Med Memorizations

Pharm so far: Pain/Inflammation, MSK

Acetaminophen – Classification

Nonopioid analgesic (COX inhibitor)

Acetaminophen – Indication

Mild-to-moderate pain

Acetaminophen – Dose

PO or rectal

Acetaminophen – Key Warnings

Overdose → liver damage (onset 48-72 hr)

Aspirin – Classification

First-generation NSAID (nonselective COX-1/COX-2 inhibitor)

Aspirin – Indication

Inflammation, mild-moderate pain, fever, dysmenorrhea, and (uniquely) platelet aggregation inhibition

Aspirin – Dose

PO

Aspirin – Key Warnings

Reye's syndrome in children/teens with viral illness

Ibuprofen – Classification

First-generation NSAID (nonselective COX-1/COX-2 inhibitor)

Ibuprofen – Indication

Inflammation, mild-moderate pain, fever, dysmenorrhea

Ibuprofen – Dose

PO

Ibuprofen – Key Warnings

GI bleeding/ulceration, kidney dysfunction

Celecoxib – Classification

Second-generation NSAID (COX-2 selective inhibitor)

Celecoxib – Indication

Inflammation, mild-moderate pain, fever, dysmenorrhea

Celecoxib – Dose

PO

Celecoxib – Key Warnings

Contraindicated with sulfa/sulfonamide allergy, 3rd trimester pregnancy, Coronary Artery Bypass Grafting pain, children <18 yr

Allopurinol – Classification

Antihyperuricemic (uricosuric/urate-lowering therapy)

Allopurinol – Indication

Hyperuricemia from chronic tophaceous gout, cancer chemotherapy, or blood dyscrasias

Allopurinol – Dose

PO or IV (infuse over 30-60 min)

Allopurinol – Key Warnings

Hypersensitivity syndrome (fever, rash) → STOP immediately

Tramadol – Classification

Dual-mechanism analgesic (opioid receptor binding + NE/serotonin reuptake inhibition)

Tramadol – Indication

Moderate to moderately severe pain

Tramadol – Dose

PO

Tramadol – Key Warnings

Seizure risk

Morphine – Classification

Opioid agonist (mu receptor)

Morphine – Indication

Moderate-severe pain

Morphine – Dose

PO/IM/IV/SC/rectal/epidural

Morphine – Key Warnings

Respiratory depression (hold dose if RR <12/min)

Butorphanol – Classification

Opioid agonist-antagonist (mu antagonist + kappa agonist)

Butorphanol – Indication

Moderate-severe pain

Butorphanol – Dose

IM, IV, or intranasal

Butorphanol – Key Warnings

Can precipitate withdrawal in opioid-dependent clients

Pentazocine – Classification

Opioid agonist-antagonist (mu antagonist + kappa agonist)

Pentazocine – Indication

Moderate-severe pain

Pentazocine – Dose

PO (combined with acetaminophen or naloxone), SC, IM, or IV

Pentazocine – Key Warnings

Schedule IV controlled substance

Naloxone – Classification

Opioid antagonist

Naloxone – Indication

Reversal of opioid effects/overdose

Naloxone – Dose

IM, IV, or SC

Naloxone – Key Warnings

Effects can wear off before the opioid does → redosing often required

Prednisone – Classification

Glucocorticoid

Prednisone – Indication

Pain/inflammation relief (many disorders), delays RA progression, prevents organ rejection, adjunct cancer therapy

Prednisone – Dose

PO/IV/IM/SC/topical/intranasal/inhaled

Prednisone – Key Warnings

Adrenal suppression

Alendronate – Classification

Bisphosphonate (anti-resorptive)

Alendronate – Indication

Prevention/treatment of postmenopausal, glucocorticoid-related, and age-related osteoporosis

Alendronate – Dose

PO, 30 min before breakfast with a full glass of water

Alendronate – Key Warnings

Esophagitis

Calcitonin Salmon – Classification

Calcitonin

Calcitonin Salmon – Indication

Postmenopausal osteoporosis

Calcitonin Salmon – Dose

Intranasal (alternate nostrils daily) or IM/SC (SC preferred

Calcitonin Salmon – Key Warnings

Anaphylaxis risk — allergy skin test required before starting

Calcium Carbonate/Citrate – Classification

Calcium supplement

Calcium Carbonate/Citrate – Indication

Hypocalcemia

Calcium Carbonate/Citrate – Dose

PO or IV

Calcium Carbonate/Citrate – Key Warnings

Hypercalcemia (constipation, kidney stones)

Denosumab – Classification

Monoclonal antibody against RANKL

Denosumab – Indication

Osteoporosis (postmenopausal clients, high-risk males, long-term glucocorticoid users)

Denosumab – Dose

60 mg subcutaneous injection every 6 months

Denosumab – Key Warnings

Osteonecrosis of the jaw

Etanercept – Classification

Biologic DMARD (TNF antagonist)

Etanercept – Indication

Decrease joint inflammation and prevent joint damage in RA

Etanercept – Dose

Subcutaneous injection, once weekly

Etanercept – Key Warnings

TB reactivation — TB test required before starting

Methotrexate – Classification

Conventional synthetic (traditional) DMARD

Methotrexate – Indication

Decrease joint inflammation and prevent joint damage in RA

Methotrexate – Dose

Once WEEKLY (PO/SC/IM) — NOT daily

Methotrexate – Key Warnings

Bone marrow suppression

Raloxifene – Classification

Selective Estrogen Receptor Modulator (SERM)

Raloxifene – Indication

Postmenopausal osteoporosis prevention/treatment

Raloxifene – Dose

PO, once daily, with or without food

Raloxifene – Key Warnings

DVT/PE/stroke risk — report calf pain or difficulty breathing

Teriparatide – Classification

Anabolic agent (synthetic parathyroid hormone)

Teriparatide – Indication

Osteoporosis — stimulates NEW bone formation

Teriparatide – Dose

20 mcg subcutaneous injection once daily

Teriparatide – Key Warnings

Hypercalcemia

Tofacitinib – Classification

Targeted synthetic DMARD (JAK inhibitor)

Tofacitinib – Indication

Decrease joint inflammation and prevent joint damage in RA

Tofacitinib – Dose

PO tablet/solution once daily (extended-release = twice daily)

Tofacitinib – Key Warnings

Neutropenia

Acetaminophen - Interventions

Monitor for overdose signs (abd discomfort, N/V, sweating, diarrhea — liver damage 48-72 hr post-OD)

Acetaminophen - Client Teaching

Do not exceed 4 g/day

Aspirin - Interventions

Monitor for GI bleeding (black stools, hematemesis)

Aspirin - Client Teaching

Take with food/milk/8oz water

Ibuprofen - Interventions

Monitor for GI bleeding

Ibuprofen - Client Teaching

Take with food/milk/water

Celecoxib - Interventions

Monitor for GI upset/bleeding

Celecoxib - Client Teaching

Take with food/milk/8oz water

Allopurinol - Interventions

STOP immediately for hypersensitivity syndrome (fever, rash)

Allopurinol - Client Teaching

Report fever/rash/abd pain/low urine output and stop medication

Tramadol - Interventions

Monitor RR — hold/stimulate breathing and give naloxone if RR <12/min

Tramadol - Client Teaching

Avoid driving/hazardous activities

Morphine - Interventions

Monitor vitals/pulse ox/lung sounds

Morphine - Client Teaching

Avoid driving

Butorphanol - Interventions

Monitor RR (withhold if <12/min)

Butorphanol - Client Teaching

Avoid driving

Pentazocine - Interventions

Monitor RR (withhold if <12/min)

Pentazocine - Client Teaching

Avoid driving

Naloxone - Interventions

Monitor vitals — rising BP/HR is expected sign of reversal