pharm - MSK opioids plus.txt

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pharm - MSK opioids plus.txt
2012-09-10 13:48:04
pharm MSK opioids plus

pharm - MSK opioids plus.txt
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  1. Avinza
  2. Kadian
  3. MS Contin
  4. OxyContin
  5. Percocet
  6. Vicodin
  7. Lortab
  8. Norco
  9. Dilaudid
  10. Nucynta
  11. Opana
  12. Duragesic TD
  13. Actig
  14. Demerol
  15. Suboxone
  16. Ultram
  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