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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
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What drugs are considered acetic acids
Ketorolac, diclofinac sodium, etodolac, drugs that end in -ac
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What drugs are in the salicylate category
Diflunisal, other drugs that end in -sal
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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
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What is the maximum daily dose of naproxen sodium
- OTC 660 mg
- Prescription 1650 mg
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What is the adult dose for naproxen?
500 stat 250 mg q 6-8 hrs
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What is the maximum daily dose for naproxen?
1500 mg
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What is the adult dose for ibuprofen?
400-600 q 4-6 hrs
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What is the maximum daily dose of ibuprofen
- 3200 mg prescription
- 1200 mg OTC
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What is the adult daily dose of ketorolac?
20 mg stat 10 mg q 4-6 hrs
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what is the maximum dose of ketorolac daily?
40 mg
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What is maximum daily dose of etodolac
1200 mg
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What is the adult daily dose of etodolac?
200-400 q 6-8 hrs
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What is the maximum daily dose of diclofinac?
50 mg q 5-6 hrs
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What is the adult dose of diclofinac?
50 mg q 6 hrs
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What is the maximum daily dose of diflunisal?
1500 mg
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What is the adult dose of diflunisal?
1000 stat 500 mg q 8 hrs
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What category is ketorolac in?
Acetic acid
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What category is etdolac in?
Acetic acid
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What category is diclofinac in?
Acetic acid
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What category is ibuprofen in?
Proprionic aicd
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What category is naproxen in?
Proprionic acid
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What category is naproxen sodium in
Proprionic acid
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What category is diflunisal in?
Salicylate
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Is mixing NSAIDs with narcotics synergistic or additive?
Additive
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Is mixing NSAIDs with acetaminophen additive or synergistic
Synergistic
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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
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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
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What are the adverse effects of NSAIDs
- - risk of ulcers and GI complications
- Platelet aggregation- reversible inhibitor
- Nephrotoxicity-decrease GFR
- CNS
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If a patient develops asthmatic symptoms from taking a specific NSAID is his mechanistic or structurally mediated
Mechanism
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If a pt develops a hypersensitivity to a single drug then is it structural or mechanistic
Structural
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How are patients treated with a mechanism mediated hypersensitivity to NSAIDs... Asthmatic rxn
Do not use NSAIDs use narcotic plus apap
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What drugs lie in the phenanthrenes?
- Morphin
- Codeine
- Oxycodone
- Hydrocodone
- Nalbuphine
- Hydromorphone
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What drugs lie in the phenylpiperidines?
- Meperidine
- Fentanyl
- Alfentanil
- Sufentanil
- Remifentanil
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What drugs lie in the phenylheptylamines?
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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
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How many mg of hydrocodone equals40 mg of codeine
5 mg
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How many mg of Oxycodone equals 40 mg of codeine
2.5 mg
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How many mg of meperidine equals 40 mg of codeine
50 mg
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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
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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
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Which drugs are more common to have a pseudoallergy
Low potency like meperidine and codein
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What are the symptoms of pseudoallergy
Hypotension, flushing, pruritis, sweating
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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
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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
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What is the prescribing regimen for hydrocodone?
5/500 APAP q 4-6 hrs prn pain take with food or milk
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What is the prescribing regimen of Oxycodone?
5/500 APAP q 4-6 hrs take with food or milk
Max dose 8/24 hrs
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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
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What is the pediatric dose for APAP
10 mg/kg q 4-6 hrs 65 mg/kg max
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What is the pediatric dose of ibuprofen
5-10mg/kg q4-6hrs 300 mg max
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What is the pediatric dose for codeine
0.5 mg/kg q 4 hrs 120mg max
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What is the pediatric dose for hydrocodone
0.1-0.2 mg/kg
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What are the precautions associated with codeine
Impaired ventilation, asthma, high intracranial pressure
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What are the precautions associated with hydrocodone
Most addictive schedule 3, health care workers are most at risk for problems
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What are the precautions associated with meperidine
Normeperidine can accumulate with repeated dosing causing seizures AVOID MAOIs
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What are the precautions associated with Oxycodone
Causes euphoria and is a schedule 2 substance
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If a patient presents with gastritis or alcohol use how should they be managed?
Use etodolac or cox2 use prophylactic for GI irritation
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How should patients with hepatic disease be managed
Avoid diclofinac or oxicams
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How should patients on warfarin be managed
Avoid all NSAIDs may try cox2 or diflunisal
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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
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What is the max dose of apap acute and chronic
- Acute 4000mg/day
- Chronic without monitoring 2600mg/day
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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
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What is the mechanism of tramadol?
Binds mu receptors and inhibits serotonin and NE reuptake
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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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