Acetaminophen (Tylenol)
Max Dose?
Aspirin (ASA)
Celecoxib (Celebrex)
Class: Analgesic, not nsaid
Action: analgesic(pain reliever), antipyretic(fever reducer)
Adverse reactions/side effects: HEPATIC FAILURE,
HEPATOTOXICITY (OVERDOSE ). Overdose because of one metabolic pathway is over utilized & a minor one is used to a greater extent accumulating in Liver
Dose: PO (Adults and Children > 12 yr): 650 mg q 4-6 hr
Max = 4000mg/24 hrs
Class: NSAID
Action: analgesia, reduces inflammation, reduces fever, and affects blood clotting
Adverse reactions/side effects: GI BLEEDING , dyspepsia, epigastric distress, nausea EXFOLIATIVE
DERMATITIS , STEVENS-JOHNSON SYNDROME ,
TOXIC EPIDERMAL NECROLYSIS .
ALLERGIC
REACTIONS INCLUDING ANAPHYLAXIS AND
LARYNGEAL EDEMA .
Dose: PO (Adults): 650mg 4-6q daily
Class: NSAID (selective)
Action: inhibits COX-2 pain relief and inflamation
Adverse reactions/side effects: GI BLEEDING,
EXFOLIATIVE DERMATITIS , STEVENS-JOHNSON
SYNDROME , TOXIC EPIDERMAL NECROLYSIS ,
Dose: PO 100-200(RA)
Ibuprofen (Motrin)
Ketorolac (Toradol)
Class: NSAID
Action: analgesic, anti-inflammatory, antipyretic
Adverse reactions/side effects: GI BLEEDING ,
HEPATITIS , constipation, dyspepsia, nausea, vomiting,
EXFOLIATIVE DERMATITIS , STEVENS-JOHNSON
SYNDROME , TOXIC EPIDERMAL NECROLYSIS,
ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS
Dose: PO (Adults): Anti-inflammatory --300-800 mg 3-4 times daily (not to exceed 3600 mg/day).
Class; Non-Opioid NSAID – prescription
Action: moderate – severe pain 5 DAYS OR LESS
Adverse reactions/side effects: : GI BLEEDING ,
EXFOLIATEVE DERMATITIS, STEVENS-
JOHNSON SYNDROME, TOXIC EPIDERMAL
NECROLYSIS , drowsiness, anaphylaxis
Dose: IM/ IV 15-30 mg q6h, PO 10 mg q4-6 h

Tylenol with Codeine (#3 and #4)
Class: Narcotic NSAID Pain reliever.
Action: mild – moderate pain. metabolizes to morphine
Adverse reactions/side effects: Constipation
Dose: PO 15-60 mg q4-6hr
Notes: Step II drug. #3 (30 mg) #4 (60 mg Codeine)
Morphine Sulfate
Meperidine (Demerol
Hydromorphone (
)
Dilaudid)
Class: Narcotic/Opioid analgesic
Action: Mode – Sev Pain Relieves pain by depressing the central nervous system.
Adverse reactions/side effects: RESPIRATORY
DEPRESSION, Constipation, vertigo, fatigue
Dose: IM IV 2.5 – 10mg q2-3 hr, initial 10-30 mg
Notes: Rash/hives – from iv or epidural morphine. Don’t stop because of little itching.
Note: MAO alert Step III. Binds to CNS receptors. For
Heart Patients: chest pain, pulm edema. Cancer, anxiety, nonproductive cough.
Class: Opioid Analgesics
Action: Moderate to severe pain metabolized to normeperidine and accumulated in renal insufficient clients. Toxic increases seizure risk
Adverse reactions/side effects: SEIZURES , confusion, sedation, hypotension, constipation, nausea, vomiting
Dose: p. o,. 50-100 q3-4 hr, IV 15-35 mg/hr NOT for clients > 65yrs. Avoid > 48hrs.
Note: MAO alert, Contraindicated w/impaired renal function. Short acting, irritating to tissues.
Class: Opioid Analgesic
Action: mod – severe pain. Lower doses for suppressing cough
Adverse reactions/side effects: confusion, sedation, hypotension, constipation
Dose: PO 1-4 mg q4-6
Note: MAO alert – risk for hypertension, resp. depression.
Muscle ridigidity, coma, sezieures, deth.
Hydrocodone (Vicodin, Norco, Lortab)
Vicodin, Norco, Lortab – special consideration?
Class: Opioid Analgesic, antitussive
Action: mod – severe pain. Lower doses for suppressing cough.
Adverse reactions/side effects: confusion, dizziness, sedation, hypotension, constipation, dyspepsia, nausea
Dose: PO 2.5-5 mg q4 hr
Note: MAO alert
Be aware of acetaminophen when used in combination drugs.Vicodin, Norco, Lortab

Codeine
Fentanyl (duragesic)
Propoxyphene (Darvon)
Carisoprodol (Soma)
Gabapentin (Neurotin)
Class: Opioid Analgesic,
Action: Mild – Moderate Pain. Not as effective as morphine.
Adverse reactions/side effects: constipation
Dose:15-60 mg q4-6
Step III Drug
Class: Opioid Analgesic, Anesthetic Adjunct
Action: Transdermal Patch for chronic-terminal cancer pain
Adverse reactions/side effects: APNEA ,
LARYNGOSPASM (RESPIRATORY DEPRESSION IF
BY PO)
Dose- 0.5 – 1 mcg/kg patch, transmucosal(Buccal)
Note: MAO alert
Class: Opioid Analgesic,
Action: mild-moderate pain
Adverse reactions/side effects: dizziness, weakness, nausea
Dose: PO 65mg q 4 hr (1 T)
Notes: MAO alert
Avoid with older adults, toxic metabolic
Class: Analgesic Adjunct
Action: Chronic pain.
anticonvulsants
Adverse reactions/side effects: confusion, depression, drowsiness, ataxia
Dose: PO adults 300mg tid
Notes: Renal Impairment
PO (Adults and Children >12 yr): CCr 30-60 ml/min --
300 mg twice daily; CCr 15-30 ml/min --300 mg once daily; CCr < 15 ml/min --300 mg once every other day; further adjustments are based on clinical response.
Class: Prescription, non controlled
Action: skeletal muscle relaxation, probably due to CNS depression.
Adverse reactions/side effects: ANAPHYLACTIC
SHOCK, dizziness drowsiness.
Dose: PO 250-350 –

Lidocaine
Tramadol (Ultram)
Class: local anesthesia.
Action: Control of ventricular arrhythmias. Given intradermal to administer local anesthetic prior to minor surgical procedures.
Adverse reactions/side effects: SEIZURES, CARDIAC
ARREST, ALLERGIC REACTIONS, ANAPHYLAXIS, confusion, drowsiness
Dose: IV(immediate effect):1-1.5, IM (5-15 min) 300mg
Note: also used during cardiac arrest by pulmonary route. If IV can’t be accessed.
Class: Analgesic
Action: decreases pain Opioid Like – not chemically related. Like low dose codeine. Nonsevere pain
Adverse reactions/side effects: SEIZURES, dizziness, headache, somnolence-drowsiness, constipation, nausea
Dose: 50-100PO [ Renal Impairment
PO (Adults): CCr <30 ml/min --increase dosing to q 12 hr
(not to exceed 200 mg/day).
Hepatic Impairment PO (Adults): 50 mg q 12 hr.
]