Pain

Question 1

What are the two main categories of pain?

Answer 1

Nociceptive: sensory nerves (nociceptors) identify tissue damage
- visceral or somatic pain
Pathophysiologic: damage or malfunction of nervous system

Question 2

What is used to assess a patient’s pain?

Answer 2

Descriptions & Observations
- type quality of pain?
- time or day
- agitating/ remitting factors
Pain scales to assess severity

Question 3

What are the formulations of Acetaminophen?

Answer 3

FeverAll: rectal suppository
Ofirmev: injection
Tylenol: oral

\+ hydrocodone = Lorcet, Lortab, Norco, Vicodin
\+ oxycodone = Endocet, Percocet
\+ codeine (Tylenol # 2, 3, 4)
\+ tramadol = ultracet
\+ caffeine = excedrin tension headache
\+ ASA/Caffeine = Excedrin ES, Excedrin migraine
\+ caffeine/pyrilamine = midol complete
\+ butalbital/caffeine = fioricet
\+ diphenhydramine = tylenol PM ES
\+ ibuprofen = advil dual action

Question 4

What is the MDD of acetaminophen?

Answer 4

< 4,000 mg daily

Question 5

What is the pediatric dosing of acetaminophen?

infant?

Answer 5

10-15 mg/kg q4-6h
MDD: 5 doses/day

160 mg/5mL

Question 6

Acetaminophen: BBW, warnings, SEs, and antidote

Answer 6

BBW: hepatotoxicity (associated with > 4 gms/day or use of multiple acetaminophen-containing products

Warnings: severe skin rxns (SJS/TEN), renal impairment

SE: well tolerated

antidote: N-acetylcysteine (NAC)

Question 7

How do NSAIDs work?

Answer 7

non-selective COX inhibition or selective

COX-1 and -2 catalyze conversion of arachidonic acid to PGs and thromboxane A2

COX-1 protects gastric mucosa, so selective agents are typically GI protective

Question 8

What happens if COX-1 is blocked?

Answer 8

decreased formation of TXA2 - which is needed for platelet activation and aggregation

Question 9

What are the non-aspirin boxed warnings?

Answer 9

GI risk, CV irks, Coronary artery bypass graft (CABG) surgery

Question 10

What are the side effects of NSAIDs?

Answer 10

• decrease renal clearance (decrease blood flow to glomerulus)
• increase blood pressure
• premature closure of ductus arteriosus (avoid in 3rd trimester)
• nausea
• photosensitivity

Question 11

Would an NSAID ever be used to close DA? and when should you use after birth to do so?

Answer 11

the DA should close on it’s own, but yes, it can be used to help close it if necessary

can use IV NSAIDs within 14 days after birth

Question 12

Ibuprofen

• selective or non?
• names
• dosing
• SEs
• additional notes

Answer 12

• non
• Advil, Caldolor, Motrin IB, NeoProfen
• OTC: 200-400 mg q4-6h
  Rx: 400-800 q6-8h (MDD: 3.2 gm/day)
• dyspepsia, abdom pn, nausea
• neoprofen inj for closure of PDA in premature infants
• limit OTC self-treatment to < 10 days

Question 13

What is the pediatric dosing of ibuprofen?

Answer 13

5-10 mg/kg/dose q6-8h

MDD: 40 mg/kg/day