Pain- opioids and muscle relaxants

vitohuxo's version from 2016-03-17 03:05


Question Answer
opioids moamu receptor agonists in the CNS and this primary mechanism pain relief.
REMS for all ER opiods primary componentseducation for all prescribers and they must counsel the patients.
common dosing IR morphine 10-30mg every 4 hours PRN
common dosing ER morphine15-200mg every 8-12 hours. do not crush and chew!! can sprinkle on applesauce
IV morphine dose opiod naive2.5-5mg every 3-4 hours PRN
methylnaltrexone (relistor)laxative for constipation from opiods SC.....senna S must have failed to give. blocks opiod receptors peripherally in the gut. do not use routinely!!!!
duragesic-fentanyl dosing patch1 patch every 72 hours (occasionally 48 hrs if pain is controlled but doesnt last long enough instead of increasing dose)
fentanyl can convert a patient usingmorphine 60mg per day or equivalent for at least 7 days.
Ionsys morphinehospital use only....remove before discharge...transdermal
analgesic effect patch seen after how many hours8-16 hours
3A4 inhibis can cause fatal overdosehydrocrodone ER and fentanyl and oxycodone and tramadol
dialudid oral dose opiod naive2-4 mg every 4-6 hours PRN
dialudid iv dose opiod naive0.2-1 mg every 2-3 hours PRN
opana oxymorphone
take on empty stomachoxymorphone
life threating QT prolongation and serotonergicmethadone
demerolmeperidine. short duration of action and renal impariemtn and elderly risk CNS toxicity. serotonergic
tramadol MOAmu opiod receptor agonist, inhibior of NE reuptake and serotonin. tramadol no same boxed warnings as other opiods
tapentadol MOAmu opiod receptor agonist, inhibior of NE reuptake and serotonin. same boxed warning as other opiods
do not use if seizure risktramadol and tapentadol
tramadol benefitlower GI SE and lower sedation usually for people.
tramadol use in children under 17 of label. can cause slowed or difficult breathing
if switching to morphine and renal insuff thendecrease dose by 50%.
methylnaltrexone dose12mg SC daily
buprenorphine moapartial mu agonist low doses and antagonist higher doses. lower doses treat pain and higher treat addiction.
butrans dose opiod patch once weekly.
suboxone buccal film of buprenorphine plus naloxone for opiod dependence. prescribers need X DEA number.
how suboxone worksbinds receptors tightly in brain....still already on another narcotic can go into severe withdrawal since will immed kick the other one off. patient should be having some signs of withdrawal
how much time between opiod and start suboxone?it is important that the individual has not taken any other opiates for at least 12 to 18 hours before the first dose of buprenorphine, otherwise they could go into precipitated withdrawal which is basically characterized by intensified withdrawal symptoms (worse than the normal opiate withdrawals that the person is used to). To avoid precipitated withdrawal symptoms, follow the doctors orders and make sure that you are currently in withdrawal at the time of your first administered buprenorphine (or Suboxone) dose.
zanaflextizanidine...doc said less drowsy
SE all muscle relaxantsexcessive sedation, dizziness, confusion
cyclobenzaprine SEdry mouth, serotonergic, may exacerbate arythmias
tizanidine SEhypotension, dizziness, weakness
robaxin methocarbamol
poor 2c19 metabolizers can have higher concentrationsSoma

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