Analgesia- Dental Therapeutics-1.txt
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What drugs are in the propel IC acid category
- Ibuprofen, naproxen, naproxen sodium OTC, prescription naproxen sodium
- Drugs that end in -en
What drugs are considered acetic acids
Ketorolac, diclofinac sodium, etodolac, drugs that end in -ac
What drugs are in the salicylate category
Diflunisal, other drugs that end in -sal
What is the adult dose naproxen sodium
OTC 400 stat 220 mg q 8-12 hrs
Prescription strength 550 stat 275 mg q 6-8 hrs
What is the maximum daily dose of naproxen sodium
- OTC 660 mg
- Prescription 1650 mg
What is the adult dose for naproxen?
500 stat 250 mg q 6-8 hrs
What is the maximum daily dose for naproxen?
What is the adult dose for ibuprofen?
400-600 q 4-6 hrs
What is the maximum daily dose of ibuprofen
- 3200 mg prescription
- 1200 mg OTC
What is the adult daily dose of ketorolac?
20 mg stat 10 mg q 4-6 hrs
what is the maximum dose of ketorolac daily?
What is maximum daily dose of etodolac
What is the adult daily dose of etodolac?
200-400 q 6-8 hrs
What is the maximum daily dose of diclofinac?
50 mg q 5-6 hrs
What is the adult dose of diclofinac?
50 mg q 6 hrs
What is the maximum daily dose of diflunisal?
What is the adult dose of diflunisal?
1000 stat 500 mg q 8 hrs
What category is ketorolac in?
What category is etdolac in?
What category is diclofinac in?
What category is ibuprofen in?
What category is naproxen in?
What category is naproxen sodium in
What category is diflunisal in?
Is mixing NSAIDs with narcotics synergistic or additive?
Is mixing NSAIDs with acetaminophen additive or synergistic
What are the general prescribing guidelines with NSAIDs
- 1. NSAIDs can be mixed with narcotics or acetaminophen for additional effects
- 2. Avoid NSAID NSAID combo ( platelets and GI problems)
- 3. If NSAID failure switch chemical classes
What are the general rules for prescribing NSAIDs in the clinics
- Start with 600-800 mg ibuprofen qid
- - schedule dose for opiod sparing
- - APAP synergistic
- 2. Inadequate response switch categories
- 3. Ketorolac produces highest pain relief
- - screen for GI and renal problems
What are the adverse effects of NSAIDs
- - risk of ulcers and GI complications
- Platelet aggregation- reversible inhibitor
- Nephrotoxicity-decrease GFR
If a patient develops asthmatic symptoms from taking a specific NSAID is his mechanistic or structurally mediated
If a pt develops a hypersensitivity to a single drug then is it structural or mechanistic
How are patients treated with a mechanism mediated hypersensitivity to NSAIDs... Asthmatic rxn
Do not use NSAIDs use narcotic plus apap
What drugs lie in the phenanthrenes?
What drugs lie in the phenylpiperidines?
What drugs lie in the phenylheptylamines?
What rules for prescribing nsaids to the elderly
- -Use short half life NSAID ibuprofen
- - higher risk of GI Bleed
- -- higher in elderly females, age increase, increase w previous GI bleed, increase prednisone use
- - consider APAP #3 q 4-6 hrs 1 tablet
How many mg of hydrocodone equals40 mg of codeine
How many mg of Oxycodone equals 40 mg of codeine
How many mg of meperidine equals 40 mg of codeine
How do you manage a patient with a pseudoallergy to an opiod
- Use half the dose of a more potent oral agent
- Consider adding diphephenhydramine
What is the regimen for minimizing risk of pseudoallergy
- - use a nonopoiod analgesic first
- - decrease opiod dose if tolerated
- - administer oral rather than parenteral
- - use low dose of more potent opiod
- - premed with diphenhydramine 25 mg 30 min before opiod use
Which drugs are more common to have a pseudoallergy
Low potency like meperidine and codein
What are the symptoms of pseudoallergy
Hypotension, flushing, pruritis, sweating
List major adverse effects of opioids?
- Nausea computing increased by vestibular stimulation
- - constipation- no tolerance built up
- - miosis- no tolerance to constricted pupils
- - histamine release- doesn't indicate allergic rxn
- - respiratory depression- tolerance builds quickly
What is the prescribing regimen of codeine?
30 mg codeine with 300 mg tylenol 1-2 tabs q 3-4 prn pain take qith food/ milk
Max 14/24 hrs
What is the prescribing regimen for hydrocodone?
5/500 APAP q 4-6 hrs prn pain take with food or milk
What is the prescribing regimen of Oxycodone?
5/500 APAP q 4-6 hrs take with food or milk
Max dose 8/24 hrs
What patients should never be prescribed NSAIDs?
- - Patients with moderate renal failure
- - patients already taking an NSAID
- - patients taking warfarin
- - patients with a recent peptic ulcer disease
What is the pediatric dose for APAP
10 mg/kg q 4-6 hrs 65 mg/kg max
What is the pediatric dose of ibuprofen
5-10mg/kg q4-6hrs 300 mg max
What is the pediatric dose for codeine
0.5 mg/kg q 4 hrs 120mg max
What is the pediatric dose for hydrocodone
What are the precautions associated with codeine
Impaired ventilation, asthma, high intracranial pressure
What are the precautions associated with hydrocodone
Most addictive schedule 3, health care workers are most at risk for problems
What are the precautions associated with meperidine
Normeperidine can accumulate with repeated dosing causing seizures AVOID MAOIs
What are the precautions associated with Oxycodone
Causes euphoria and is a schedule 2 substance
If a patient presents with gastritis or alcohol use how should they be managed?
Use etodolac or cox2 use prophylactic for GI irritation
How should patients with hepatic disease be managed
Avoid diclofinac or oxicams
How should patients on warfarin be managed
Avoid all NSAIDs may try cox2 or diflunisal
What is the controversy surrounding use of ketorolac
Has tons of side effects but good for substance abuse patients because of high peak pain relief
What is the max dose of apap acute and chronic
- Acute 4000mg/day
- Chronic without monitoring 2600mg/day
What are he potential toxicities associated with overuse of APAP
Doses above2765 mg daily increase INR in patients on warfarin
Toxicityis increased by fasting or alcohol consumption
What is the mechanism of tramadol?
Binds mu receptors and inhibits serotonin and NE reuptake
What are the uses for tramadol
- CANNOT prescribe for people with opioid dependent history
- CANNOT prescribe for patients allergic to codeine
- - rescue med for bad gut and patients with neuropathic ain
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