Rogers Drugs - non-malignant pain

Acetaminophen Dosing

Adults: 325-1000mg q4-6hrs prn with a max of 3-4g/day. Kids: 10-15mg/kg po q4-6hrs prn with a max of 75mg/kg

NSAIDs SE

BBW for GI bleeding and increase in CV events. Nephrotoxicity and fluid retention.

Ibuprofen Dosing

Adults: 200-800mg po q4-6hrs prn (max 3200mg/day). Peds: 5-10mg/kg po q4-6hrs prn (max 40mg/kg/day or 2400mg, whichever is less)

Aspirin Dosing

Adults: 325-1000mg po q4-6hrs prn (max 4g/day)

Aspirin CP

Avoid in kids and patients taking antiplatelets or blood thinners

Diclofenac dosing

50mg po q8h or 2-4g topically 4 times a day

Naproxen dosing

220-500mg q6-12hrs (max 1000mg/day)

Keterolac

1) Brand

2) Dosing

Toradol. Adults: 15-30mg IM/IV q6hrs prn or 10 mg po q6hrs prn. Peds: 0.5mg/kg/dose IM/IV q6hrs prn

Keterolac CP

1) brand

2) CP

Toradol. Max duration of 5 days due to increased GI bleeding risk. Oral is used as continuation of IM/IV

Celecoxib

1) Brand

2) Dosing

Celebrex. Adults: 200mg po bid

What NSAIDs can you use if an oral option is not possible?

Acetaminophen, Ibuprofen, Diclofenac, and Keterolac

Gabapentin

1) Brand

2) Dosing

Neurotin: 100-300mg PO TID with max 3600mg/day

Pregablin

1) Brand

2) Dosing

Lyrica: 75mg PO BID with max 600mg/day

Gabapentinoids SE

sedation, dizziness, peripheral edema

Gabapentinoids CP

renally dosed, titrate up dose to limit sedation, can use in combo

Venlafaxine

1) Brand

2) Dosing

Effexor: 37.5-75mg PO daily with max 225mg/day

Duloxetine

1) Brand

2) Dosing

Cymbalta: 30mg po daily for a week, then 60mg po daily

TCAs

1) Drugs + Brand name

2) SE

3) Dosing

Amitriptyline and Nortriptyline/ Pamelor. SE are anticholinergic and sedation. Dose for both is 10mg po qhs with max of 150mg/day.

What are examples of muscle relaxants?

SE?

CP?

Cyclobenzaprine, Baclofen, Carisoprodol, Methocarbamol, and Tizanidine. SE are sedation/drowsiness, dizziness, dry mouth, and vision changes. It is used short term and carisprodol is C4

Cyclobenzaprine

1) Brand

2) Dosing

Amrix: 5mg PO TID with a max of 30mg/day

Baclofen

1) formulation

2) dosing

Oral suspension, 5mg po TID with max 80mg/day

Carbamazepine

1) Brand

2) Dosing

3) CP

Tegretol 200-400mg/day divided into 2-4 doses with max of 1200mg/day. Increased hypersensitivity in HLA B1502. Autoinducer of hepatic enzymes

Lidocaine

1) dosing

2) SE

3) CP

AAA 1 patch and remove 12 hours later. SE of hypotension and arrythmia but low with patch. CP of tachyphylaxis with continuous use and 12hrs break in between patches

Capsaicin

1) Dosing

2) CP

Cream, gel, liquid, lotion: apply 3-4x a day. Patch: AAA 1 patch qd and remove 8 hours later. CP of washing hands and don’t get into eye

What non-malignant pain meds can be used in elderly to minimize SE

Acetaminophen, topical agents like Lidocaine, diclofenac, and capsaicin, SNRIs, and gabapentinoids