Therapeutics - Pain 2
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If a patient fails on one NSAID should you try a different drug class or a different NSAID?
Try a different NSAID
What is the relative bioavailability of NSAIDs?
To what extent are NSAIDs subject to 1st pass metabolism?
To what extent are NSAIDs bound to albumin?
- Tightly (except ASA)
- Will displace Warfarin
- Watch with Phenytoin
ASA has a serious DDI with what group of drugs and how can this be coped with?
- Give ASA 2 hours prior to NSAIDs or 8 hours after
NSAIDs may effect renal clearance of what drug?
How can you alleviate GI discomfort with NSAID use?
Take with food or milk
What level of GI SEs requires DC?
If GI ulceration occurs with NSAID use, what options exist for the patient?
- Combine with misoprostal or a PPI
- Consider Celecoxib
Due to platelet function/aggregation SEs of NSAIDs, how long prior to surgery should they be DC’d?
What are the risk factors for NSAID induced nephrotoxicity?
- >60 years
- Hx of GI events
- Concomitant steroid therapy
Due to NSAID renal effects, what concomitant disease states should be cautioned?
What level of pain is celecoxib indicated for?
Mild to moderate
What are the SE for Celecoxib?
- GI toxicity (less than with COX-1 inhibitors)
- Renal effects
- Cardio effects
What effect does Ibuprofen have on ASA hematologic/cardio-protection?
IBU negates cardio-protection of ASA
How do COX-2 inhibitors compare to other NSAIDs in terms of GI toxicity?
Less with COX-2’s
How do COX-2 inhibitors compare to other NSAIDs in terms of Renal toxicity?
Which NSAID has not been shown to cause cardiovascular risk?
How should you treat a patient using an NSAID with concomitant CV issues?
- Lowest possible dose
- Use only when benefits outweigh risks
By what mechanism do NSAIDs worsen or cause HTN?
- Na retention
In what time frame does NSAID induced HTN occur?
A BP change due to NSAIDs dose dependent or independent?
NASIDs can reduce the efficaciy of what HTN meds?
How can you work to avoid NSAID induced HTN?
- Lowest dose possible
- Do not take daily
NSAIDs increase the risk of bleeding when combined with what other drugs?
- Other NSAIDs
Under what condition may NSAIDs decrease the efficacy of clopidegrel?
When combined with a PPI
What effect do NSAIDs have on Lithium?
May increase Lithium level
What is the adult dosing of APPA?
500-100 mg Q4-6 hours
When should you avoid APAP?
When should you avoid ASA?
Children under 15 with a viral infection
What is the adult dosing for IBU?
200-400 mg Q6-8 hours
What is the pediatric dosing for IBU?
5-10 mg/kg Q6-8 hours
What is the max dose of IBU per day?
When should you not use IBU?
3rd trimester of preganancy
What is the OTC IBU tablet size?
What is the Rx IBU tablet size?
What is the dosing for Ketorolac?
30-60 mg I/IM Q6H
In what patient population should you reduce the Ketorolac dose?
What is the Max dose of Ketorolac?
- 150 mg 1st day
- 120 mg during days 2-5
What is the max days a person can receive Ketorolac?
What disease states should you watch for when giving Ketorolac?
- Renal insufficiency (particularly in the elderly)
What is the normal dosing for Celecoxib?
200-400 mg Q12-24 hours
What is the max dose for Celecoxib?
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