Term
|
Definition
Fluticasone
Chronic tx of asthma
MDI individualized BID
MDI (44, 110, 220 mcg)
rinse mouth |
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Term
|
Definition
Fluticasone
100 to 250 mcg BID
DPI; (50,100,250mcg)
rinse mouth |
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Term
|
Definition
Budesonide
chronic treatment of asthma
BID
DPI (90, 180mcg)
rinse mouth
Pt consult: not for use with spacer, prime with one dose prior to initial use of the unit, pt may not taste or feel the powder inhalation |
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Term
|
Definition
Budesonide
chronic asthma treatment
BID
respules given via nebulizer (0.25, 0.5, 1mg/2mL)
rinse mouth |
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Term
|
Definition
Ciclesonide
chronic treatment of asthma
BID or q12h whichever you prefer
MDI; (80, 160 mcg)
rinse mouth
prime with 3 sprays on initial use |
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Term
|
Definition
Mometasone
QD-BID
DPI; (110, 200 mcg)
rinse mouth |
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Term
|
Definition
Salmeterol
chronic treamtent and prevention of bronchospasm
1 inhalation q12h
DPI; can use 1 inhalation 30 mins pre-exercise for prophylaxis
max dose 100mcg/day (from class) |
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Term
|
Definition
Formoterol
chronic treatment and prevention of bronchospasm
1 inhalation q12h
DPI; capsule for inhalation; 1 inhalation at least 15 minutes pre-exercise for prophylaxis
max 24 mcg/day (from class) |
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Term
|
Definition
Formoterol
chronic treatment of COPD
1 nebulized vial q12h
20mcg per 2mL vial
max 40 mcg/day (from class) |
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Term
|
Definition
Arfomoterol
chronic treatment of COPD
1 nebulized vial q12h
15mcg per 2mL vial
max 30 mcg/day (from class) |
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Term
|
Definition
Fluticasone/Salmeterol
chronic treatment of asthma/COPD
1 inhalation q12h
DPI; (100/50, 250/50, 500/50)
rinse mouth |
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Term
|
Definition
Fluticaonse/Salmeterol
chronic treatment of COPD
2 inhalations q12h
MDI; (45/21, 115/21, 230/21 mcg)
rinse mouth |
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Term
|
Definition
Budesonide/Formoterol
chronic treatment of asthma/COPD
2 inhalations q12h
MDI; (80/4.5, 160/4.5 mcg)
rinse mouth |
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Term
|
Definition
Mometasone/Formoterol
chronic treatment of asthma
2 inhalations q12h
MDI (100/5, 200/5 mcg)
rinse mouth |
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Term
|
Definition
Flunisolide
chronic treatment of asthma
QD-BID
MDI (80mcg/inhalation)
prime with 2 sprays prior to use |
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Term
|
Definition
Albuterol
relief of bronchospasm
2 puffs q4-6h prn
MDI; can use 2 inhalations 15 minutes pre-exercise for prophylaxis |
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Term
| Proventil inhalation solution |
|
Definition
Albuterol
relief of bronchospasm
0.63-2.5 mg TID-QID
0.63, 1.25, 2.5/3mL pre-filled vials; 5mg/1mL solution for nebulization |
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Term
|
Definition
Levalbuterol
relief of bronchospasm
2 inhalations q4-6h prn
MDI |
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Term
| Xopenex inhalation solution |
|
Definition
Levalbuterol
relief of bronchospasm
0.31-1.25mg q4-8h
(0.31, 0.63, 1.25 per 3 mL) pre-diluted
1.25 mg per 0.5 mL is concentrate and needs to be diluted |
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Term
|
Definition
Zafirlukast
chronic treatment of asthma
ADULT: 20mg BID on an empty stomach
5-11y/o: 10mg BID on an empty stomach
AE: headache |
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Term
|
Definition
Montelukast
chronic treatment of asthma/allergic rhinitis
2-5y/o - 4mg qpm
6-14y/o - 5mg qpm
>or= 15 - 10mg qpm
AE: headache, restlessness
used daily, chronic treatment |
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Term
| Cromolyn inhalation solution |
|
Definition
Cromolyn
chronic treatment of asthma and excercise-induced bronchospasm
1 vial by nebulization TID-QID
for nebulization (20mg/2mL); not for acute treatment; may take 4 weeks for effect
AE: cough, sore throat
oral form is used for IBD |
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Term
|
Definition
Prednisone
short-term treatment of respiratory inflammation, asthma exacerbations, acute exacerbations of COPD
1-2mg/kg/d for pediatricts
40-60 mg/d adults
1 or more doses
commonly used as a steroid "burst" for 3-10d; dosed as single dose or 2 divided doses |
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Term
|
Definition
Methylprednisone
short-term treatment of respiratory inflammation (asthma, COPD)
1-2mg/kg/day for pediatrics; 40-60mg/day adults
1 or more doses
commonly used as a steroid "burst" for 3-10d; dosed as single dose or 2 divided doses |
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Term
|
Definition
Prednisolone
short-term treatment of respiratory inflammation (asthma, COPD)
1-2mg/kg/day for pediatrics; 40-60mg/day adults
1 or more doses
3-10 day steroid "burst" single dose or 2 divided doses; 15mg/5mL or 5mg/5mL solution' 10,15,30 mg orally dispersible tab |
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Term
|
Definition
Theophylline
asthma/bronchospasm associated with COPD
individualized in 1 to 3 doses
serum concentration monitoring necessary range 5-15 mcg/mL adults; 5-10mcg/mL peds
DI: cimetidine, quinolone Abx, macrolides, pentoxifylline, smoking, CYP 1A2 inhibitors/inducers, absorption affected by foods(bbq increases absorption)
CI: active peptic ulcer, seizure disorder
AE: GI, CNS (tremors) |
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Term
|
Definition
Ipratropium
maintenance tx of bronchospasm (COPD)-MDI, rhionrrhea (allergic/non-allergic)-nasal spray
2 inhalations TID-QID
up to 12 inhalations/day; use on schedule, not prn
CI/Precautions: not for acute attacks; anticholinergic precautions
AE; oral-dry mouth, couch, HA Nasal-dryness, epistaxis, irritation, HA |
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Term
|
Definition
Tiotropium
maintenance tx of bronchospasm (COPD)
1 inhalation daily
DPI-handihaler; 18mcg cap for inhalation; repeat inhalation of same capsule to ensure delivery
Pharmacology/PK: selective muscarinic receptor antagonist, half life 5-6 days
CI/precautions: anticholinergic (caution with glaucoma and BPH)
AE: dry mouth, constipation
PT consult: keep in original pkg till use |
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Term
|
Definition
Indacaterol
chronic treatment of COPD, LABA
1 inhalation daily
DPI; 75mcg cap for inhalation; max dose 1 puff q d
half life 55 hours
AE: cough, oropharyngeal, soreness, nasopharyngitis, HA. DI: can potentiate QTc prolongations |
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Term
|
Definition
Aclidinium
maintenance tx of bronchospasm (COPD)
1 inhalation BID
DPI; 400mcg/inhalation
Pharmacology/PK: anticholinergic, half-life 5-8 hrs
DI: anticholinergic agents, pramlintide
CI/precautions:immediate hypersensitivity reactions, paradoxical bronchospasm
AE: HA, nasopharyngitis, cough, anticholinergic effects
PT Consult: discard 45 days after removing from pkg, if they don't hear a click need to start over |
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Term
|
Definition
Roflumilast
maintenance tx to reduce COPD exacerbations
500 mcg daily
500mg tab for severe COPD with bronchitis and h/o exacerbations
Pharmacology: selective phosphodiesterase-4 (PDE4) inhibitor
CI: moderate to severe liver impairment, warnings related to suicidality and weight loss
AE: insomnia, decreased appetite/weight loss, diarrhea
DI:not to be used with strong P450 inducers, systemic exposure will be increased when admin with 3A4 and 1A2 inhibitors
Pt Consult: FDA MedWatch guide must be given when dispensing (mood changes, including suicidal thoughts, sleep disturbances |
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Term
| Duoneb inhalation solution |
|
Definition
Ipratropium/Albuterol
maintenance tx of bronchospasm (COPD)
1 nebulized vial q6h
max dose 1 nebulized vial q4h; 0.5mg ipratropium & 2.5 mg albuterol/3mL vial
Pt Consult: protect from heat and light, keep in original foil containers |
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Term
|
Definition
Ipratropium/Albuterol
maintenance tx of bronchospasm (COPD)
2 puffs QID
max 12 puffs/day; 18mcg ipratroium and 90mg albuterol/puff |
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Term
|
Definition
Fexofenadine
allergic rhinitis
60mg BId or 180mg Daily (adult)
also available 30mg ODT and 6mg/mL syrup (pediatrics) |
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Term
|
Definition
Fexofenadine/Pseudoephedrine
allergic rhinitis
D-12 (fex 60mg/pseudo 120mg)= 1 tab q12h
D-24 (fex 180mg/pseud 240mg)= 1 tab q24h
CI/precautions: severe HTN/CAD
AE: HA, insomnia |
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Term
|
Definition
Desloratadine
allergic rhinitis/chronic urticaria
5mg daily (adult)
2.5mg ODT and 2.5mg/5mL syrup pediatrics
Pt Conslut: avoid OTC cough, cold, allergy products unless directed |
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Term
|
Definition
Desloratadine/Pseudoephedrine
D-12 (deslor 2.5mg/pseudo 120mg)=1tabq12h
D-24 (deslor 5mg/pseudo 240)=1 tab q24h
CI/precautions: severe HTN/CAD
AE: HA, insomnia
PT Consult: avoid OTC cough, cold, allergy products |
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Term
|
Definition
Cetirizine
allergic rhinitis
10mg once daily
5, 10mg tabs; 1 mg/mL syrup; 5, 10mg chewable tabs
AE: drowsiness/somnolence, fatigue, dry mouth |
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Term
|
Definition
Cetirizine/Pseudoephedrine
allergic rhinitis
1 tab q12h cetirizine 5mg/pseudoephedrine 120mg ER tabs
Precautions: additive CNS depressants/sympathomimetics
AE: nervousness, insomnia |
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Term
|
Definition
Fluticasone propionate
allergic rhinitis
2 sprays each nostril daily
alternative dosing 1 spray each nostril BId; utilize for chronic, not prn tx |
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Term
|
Definition
Fluticasone furoate
allergic rhinitis
2 sprays each nostril daily
utilize for chronic not prn tx; 1 spray each nostril daily for maintenance may be used |
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Term
|
Definition
Mometasone
2 sprays each nostril daily
utilize for chronci not prn tx |
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|
Term
|
Definition
Budesonide
allergic rhinitis
1-2 sprays each nostril daily
utilize for chronic, not prn tx |
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Term
|
Definition
Ciclesonide
allergic rhinitic
2 sprays each nostril daily
utilize for chronic, not prn tx max dose 2 sprays in each nostril BID |
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Term
|
Definition
Beclomethasone
allergic rhinitis
1-2 sprays each nostril BID
not prn tx |
|
|
Term
|
Definition
Triamcinolone
allergic rhinitis
2 sprays each nostril daily
not prn tx
1 spray each nostril daily for maintenance may be used |
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Term
|
Definition
Azelastine/Fluticasone
seasonal allergic rhinitis
1 spray each nostril BID
138 mcg/azelastine 50mcg fluticasone per spray; not for prn
nasal steroid + antihistamine
DI: CNS depressants
AE: cough, epistaxis, HA, fever, abnormal taste |
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Term
|
Definition
Phenylephrine
nasal congestion
10mg q4h prn
use no more than 7 days, max 60mg/24h
CI: severe CAD/HTN
AE: insomnia, restlessness, GI |
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Term
|
Definition
Pseudoephedrine
60 mg q4-6h prn 2 tabs per dose; max dose for all forms is 240mg/day
CI: severe CAD/HTN
AE: insomnia, restlessness, GI |
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Term
|
Definition
Benzonatate
symptomatic relief of nonproductive cough
100-200mg TID
generally 100mg TID; max 600mg/day; do not suck or chew caps
PK: onset in 15-20 min
CI/precautions: caution with PABA class anesthetic allergy, if chew or suck could cause bronchospasm/CV collapse
AE: drowsiness, HA
Pt consult: swallow whole, keep away from children |
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Term
|
Definition
Chlorpheniramine/Hydrocodone
relief of cough/upper respiratory symptoms
1 tsp (5mL) q12h (adult) Pennkinetic ER suspension; (hydrocodone 10mg & chlorpheniramine 8mg)/5 mL; 2 tsps per day max
controlled- CIII
DI: CNS depressants
CI/precautions: pulmonary disease/asthma, BPH
AE: drowsiness, dry mouth, constipation |
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Term
|
Definition
Chlorpheniramine/Hydrocodone
relief of cough/upper respiratory symptoms
1 cap q12h (adult)
8mg chlorpheniramine/10mg hydrocodone per ER cap; max dose 2 caps/24 h
same content as Tussionex |
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Term
|
Definition
Hydrocodone/Homatropine
relief of cough/upper respiratory symptoms
1 tsp (5mL) q4-6h prn (adult)
5mg hydrocodone/1.5mg homatropine per 5mL; max dose 30mL/24h
Controlled- CIII
DI: CNS depressants
AE: drowsiness, dry mouth, constipation |
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Term
|
Definition
Codeine/Guafenesin/Pseudoephedrine
relief of cough/expectorant
2 tsp (10mL) q4h prn (adult)
10mg codeine/100mg guaifenesin per 5mL; max dose 40mL/24h
DI: CNS depressants
AE: drowsiness, constipation
PT Consult: drink ample water to loosedn secretions |
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Term
|
Definition
Meperidine
Moderate to moderately severe pain
50-150 mg po q 3-4h (prn)
Max dose individualized
tabs, liquid, injection
PK: active metabolite, normeperidine, can accumulate and cause CNS AE including seizures
CI: MAO Inhibitors
DI: phenothiazines |
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Term
|
Definition
Fentanyl transdermal
chronic pain
individualized (apply patch q 72hrs)
12.5, 25, 50, 75, 100 mcg/hr transdermal (start no > 25mcg/hr if naive)
PT Consult:apply to normal dry skin on upper torso; clip (not shave) hair prn, do not irritate site with soap or lotion before application, apply with pressure for 10-20 seconds, keep out of trash cans, should fold on itself and flush, rotate sites to avoid irritation, use hyrdocortisone if irritation, if dose change needed do not increase until after 2 cycles (1 week) |
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Term
|
Definition
fentanyl citrate buccal tab
break through cancer pain (prn)
individualized (100mcg initial)
initial max up to 2 tabs each side of mouth, separate doses by 4 hrs. Titration limit to max 4 tabs simultaneously
100, 200, 400, 600, 800 mcg buccal tabs (strengths not bioequivalent)
PT Consult: no food or drink for 30 min after placement. Swallow remaining tab remnants with water after 30 min. Can repeat 2nd dose at 30 min if prescribed |
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Term
|
Definition
fentanyl citrate buccal lollipop
break through cancer pain (prn)
individualized (200 mcg initial)
max 4 units/day (max 2/episode), separate by 4 hrs
200,400,600,800, 1200,1600 mcg buccal lollipops; for opioid tolerant
Pt Consult: try to finish lozenge in 15 min, do not crush or chew, can repeat 2nd lozenge 30 min after initial placement; GI absorption and response later than transmucosal |
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Term
|
Definition
morphine sulfate extended release
moderate to severe pain
individualized (q8-12hrs)
15,30,60,100,200 mg tabs |
|
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Term
|
Definition
morphine sulfate extended release
moderate to severe pain
individualized (q24hrs)
30,45,60,75,90,120 mg caps
Pt Consult: can sprinkle on applesauce but need to swallow whole, not chew |
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Term
|
Definition
morphine sulfate extended release
moderate to severe pain
individualized (q24hrs)
10,20,30,50,60,80,100,200 mg caps |
|
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Term
|
Definition
morphine sulfate immediate release
moderate to severe pain
individualized (q4hrs prn)
15,30 mg tabs |
|
|
Term
|
Definition
morphine sulfate/naltrexone
moderate to severe pain
individualized (q12hrs) not for prn use
20/0.8, 30/1.2, 60/2, 80/3.2, 100/4 mg tabs
Pt Consult: naloxone core not absorbed |
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Term
|
Definition
hydromorphone extended release
moderate to severe pain
individualized (q24hrs)
8, 12, 16 mg tabs |
|
|
Term
|
Definition
hydromorphone immediate release
moderate to severe pain
individualized (2-4 mg q 4-6 hrs initially) prn
2, 4, 8 mg tabs, also liquid and injection |
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|
Term
|
Definition
oxycodone extended release
moderate to severe pain
individualized (q12hrs)
10,15,20,30,40,60,80 mg tabs |
|
|
Term
|
Definition
oxycodone immediate release
moderate to severe pain
individualized (q4-6hrs)
5,15,30 mg tabs, 5 mg caps (generic) |
|
|
Term
|
Definition
tapentadol
acute pain
50-100 mg q 4-6hrs
max 600 mg daily after day 1
50,75,100 mg tabs
CI/warnings: CI with MAOI use, warning for seizure conditions
DI: concomitant use of SSRI and SNRI, same warnings as tramadol |
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Term
|
Definition
oxycodone with acetaminophen
moderate to moderately severe pain
1-2 tabs q 4-6hrs prn
max 1 gram APAP/dose (4 g/day)
2.5,5,7.5,10/325 mg; 7.5/500; 10/650 mg tabs |
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|
Term
|
Definition
oxycodone with aspirin
moderate to moderately severe pain
1 q 4-6 hrs prn
max 12 tabs/day
5/325 mg tabs |
|
|
Term
|
Definition
hydrocodone with APAP
moderate to moderately severe pain
1-2 tabs q 4-6hrs prn
max 8 tabs/day (6 for 10/500)
2.5,5,7.5,10 mg/500mg tabs |
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Term
|
Definition
hydrocodone with APAP
moderate to moderately severe pain
15 ml q 4-6hrs prn
max 90 ml/day
2.5mg/167mg per 5 ml |
|
|
Term
|
Definition
hydrocodone with APAP
moderate to moderately severe pain
1 tab q 4-6hrs prn
max 6 tabs/day
Plus=7.5/650 mg Lorcet=10/650 |
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|
Term
|
Definition
hydrocodone with ibuprofen
acute pain, short term. Not for arthritis
1 tab q 4-6hrs prn
max 5 tabs/day
7.5/200 mg tabs
DI: NSAID interactions (lithium, diuretics, wararin) plus opioid
CI: NSAID allergy |
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|
Term
|
Definition
codeine with APAP
moderate to severe pain
1 tab q 4 hrs prn
max 6 tabs/day
#4 tabs (60/300) |
|
|
Term
|
Definition
codeine with APAP
mild to moderate pain
1-2 tabs q 4 hrs prn
max 4 g APAP &/or 360mg codeine/day
#2 tabs (15/300, #3 tabs (30/300) |
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Term
|
Definition
tramadol
moderate to moderately severe pain
50-100mg q 4-6hrs prn
max 400 mg/day (8 tabs), renal adjustment
50 mg tabs
DI: CNS depressants, TCAs, SSRIs
CI: h/o addiction, acute intoxication, precaution seizure concern
AE: mu opioid activity, dizziness, drowsiness, nausea, constipation, dry mouth
Pt Consult: avoid alcohol; causes drowsiness, take with food or milk if needed but slows absorption |
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Term
|
Definition
tramadol
moderate to moderately severe pain
100 mg qd
max 300 mg qd
100,200,300 mg tabs |
|
|
Term
|
Definition
tramadol with APAP
moderate to moderately severe pain
2 tabs q 4-6hrs prn
max 8 tabs/day
37.5 mg tramadol/325 mg APAP per tab |
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Term
|
Definition
butalbital, APAP, caffeine
tension headache
1-2 tabs q 4hrs prn
max 6 tabs
50mg butalbital, 325 APAP, 40 mg caffeine
DI: enzyme induction due to barbiturate- Warfarin
CI/precaution: hypersensitivity
Pt Consult: drowsiness |
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Term
|
Definition
butalbital, aspirin, caffeine
tension headache
1-2 tabs q 4hrs prn
max 6 tabs/day
50mg butalbital, 325 aspirin, 40mg caffeine
DI: enzyme induction due to barbiturate- warfarin, aspirin
CI/precaution: hypersensitivity (aspirin); PUD, coagulation disorders
Pt Consult: drowsiness |
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Term
|
Definition
buprenorphine/naloxone sublingual
treatment of opioid dependence
16 mg buprenorphine/day
maintenance: taper according to effects
SL-tabs, films (buprenorphine/naloxone):2/0.5mg, 8/2mg
Warnings: precipitation of physical withdrawal may occur
Pt Consult: MUST administer SL (poor oral bioavailability) |
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Term
|
Definition
minimize day/night symptoms
minimize exacerbations/hospital visits
minimize limits on activity and missed days
maintain near normal pulmonary function
minimize need for beta-2 agonist
minimal adverse effects from medications |
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|
Term
Systemic Corticosteriods
Class Contraindications
Class Precautions
Class AE
PT Consult |
|
Definition
CI: systemic fungal infections
Precautions: herpes co-infection, renal dysunction, HTN, osteoporosis, PUD, DM
AE: Upset stomach/N/V, fluid retention, increased glucose, decreased K, behavioral disturbances. PUD, osteoporosis/Cushing's complications (with long term use)
PT Consult: take oral with food or milk, do not stop abruptly, need to taper if >=14 days |
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|
Term
Nasal Corticosteroids
Class Precautions
Class AE
Class Pt Consult |
|
Definition
Precautions: bacterial/viral infections of the upper airways, unhealed nasal wounds
AE: HA, pharyngitis, epistaxis, cough
Pt consult: shake before using, prime until "fine mist" is seen, tild head slightly forward, inhale through nose exhale through mouth, effects may not be seen before a few days up to 3 weeks, can use concomitant decongestants |
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|
Term
Acute Pain Characteristics
Chronic Pain Characteristics
Malignant Pain |
|
Definition
Acute- vital sign changes, physical manisfestations
Chronic- >3 months, signs of pain diminish, vital sign changes may not be there
Malignant- could be acute or chronic |
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Term
| Equianalgesic Dosing Principles |
|
Definition
1. calculate total daily dose (TDD) received in mg (including prn doses). IF converting to a different opioid, decrease TDD by 25%
2. determine the equianalgesic TDD in mg based on known equivalencies
3. divide the TDD into an appropriate regimen of sustained-release product
4. provide "as needed" immediate release product equivalent to about 15% of the final TDD on a schedule of every 3-4 hrs |
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|
Term
Opioid Analgesics
Class contraindications/precautions
Class DI
Class AE
Pt Consult |
|
Definition
CI/precautions: respiratory depression/pulmonary disorders, GI obstruction
DI: concomitant CNS depressants
AE: dizziness, drownsiness, N/V, constipation
Pt Consult: take oral dosage forms with food or milk to lessen GI effects, alcohol use will intensify CNS depression |
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