Pain management

All about opioids and other pain managment

Hydrocodone/Acetaminophen Brand/Form

Norco: Tabs. Oral Susp.

Hydrocodone/Acetaminophen Indications

Moderate to severe pain

Hydrocodone/Acetaminophen MOA

Binds to Mu receptors in the CNS to alter pain perception

Hydrocodone/Acetaminophen common side effects

pruritis-(itching), constipation, nausea/vomiting, dizziness, somnolence-(drowsiness)

Hydrocodone/Acetaminophen severe side effects

Respiratory depression, Opioid withdrawal

Hydrocodone/Acetaminophen Boxed Warnings

Addiction, Abuse, and Misuse. Life threatening respiratory depression, accidental ingestion, Co-use W/ benzodiazepines, co-use W/ CYP3A4 inhibitors, liver failure.

Hydrocodone/Acetaminophen contraindications

Depressed respiration, Hypersensitivity, acute or severe bronchial asthma, hypercarbia.

Oxycodone/acetaminophen brand/form

Percocet: tabs, caps, oral sol,

Oxycodone/acetaminophen Indications

Moderate to severe pain

Oxycodone/acetaminophen MOA

Inhibition of Mu opioid receptors in CNS to alter pain perception.

Oxycodone/acetaminophen Common side effects

Pruritis, constipation, nausea/vomiting, dizziness, somnolence.

Oxycodone/acetaminophen Severe side effects

Respiratory depression, opioid withdrawal

Oxycodone/acetaminophen box warnings

Abuse, addiction, and misuse. Life threatening respiratory depression, accidental ingestion, co-use W/ benzodiazepines, co-use W/ CYP3A4 inhibitors, liver failure.

Oxycodone/acetaminophen contraindications

Respiratory depression, hypersensitivity, acute/chronic Bronchial asthma, hypercarbia

Oxycodone Formulations

Tablet - Roxicodone, ER tablet - Oxycontin, capsule, oral sol.

Oxycodone Indacations

Chronic Pain

Oxycodone MOA

Binds to MU opioid receptors in CNS to alter pain perception

Oxycodone Common adverse effects

Constipation, nausea/vomiting, pruritis, dizziness, somnolence.

Oxycodone severe adverse effects

Respiratory depression and opioid withdrawal

Oxycodone boxed warnings

Addiction, abuse, misuse, life-threatening respiratory depression, accidental ingestion, co-use W/ benzodiazepines and other CNS depressants, co-use W/ CYP3A4 inhibitors, neo-natal opioid withdrawal.

Oxycodone contraindications

Hypersensitivity, respiratory depression, acute or chronic bronchial asthma/hypercarbia, known or suspected ileus or GI obstruction.

Tramadol formulations

tabs - Ultram, osmotic ER tabs, ER caps, oral susp, oral sol.

Tramadol Indications

Moderate to severe pain

Tramadol MOA

MU opioid receptor inhibitor, mild serotonin/norepinephrine reuptake inhibitor.

Tramadol common adverse effects

pruritis, constipation, flushing, nausea/vomiting, dizziness, somnolence, headaches, insomnia.

Tramadol severe adverse side effects

seizure, difficulty breathing, respiratory depression, serotonin sickness.

Tramadol Boxed warnings

addiction, abuse, misuse, life-threatening respiratory depression, accidental ingestion, ultra rabid metabolism of Tramadol, co-use W/ benzodiazepines or other CNS depressants, neo-natal opioid withdrawal, co-use with CYP3A4 and CYP2D6 inhibitors and inducers.

Tramadol contraindications

hypersensitivity, children under 12, children under 18 after tonsillectomy and adenoidectomy, respiratory depression, acute/severe bronchial asthma, known or suspected GI obstruction, concurrent use W/ MAOI within 14 days.

Meloxicam formulations

tabs - Mobic, oral susp.

Meloxicam indications

mild to moderate pain, signs/symptoms of rheumatoid/osteo arthritis, dysmenorrhea, migraine, fever.

Meloxicam MOA

Blocks synthesis of cyclooxygenase enzymes (COX), decrease formation of prostaglandins (PGs), decrease formation of thromboxane A2 (TXA2).

Meloxicam common adverse effects

dyspepsia, nausea, hypertension, increased bleeding.

Meloxicam severe side effects

GI bleeding, renal impairment, severe rash.

Meloxicam boxed warnings

cardiovascular risk: increased risk of MI and CVA, treatment of peri-operative pain in CABG, GI risk: increased risk of bleeding, ulceration, and perforation.

Meloxicam Contraindications

Hypersensitivity, Asthma, urticaria, or allergic like reactions after NSAIDs, CABG patients, renal insufficiency.

Meloxicam Class

NSAID

Oxycodone class

Opioid agonists

Hydrocodone/acetaminophene Class

Opioid agonists

Oxycodone/acetaminophen Class

Opioid agonists

Naproxen Formulations

Tab - Naprosyn, ER tab, oral sol, GR tab, sodium tab.

Naproxen Class

NSAIDs

Naproxen MOA

Inhibition of COX synthesis, TXA2, PG.

Naproxen Common Adverse effects

Increased bleeding, nausea, hypertension, dyspepsia. N

Naproxen Severe adverse effects

GI bleeding, renal impairment, severe rash.

Naproxen Box Warnings

GI: Perforation, ulceration, and bleeding, CV: MI and CVA. treatment of peri-operative pain in CABG.Napr

Naproxen Contraindications

Asthma, urticaria, and allergy like reaction after NSAIDs, CABG, renal insufficiency, hypersensitivity.

Diclofenac Class

NSAIDs

Diclofenac Formulations

GR Tabs - Voltaren, Sodium ER tab, topical gel, topical sol., injectable sol., potassium tab, potassium cap, topical patch, low dose cap.

Diclofenac MOA

Inhibition of COX synthesis, TXA2, PG.Diclofenac

Diclofenac Indications

Mild to moderate pain, osteo/rheumatoid arthritis, dysmenorrhea, migraine, fever.

Diclofenac common adverse effects

Increased bleeding, hypertension, nausea, dyspepsia

Diclofenac severe adverse effects

renal impairment, severe rash, GI bleeding.

Diclofenac Boxed warning

Peri-operative pain for CABG, CV: MI and CVA, GI: perforation, ulceration, increased bleeding.

Diclofenac Contraindications

Hypersensitivity, asthma, urticaria, and allergy like reaction after NSAIDs, renal insufficiency, CABG patients.

Opioid counseling

Drowsiness/dizziness, don’t drive, constipation, avoid alcohol, don’t crush ER, naloxone, avoid other acetaminophen.

NSAID Counsiling

Food, avoid other NSAIDs, not if pregnant, bleeding risk, hypertension risk, report CV or GI events.

Cyclobenzaprine Class

Muscle Relaxents

Cyclobenzaprine Formulation

Tabs - Flexeril, ER cap

Cyclobenzaprine Indications

Skeletal muscle spasms, fibromyalgia

Cyclobenzaprine MOA

acts at brain stem reducing tonic somatic motor activity

Cyclobenzaprine Common adverse effects

sedation, dizziness, somnolence, confusion, xerostomia

Cyclobenzaprine serious adverse effects

syncope, neuroleptic malignant syndrome, serotonin syndrome, cardiac dysrhythmia, MI, CVA

Cyclobenzaprine Boxed warnings

None

Cyclobenzaprine contraindacations

concomitant use of monoamine oxidase inhibitors within 14 days, acute recovery from MI, arrythmias, congestive heart failure, heart block, hyperthyroidism.

tizanidine class

Muscle relaxants

tizanidine formulations

tab - Zanaflex, Caps

tizanidine indications

SM spasms,