxycodone - IR formulation - CR: OxyContin, Endocet or Percocet is + APAP - Box warning: CYP3A4i - SE: Pruritus

Question 31

Opana

Answer 31

- Oxymorphone | - Take on an empty stomach!

Question 32

IV/IM Opioid Conversions

Answer 32

Morphine 10 mg : Hydromorphone 1.5 mg

Question 33

Oral Opioid Conversions

Answer 33

Morphine 30 mg : Hydromorphone 7.5 mg : Oxycodone 20 mg

Question 34

Opioid Allergy

Answer 34

Tend to Cross-React: - Codeine - Hydrocodone - Oxycodone - Morphine - Hydromorphone - Oxymorphone - Buprenorphine - Heroin