Opioid Selection

PAIN MANAGEMENT

“Morphine is the best first choice for chronic potent opioid therapy (SOR B). It is reliable and inexpensive, and equivalent doses can be easily calculated if the patient must later be switched to another medication. Transdermal fentanyl and hydromorphone are...

Pain management in patients with both chronic liver and kidney disease

PAIN MANAGEMENT

“In patients with significant renal or hepatic dysfunction, fentanyl (given IV) is the opioid of choice.” Pain mgt in patients with CKD (Renal Insufficiency or ESRD on Dialysis). Pain management in patients with advanced chronic liver disease or...

Pain Management in Patients with Advanced Chronic Liver Disease or Cirrhosis

PAIN MANAGEMENT

Nociceptive pain. -Acetaminophen “is an effective and safe analgesic for most patients with chronic liver disease.” Limit to 2g per day. Avoid it in patients with severe alcoholic hepatitis or acute liver injury. -Opioids. Use “cautiously in patients...

Pain Management – PRN Medications

2nd INPATIENT, Clinic A/P, adults, Clinic A/P, Peds, Hospital A/P, Adults, Hospital A/P, Peds, PAIN MANAGEMENT

Mild Pain Acetaminophen(Tylenol) 650mg PO q6h PRN pain, fever Acetaminophen (Tylenol) 650 mg Rectal suppository, Q4hr PRN pain, fever Motrin (Ibuprofen) 600mg PO q8h PRN mild pain Moderate Pain -Naproxen 500mg PO then 250mg q8h (max 1250mg/ day) PRN -Ketorolac...

Pain Medications/Therapeutic Agents by Class

PAIN MANAGEMENT

Neuropathic pain: Amitriptyline / Gabapentin / pregabalin; also SNRIs e.g. duloxetine. -Restless leg syndrome: Requip/ Ropinirole -Duloxetine is used by Dr. Toby for a patient who doesn’t do well with Gabapentin. Can use both. Anti-inflammatory: Mobic (systemic)...

Pain Management for patients with Allergic Reaction to Morphine

PAIN MANAGEMENT

Patients with allergies to morphine can use synthetic opioids(group 3). Synthetic opioids – Tramadol, Fentanyl, propoxyphene, methadone, and meperidine. Non-opioid pain medications.