1. FDA approved
1.1. Ketorolac
1.1.1. Pain Short Term
1.1.2. Not for
1.1.2.1. Headache
1.1.2.2. Sickle Cell
1.1.2.3. post op
1.1.2.4. pre op
1.1.2.5. fracture reduction
1.1.3. IV
1.2. Tylenol
1.2.1. more than 2 years
1.2.2. Lowers the need for Opiods
1.2.3. Not for
1.2.3.1. Migraines
1.2.3.2. Post OP
1.2.3.3. Vaccine
1.2.3.4. Osteoarthritis
1.2.4. Rectal 40-60 mg/kg
1.2.5. 28-32 weeker give 8-12 hours
1.2.6. Max Dose 4000mg/day
1.3. Ibuprofen
1.3.1. >6 months
1.3.2. No NSAID with Renal
1.3.3. Not for
1.3.3.1. pediatric migraines
1.3.3.2. vaccine prophylaxis
1.3.4. Headaches >6 monts
1.3.5. Rheumatoid Arthritis > 12 years old
1.3.6. Dysmenorrhea >12 years old
1.3.7. Prescription till 1989
1.3.8. Black Box GI/CV
2. BASAL RATE= INCRESE SE
3. Epidural decrease Side Effect increase blood flow area
4. Acute pain goes to chroni when not treated
5. oral longer onset and last longer
6. right dose
6.1. right med
6.1.1. right patient
6.1.1.1. right time
6.1.1.1.1. right route
6.2. less than 6 months less 10 kg or history of apnea, start with 1/4 to 1/2 intial recommendation and titira up as needed
6.2.1. >50kg use adult dose
7. NOT FDA Approved
7.1. Codiene
7.1.1. not for
7.1.1.1. sickle cell
7.1.2. ultrametabolite - morphine active/norcodeine- not active
7.1.2.1. Asians, whites, AA
7.1.3. best for coughing
7.2. Meperidiene
7.2.1. Demerol
7.2.2. not first line
7.2.3. < 48 hours
7.2.4. normepidine- is a toxic metabolite of meperidine
7.2.4.1. normeperidine is a cerebral irritant and accumulation can lead to seizures in otherwise healthy persons
7.3. Oxycodone
7.3.1. without tylenol
7.3.2. with Tylenol= Percocet
7.3.3. use together but not in one drug
7.3.4. start with oxycodone for 24 hours then split in half
7.3.5. not for
7.3.5.1. post op
7.3.5.2. arthritis
7.3.5.3. cancer pain
7.3.5.4. neuropathic
7.4. Morphine
7.4.1. not for
7.4.1.1. PCA
7.4.1.2. sickle cell
7.4.1.3. ventilator patient
7.4.1.4. depression
7.4.1.5. cancer pain
7.4.2. 0,1-0,2 mg/kg every 2 - 4 hours max 15mg/day
7.4.3. IV IM SQ
7.4.4. really works 1-2 hours
7.5. Methadone
7.5.1. Withdrawal = 24 hours heroin addict
7.5.2. pain every 6 hours
7.5.3. it stacks 1/2 life between 15=155 hours so if you give a dose every 6 hours 1/2 is 15 hours if give next dose your going to give before the first dose was completely gone its going to stakc expect delay onset
7.6. Fentanyl
7.6.1. 0.1mg = 10mg morphine
7.6.2. 1/2 life= 6 minutes
7.7. Dilaudid Hydromoprhone
7.7.1. stacks
7.7.2. 4-5 x's 1/2 = peak
7.8. Hydrocodone Acetaminophen
7.8.1. >2 y/o
7.8.2. max 6 doses
7.8.3. no more than 4000mg/24 hour