pharm - MSK opioids plus.txt

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tallone4830
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170045
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pharm - MSK opioids plus.txt
Updated:
2012-09-10 13:48:04
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pharm MSK opioids plus
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pharm - MSK opioids plus.txt
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  1. Avinza
    morphine
  2. Kadian
    morphine
  3. MS Contin
    morphine
  4. OxyContin
    oxycodone
  5. Percocet
    oxycodone/acetaminophen
  6. Vicodin
    hydrocodone/acetaminophen
  7. Lortab
    hydrocodone/acetaminophen
  8. Norco
    hydrocodone/acetaminophen
  9. Dilaudid
    hydromorphone
  10. Nucynta
    tapentadol
  11. Opana
    oxymorphone
  12. Duragesic TD
    fentanyl
  13. Actig
    fentanyl
  14. Demerol
    meperidine
  15. Suboxone
    buprenorphine/naloxone
  16. Ultram
    tramadol
  17. opioids MOA
    bind to opioid receptors (G-protein coupled) located in the brain and spinal cord. The main opioid receptor is the Mu receptor, of which there is over 100 polymorphisms (variation in response! -- may also be incomplete cross tolerance between opioids)
  18. opioids IND
    pain, cough, diarrhea, dyspnea
  19. opioids CI
    decreased LOC, elderly, hepatic/renal impairment, addiction hx
  20. opioids INT
    opioids + sedatives (respiratory depression)
  21. opioids SE
    respiratory depression, NV, pruritis, urinary retention/constipation, miosis, truncal rigidity, sphincter of Oddi spasm.
  22. Vicodin dosing
    hydrocodone/acetaminophen, 2.5-10mg hydrocodone PO q4-6h PRN
  23. Percocet dosing
    oxycodone/acetaminophen, 2.5-10mg oxycodone PO q6h PRN
  24. Oxycontin dosing
    ER oxycodone, 10mg PO q12h
  25. Ultram dosing
    tramadol, 50-100mg PO q4-6h PRN
  26. opioid OD
    apnea/hypoventilation/hypoxia, miosis, decr LOC, track marks
  27. opioid WD
    rhinorrhea/lacrimation, yawning, chills/piloerection, hyperventilation, hyperthermia, mydriasis, muscular aches, V/D, anxiety/hostility
  28. methylnaltrexone
    does not cross BBB, so useful for peripherally mediated SE (like constipation) w/o reducing analgesic effects
  29. Mu1 vs. Mu2
    Mu1 = sedation, analgesia, euphoria. Mu2 = constipation, respiratory depression.
  30. short-acting opioids
    hydrocodone, hydromorphone, morphine, oxycodone
  31. long-acting opioids
    fentanyl TD, ER morphine, ER oxycodone, methadone
  32. opioid ER formulations
    ONLY FOR CONTINUOUS PAIN CONTROL FOR AN EXTENDED PERIOD (not PRN). do not cut/crush/chew/dissolve tablets (risk of OD due to faster release -- alcohol can also speed release from capsules).
  33. morphine
    "gold standard" -- metabolites include morphine-6-glucoronidate (more potent, renally cleared so adjust dose if needed).
  34. codeine
    pro-drug metabolized to morphine by 2D6 (genetic variability / interactions). don't use in kids (URMs)
  35. opioids strength
    morphine 1, hydromorphone 10, fentanyl 80
  36. tramadol
    BBW seizures, serotonin storm. Nucynta (tapentadol) is a more potent version that is not metabolized by glucuronidation and does not mess with CYP450 enzymes.
  37. methadone
    titrate slowly to effect (full effect takes 3-5 days). BBW pts tolerant to opioids may be incompletely tolerant to methadone, QT prolongation.
  38. biphosphonates CI
    hypocalcemia, vit D deficiency, hypoparathyroidism, severe renal insufficienty (monitor sCr)
  39. PTH SE
    teraparatide not studied for > 2 yr use. BBW osteosarcoma.
  40. colchicine PK
    narrow TI (CYP3A4/P-GP)
  41. denosumab SE
    skin rxn including eczema
  42. calcium levels
    1000mg/d, 1200 if 50+. vitamin D 1000+U/d.
  43. colchicine MOA
    decr 1) infl med, 2) neutro adhes/chemotax, 3) phag of urate crystals
  44. COX1
    GI protective
  45. NMDA vs GABA
    NMDA analgesic, no apnea, incr CBF/ICP (GABA opposite)
  46. ketamine
    dysphoric/dissociative, SNS activator (less hypotension risk), bronchodilator (intubation of asthma)
  47. NNB SE
    mivacurium hypotension (histamine release). pancuronium tachycardia (vagolytic).
  48. DNB SE
    hyperkalemia, muscle pain, bradycardia esp in kids (pretx c atropine)
  49. Hoffman degredation
    spontaneous breakdown (no hepatic/renal needed). atracurium and cisatracurium (NNBs -- mivacurium pseudocholinesterase-metablized).
  50. APAP osteoarthritis
    300-800mg TID-QID
  51. APAP pain
    400mg q4-6h PRN
  52. APAP fever
    200-400mg q4-6h PRN
  53. APAP anti-inflammatory
    600mg QID x 7-14d

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