Cmt Prep Challenge #16

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This opioid analgesic is used to manage moderate to severe pain, and as an adjunct to anesthesia and preoperative sedation. It is available as 50-mg and 100-mg tablets; a 50-mg/5 ml oral syrup; injectable solutions of 25 mg/ml, 50 mg/ml, 75 mg/ml, and 100 mg/ml; and a 10-mg/ml solution for continuous injection. It is administered preferably by IM or slow IV injection because oral administration is less effective, and subcutaneous administration tends to be very irritating and painful. The usual initial dosage in adults is 50 mg orally, or 50-75 mg IM or SC, every 3-4 hours as needed. The usual dosage range may vary between 50-150 mg every 2-4 hours as needed. When used preoperatively, a dosage of 50-100 mg is given 30-90 minutes before anesthesia is started. The dosage for slow IV injection, is 15-35 mg/hour. This medication should not be used in patients with kidney or liver failure because when it is not excreted quickly enough, a toxic metabolite can accumulate, resulting in twitches, tremors, agitation, and seizures. This same toxicity can occur with high doses or prolonged use of this medication. Usual side effects are drowsiness, dizziness, and nausea.

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Demerol (meperidine hydrochloride)

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A centrally acting opioid analgesic, this medication is indicated to manage moderate to moderately severe acute or chronic pain in adults. It is available as a 50-mg tablet. The dosage is titrated to minimize the risk of adverse effects. The usual initial dosage is 25 mg orally once daily in the morning. The dosage may be increased by doses of 25 mg every 3 days up to a dosage of 25 mg 4 times daily, then increased by 50 mg daily for 3 days, up to 50 mg 4 times daily. Once titration has been completed, the usual maintenance dosage is 50-100 mg every 4-6 hours as needed, with a maximum dosage of 400 mg. With proper titration, this analgesic is generally well tolerated. Common side effects are constipation, nausea, dizziness, headache, and somnolence.

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Ultram (tramadol hydrochloride)

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Patients who suffer from painful migraine headaches are likely to find relief with this "triptan" medication. It is indicated to relieve severe pain and other symptoms of migraine headaches, with or without an aura. This medication is available as 5-mg and 10-mg tablets (to be swallowed), and as 5-mg and 10-mg disintegrating tablet that dissolve in the patient's mouth. Patients are instructed to treat migraine headache symptoms as soon as the migraine begins. Starting the medication right away helps prevent severe migraine symptoms. The usual adult dosage with or without an aura is 5-10 mg orally. If pain relief does not occur within about 1 hour, the patient may repeat the dose. The maximum dosage over 24 hours is 30 mg. Common side effects are chest tightness or pressure, nausea, fatigue, dizziness and somnolence.

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Relpax (rizatriptan)

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A patient may purchase this over-the-counter analgesic to relieve mild to moderate pain and fever. It is available as oral tablets and capsules; oral solutions, liquids, and suspensions; and rectal suppositories. Depending on the dosage form, this medication is available in adult strengths of 325 mg, 500 mg, and 650 mg and in pediatric strengths of 81 mg, 125 mg, and 160 mg.. The usual dosage in adults is 650-1000 mg orally every 4 hours as needed (maximum 4 grams per day), or 650 mg rectally every 4-6 hours (maximum 6 suppositories/24 hours). The usual dosage in children ages 3 months - 3 years is 10-15 mg/kg/dose every 4-6 hours (maximum 5 doses/day); in children ages 3-6 years, 120-125 mg every 4-6 hours (maximum 720 mg/24 hrs) ; and in children ages 6-12 years, 325 mg every 4-6 hours (maximum 2.6 g/24 hours). The danger with this medication is liver damage which usually results from acute overdose. In addition, because this medication is so well tolerated, people tend to take large dosages or too many doses in a short period of time, or may take large doses of the drug daily for chronic pain. Drinking alcoholic beverages while being treated with this drug adds to the risk of hepatotoxicity. Another factor adding to the danger of drug overdose is that this medication is found in many over-the-counter combination products such cold, sinus, and allergy preparations, sleep aids, and other products. People are often not aware that this drug may be in two or more of the OTC products they are taking on a regular basis. Hepatotoxicity can be monitored thought routine medical exams and bloodwork.

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Tylenol (acetaminophen)

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You may see this opioid analgesic patch prescribed to a cancer patient to manage persistent moderate to severe chronic pain. It is used only in patients who are already receiving an opioid medication, and who require continuous, around-the-clock therapy. It is available as patches that deliver 1.25 mg, 2.5 mg, 5 mg, 7.5 mg and 10 mg of the medication over a 72-hour period. It may be used in pediatric patients over the age of 2 years, as well as adults. To find the initial dosage, the healthcare provider must use a conversion chart provided in the prescribing information. The conversion chart explains which patch dosage to use based on the opioid and the dosage the patient is taking. The patch must be used on intact, non-irritated skin, usually on the chest, back, flank (side) or upper arm. Common adverse effects are pruritus, sweating, nausea, constipation, dizziness, and sedation.

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Duragesic (fentanyl)

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This centrally acting skeletal muscle relaxant is used to relieve painful muscle spasms. It is available as a 350-mg tablet. The usual dosage is one tablet 4 times daily in adults and children over the age of 12 years. Common adverse effects are dizziness and drowsiness. Less common side effects my include nausea, orthostatic hypotension, and syncope.

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Soma (carisoprodol)

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Classified as an anticonvulsant, this medication is indicated to treat postherpetic neuralgia. It is also used "off-label" to prevent migraine headache attacks and to manage chronic nerve pain associated with trigeminal neuralgia, cancer, multiple sclerosis, and peripheral neuropathies resulting from diabetes and HIV. It is available as 100-mg, 300-mg, 400-mg, 600-mg, and 800-mg tablets, 100-mg, 300-mg, and 400-mg capsules, and 250-mg/5 ml oral solution. To minimize side effects, dosing is gradually titrated to a therapeutic dosage. The usual starting dosage is 300 mg the first day, 300 mg twice daily, then 300 mg 3 times daily. The dosage may be increased by 100-300 mg every 1-3 days until symptoms improve, or the therapeutic dosage is reached. The dose is individualized to the patient's needs. The recommended therapeutic dosage (administered in 3 doses daily) for postherpetic neuralgia is 900-1800 mg/day; for diabetic neuropathy, 900-3600 mg/day; and for migraine prophylaxis, 2400 mg/day.

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Neurontin (gabapentin)