Top 200

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Anonymous
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195005
Filename:
Top 200
Updated:
2013-01-24 14:23:22
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  1. Tylenol
    Acetaminophen

    use: mild pain (headache, arthritis pain, fever)

    • dosing: 500-650 mg PO every 4-6 hours PRN (max 4 g/day)
    • children: 10-15 mg/kg per dose q 4-6 hours PRN
    • hepatic impairment: 2 g/day

    AE: hepatotoxicity (rare) - >3 drink/day increases risk, concomitant use with isoniazid

    Concomitant warfarin use increases anticoagulant effect

    counseling pt: report unresolved pain/fever; do not use > 4g/day

    caution in G6PD deficiency,  other OTC contain APAP, preferred in pregnancy and breastfeeding 
  2. Fioricet, Zebutal, Dolgic Plus
    Butalbital, acetaminophen, caffeine

    use: relief of tension or muscle contraction headache 

    • dosing: 1-2 tablets q 4 hours not to exceed 6/day 
    • renal and hepatic impairment - reduce dose

    common AE: drowsiness, depression, nervousness, insomnia, nightmares, nausea

    rare AE: hallucinations, hypotension, respiratory and CNS depression, tachycardia, hepatotoxicity (>3 drink/day increases risk), concomitant use with isoniazid

    concomitant use with other CNS depressant enhances effects

    • CCB, OC, corticosteroid, cyclosporine, disopyramide, doxycycline, TCA, voriconazole, warfarin >> increases metabolism of these agents
    • -
  3. Ultram, Ultram ER, Ultracet
    Tramadol

    use: moderate to severe pain, neuropathic pain

    • initial use: 50 mg PO q 4-6 hours PRN
    • maintenance: 50-100 mg PO q 4-6 hours PRN
    • max: 400 mg/day, 300 mg/day ER product
    • renal/hepatic impairment: 50 mg PO q 12 hours (max 200 mg/day) 

    common AE: sedation, dizziness, constipation, NV, somnolence, euphoria/dysphoria 

    rare AE: hypotension, seizures > 500 mg/day, abstinence syndrome with abrupt d/c

    • carbamazepine: decrease tramadol levels
    • MAO-I, TCA, SSRI, increase risk of seizures and serotonin syndrome
    • naloxone may induce seizure 

    CNS depressant: additive respiratory and CNS depressant

    Counseling pt: may cause drowiness, abrupt d/c may result in withdrawal symptoms
  4. Actiq, Duragesic, Fentora, Sublimaze, Onsolis 
    Fentanyl

    use: severe pain

    • initial dose: 12.5-25 ug/hour every 72 hour
    • maintenance dose: titrate to response 
    • max: 4 patches

    common AE: constipation, NV, sedation, dizziness, xerostomia, pruritis (histamine release), skin rash (transdermal)

    rare AE: hallucinations, hypotension, respiratory and CNS depression

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