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113 Cards in this Set
- Front
- Back
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Fentanyl dosage forms
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INJ (Sublimaze)
TD (Duragesic) Transmucosal lozenge (Actiq, Oralet) |
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Duragesic strengths
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12, 25, 50, 75, 100mcg/h
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Hydromorphone dosage forms
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Tablet (Dilaudid)
Liquid INJ Suppository |
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Levophanol dosage forms
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Tablet (Levo-Dromoran)
INJ (IV,IM,SC) |
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Meperidine dosage forms
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Tablet (Demerol)
Liquid INJ |
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Methadone dosage forms
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Tablet (Dolophine/Methadose dispersible)
Liquid INJ |
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Morphine dosage forms
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Tablet (MSIR)
Liquid (Roxanol/MSIR) INJ CR (Oramorph SR, MS Contin, Kadian, Avinza) |
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Oramorph SR
MS Contin Kadian Avinza dosign intervals |
Oramorph SR 8-12h
MS Contin 8-12h Kadian 12-24h Avinza 24h |
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Oxycodone dosage forms
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Capsule (OxyIR)
Tablet (Roxicodone) Liquid (Roxicodone, OxyFAST) CR tablet (Oxycontin) |
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Oxymorphone dosage forms
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INJ
Supp (Numorphan) |
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Codeine dosage forms
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Tablet
Liquid INJ |
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Vicodin strength
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5/500
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Vicodin ES
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7.5/750
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Lorcet or Vicodin HP strength
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10/650
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Lortab strength
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2.5/500, 5/500, 7.5/500, 10/500
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Norco strength
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5/325, 7.5/325, 10/325
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Vicoprofen
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7.5/200
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Darvocet-N
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50--50/325, 100--100/650
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Darvon
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32, 65mg capsules
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Pentazocine dosage forms
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Tablet (Talwin)
Talwin NX= 50/0.5mg naloxone Talwin Compound = 12.5/325 ASA |
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Butorphanol dosage forms
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INJ (Stadol)
Nasal Spray (Stadol NS) |
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Nalbuphine dosage forms
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INJ (Nubain)
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Buprenorphine dosage forms
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INJ (Buprenex)
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Dezocine dosage forms
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INJ (Dalgan)
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Tramadol dosage forms
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tablet (Ultram 50mg)
Ultracet (tramdol/APAP 37.5/325) Ultram ER 100, 200, 300mg |
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Ultram max
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400mg/d
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Ultracet max
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8 tabs/d
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Ultram ER max
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300mg/d
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Pentazocine max
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600mg/d (PO)
360mg/d (IV) |
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Propoxyphene max
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600mg/d
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Naloxone dosage forms
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INJ (Narcan)
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Naloxone dosing interval, indications
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every 2-3min
opiod overdose, postoperative narcotic depression |
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Naltrexone dosage forms
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Tablet (Trexan/Revia)
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Naltrexone indications
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alcohol dependence, narcotic addiction
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Nalmefene dosage forms
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INJ (Revex)
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Nalmefene dosing interval, indications
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every 2-5min
opiod overdose, postoperative respiratory depression |
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Have a ceiling effect (a dose beyond which no further respiratory depression or analgesia is produced)
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agonist-antagonists opiods
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Little propensity to release histamine
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Fentanyl
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Associated with Torsades De pointes
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methadone
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Patients on opiods do not develop tolerance to what
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constipation
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All patients on around-the-clock opiods should be placed on what
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prophylactic bowel regimens including stool softeners, mild laxatives, fluid and fiber intake
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Management of severe constipation d/t opiods
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osmotic laxatives such as magnesium citrate and milk of magnesia
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Mydriasis occurs when
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asphyxia intervenes
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The presence of inactive metabolites makes it a preferred drug in patients with liver dysfunction
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Fentanyl
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All of the opiods are metabolized through the hepatic CYP 450 enzyme system except for
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morphine (hepatic glucorinidation)
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Analgesic effects of transdermal fentanyl can be observed after how long after application
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8-16 hours; blood concentrations are measureable w/in 2 hours after application
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Analgesia from transmucosal fentanyl citrate begins how soon, peaks, and persists for how long?
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10-15mins, 20mins, 1-2hours
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Methadone pharmacokinetics
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about 90% bound to plasma proteins and is widely distributed to tissues
accumulation is possible and dosing intervals need to be monitored d/t terminal half life of 15-55hours Analgesic efficacy does not correspond to the half life of the drug (dosed q3 hours for pain control) |
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Hydromorphone metabolism
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not known whether it is metabolized by the CYP450 system
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Metabolite may accumulate in pts with compromised renal function
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meperidine
should not be used in pts w/ renal or CNS disease for more than 48hours, or at does greater than 600mg/24hours Naloxone does not reverse this hyperexcitability |
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Produces a toxic metabolite with effects similar to normeperedine
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propoxyphene
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CYP450 enzymes metabolize what opiods
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codeine, hydrocodone, fentanyl, methadone, and oxycodone
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Require metabolism through CYP450 2D6 to active drug
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codeine, hydrocodone, and oxycodone, tramadol
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Require dosing adjustment in renal impairment
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fentanyl, morphine, and methadone (longer dosing intervals)
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Fentanyl transdermal patch administration instructions
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upper torso
use only water to clean area hold in place for min 30 secs increase in temp may result in overdose |
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This opiod contains fumaric acid which may result in serious liver toxicity
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Avinza (doses >1600mg/d)
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May be opened and beads ingested with a small amount of applesauce
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Kadian and Avinza
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Approved for sprinkle administration through a gastrostomy tube
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Kadian
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Oral transmucosal fentanyl citrate lozenge administration
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place in between the cheek and gum
consumption of lozenge should take 15mins another lozenge may be used 30 mins after the start of the first one |
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Avoid use in patients with seizure disorders
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Tramadol
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Tramadol MOA
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analog of codeine binds to mu receptors and weak inhibition of NE and serotonin reuptake
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Use of abortive therapies should be limited to how much?
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2-3 days per week
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Which medications are the only ones that don't cause rebound headaches?
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Triptans
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Role of caffeine in combination products
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Analgesic and antiinflammatory activity
increase gastric acidity and perfusion, enhancing the absorption of aspirin |
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Excedrin Migraine
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only nonRX preparation that carries a specific indication for migraine relief
ASA 250mg, APAP 250mg, caffeine 65mg |
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Midrin
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abortive medication
isometheptene (vasoconstrictor), dichloralphenazone (sedative), and APAP 5 capsules within a 12 hour period |
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Medications used for abortive therapy
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Ibuprofen, APAP, aspirin, other aspirin like analgesics
combo products containing analgesic, caffeine, and butalbital or codeine butorphanal nasal spray ergotamine, dihydroergotamine Triptans |
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Ergomar
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ergotamine 2mg SL tablet
max 6mg/d (10mg/week) |
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Ergostat, Wigrettes
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ergotamine 2mg tablet
max 6mg/d (10mg/week) 1 tab at onset then 1 every 30 min prn |
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Gynergen
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ergotamine 0.5mg/mL injection
1mg/week; IM 125-500mcg repeated if needed to weekly max |
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Medihaler-Ergotamine
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ergotamine inhalation 9mg/mL
820mcg/d (5.4mg/week) 1 inhalation (360mcg) followed by one inhaltion after 30-60min |
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Cafergot
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Ergotamine 1mg/caffeine 100mg tablet
6mg/d (10mg/week) |
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Bellergal
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Ergotamine 0.3mg/pentobarbital 20mg/bellafoline 0.1mg tablet
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Bellamine, Bellamine S, Bellaspas, Duragal-S
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ergotamine 0.6mg/pentobarbital 40mg/balladonna 0.2mg tablet
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Cafergot PB
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ergotamine 1mg/pentobarbital 30mg/belladonna 0.125mg/caffeine 100mg tablet
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Wigraine
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ergotamine 1mg/belladonna 0.1mg/caffeine 100mg/phenacetin 130mg suppository
4mg/d (10mg/week) |
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Abortives that come in suppositories
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Cafergot, Cafergot PB, Wigraine-PB
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D.H.E. 45
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dihydroergotamine INJ IV/IM 1mg/mL
2mg/d (6mg IV or 3mg IM/week) 0.5-1mg IV/IM every hour prn |
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Migranal
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dihydroergotamine nasal spray 4mg/mL
2mg/d (6mg/week) Administer one spray (0.5mg) in each nostril followed in 15 mins by an additional spray in each nostril |
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Ergotamine adverse effects
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N/V
leg weakness, myalgia, numbness and tingling in periphery, angina-like pain, tachycardia, bradycardia |
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Ergotamine contraindications
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renal or hepatic impairment
CAD PVD Sepsis Pregnancy (category X) |
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Ergotamine drug-drug interactions
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SSRIs (separate by atleast 24hours)
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Signs of ergotism
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muscle pain, paresthesias, and cold or pale extremities
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Action of dihydroergotamine
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like ergotamine, alters transmission at serotonergic, dopaminergic, and alpha adrenergic junctions
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DHE differences to ergotamine
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minimal peripheral vasoconstriction
little N/V No physical dependence Diarrhea is prominent |
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DHE pharmacokinetics
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not active orally d/t extensive first pass metabolism
has an active metabolite half life 21 hours |
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Axert
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almotriptan
max 25mg/d q2h prn |
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Imitrex
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sumatriptan
tab max 200mg/d q2h prn nasal max 40mg/d q2h prn INJ max 12mg/d; repeat in 1 hour |
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Relpax
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eletriptan
max 80mg/d; q2h prn |
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Frova
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frovatriptan
max 7.5mg/d; q2h prn |
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Maxalt
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rizatriptan
max 30mg/d; q2h prn |
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Zomig
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zolmitriptan
tablet/wafer max 10mg/d; q2h nasal max 10mg/d; q2h |
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Amerge
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naratriptan
tablet max 5mg/d; q4h |
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Triptans MOA
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5-HT1B/5-HT1D agonists
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Has the fastest onset of action when compared to other triptans
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sumatriptan SC injection
sumatriptan nasal spray has a slightly slower onset than the INJ |
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Slightly fastest onset of oral triptans, including dissolving wafers
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rizatriptan at 1-1.5hours
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Long half life triptans
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frovatriptan (25hours)
naratriptan (5hours) but slower onset of action |
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Triptans most frequent side effects
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tingling, paresthesias
sensations of warmth in head, neck, chest, and limbs |
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About 50% of patients on this triptan experience unpleasant chest symptoms described as "heavy arms" or "chest pressure" rather than pain
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sumatriptan
not related to icschemic heart disease |
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Rarely may cause angina secondary to coronary vasospasm as should not be given to patients with risk factors for CAD
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sumatriptan
PM women, men >40, HTN, hypercholesterolemia, obesity, DM, FH of CAD |
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Intranasal administration side effects
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may cause irritation in nose and throat as well as offensive or unusual taste
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Triptans drug interactions
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don't use within 24h of an ergot derivative or another triptan
don't administer within 2 weeks of stopping an MAOI |
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Triptans contraindications
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ischemic heart disease, MI, uncontrolled HTN, or other heart disease
don't use during pregnancy |
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Triptans that come in nasal formulation
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Zomig, Imitrex
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Triptans that come in wafer formulation
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Maxalt, Zomig
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Triptans that come in injection formulation
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Imitrex
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Triptans not metabolized by MAO
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Amerge, Frova, Relpax
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Triptqans not metabolized by CYP450
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Maxalt, Frova, Imitrex
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Triptans metabolized partially renally
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Amerge, Frova
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1st line prophylactic drugs for migraine
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propanolol, timolol, divalproex sodium, sodium valproate, amitriptyline
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Other drugs for prophylaxis of migraine
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topiramate, methylsergide, CCBs (verapamil, nifedipine, nimodipine), gabapentin
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Methylsergide side effects
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retroperitoneal fibrosis, leg cramps, hair loss, drowsiness, hallucinations, nightmares, insomnia, NVD, vascular insufficiency
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Methylsergide dosing
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1-6mg daily (treatment must be discontinued for 1 month every 6 months)
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