Pharm 1st test info Discussion board for module
3 ALL SOLUTION 100% CORRECT GUARANTEED
GRADE A+
Clinical pearls for lecture 10
Local Anesthetics
• Medical: most commonly used is 1-2% Lidocaine, most commonly used with 1:100K
epinephrine
• Addition of epinephrine decreases the redistribution of the LA throughout the
body, thus prolonging the effects of the anesthesia
• LA with epinephrine is often used as a hemostatic agent, particularly in
surgical/trauma settings
• Can be given as regional or local anesthesia
o Dental: most commonly used is 2% Lidocaine w/ 1:100k epi, utilized as local
infiltrations and regional blocks, providing anesthesia for 2-3 hours; many other types of LA
are on the market and can be tailored to the patient’s needs, such as Bupivicaine (Marcaine)
which causes anesthesia for 8-10 hours
o ABSOLUTE CONTRAINDICATIONS to LA use with EPI: TCA’s, MAOIs, cocaine
use, MI within 3 months
o RELATIVE CONTRAINDICATIONS to LA use with EPI: significant cardiovascular
history, MI within 6 months
o In light of the recent opioid epidemic, orthopedic surgeons and oral surgeons
are utilizing lipid-solubilized Marcaine for regional/local anesthesia, which lasts up to 3-4
days – called Exparel. As the peak inflammation occurs at 48-72 hours following surgery,
peak pain is experienced during this time. The use of Exparel and other, long-lasting local
anesthetics reduces the need for opioid use following joint/jaw surgeries. Exparel
(bupivacaine) is now FDA approved for use throughout the body.
Triptans
• Don’t use more than 2 pills in a day but wait at least 2 hours before giving second
dose
• This can lead to dependence which will result in a worse headache
o Pills are significantly cheaper than nasal sprays
• Nasal sprays are only brand name and pills are mainly generic
• Therefore, start with pills if these don’t work then move to nasal sprays
Preventative
• Personally I have seen propranolol and metoprolol used for prevention purposes, but
remember these do lower blood pressure, so make sure that these will not do more harm to
patient then prevention of HA
• Counsel patient about signs and symptoms of hypotension
• Lightheadedness and dizziness
Clinical Pearls for lecture 11
Opioids Adverse Effects
• Constipation is the biggest complaint I hear about
• Make sure to always think “pushy and mushy”
• Suggest Colace (stool softener) and docusate (stimulate)
▪ Combo pill -- dulcolax
o Nausea and vomiting
• Important to stay ahead of issue, suggest eating before taking medication
• Food on the stomach will decrease chance of having N/V
o Drowsiness is also very common
• Make sure patient doesn’t take medication and plan on driving anywhere or
isn’t planning on returning to work
o Recently, I have noticed lots of Medicare part D plans are limiting patients to
only 7 day supplies.
, •
▪ Trying to prevent opioid crisis
Norco/Percocet (Hydrocodone/APAP, Oxycodone/ APAP)
• This has APAP in it!!
• Do not allow the patient to take any OTC Tylenol, this can cause them to go above the
daily recommended amount
• Can suggest they use aleve or advil or other NSAIDS if patient needs to
supplement with something
Duragesic (Fentanyl)
• Most commonly comes in Patches that are used every 3 days
• Make sure they remove the old patch before adding a new one
• Apply to areas that don’t have a lot of hair, this prevents it from falling off early
• Rotate spots every time!
• Can be used when taking a shower, should not fall off with water
Narcan (naloxone)
• Can be prescribed to known drug abuser/friends or family of a drug abuser for
prevention of overdose
• Walgreens and CVS provide this without a prescription at select locations
Ultram (tramadol)
• Do not exceed more than 8 tablets a day
• Increases the risk of seizure
o Claim to fame – doesn’t cause as much drowsiness or upset stomach as the
opioids
Meds Bran Administr Morph Advers Pearls sched
d ation ine e ule
name poten effects
cy
Morphine Avinza IV, PO Standa Hives Accumula II
Kadian rd Constipa tion of
Oramo tion active
rph Respirat metabolit
ory es leads
depressi to
on increased
Mental confusion
issues ,
agitation,
delirium
Oxymorphon Opana PO, IM, IV 3x Similar SSS- II
e strong to above brand
er name
Hydromorph Dilaudi PO, IV 10 x Similar II
one d strong to above
Exalgo er
Hydrocodone Norco PO similar Similar II
/APAP Vicodi to above
n
Meperidine Demer PO, IM, IV Decrea Avoid Metabolit II
ol se MAOI e
potenc increase normeper
3 ALL SOLUTION 100% CORRECT GUARANTEED
GRADE A+
Clinical pearls for lecture 10
Local Anesthetics
• Medical: most commonly used is 1-2% Lidocaine, most commonly used with 1:100K
epinephrine
• Addition of epinephrine decreases the redistribution of the LA throughout the
body, thus prolonging the effects of the anesthesia
• LA with epinephrine is often used as a hemostatic agent, particularly in
surgical/trauma settings
• Can be given as regional or local anesthesia
o Dental: most commonly used is 2% Lidocaine w/ 1:100k epi, utilized as local
infiltrations and regional blocks, providing anesthesia for 2-3 hours; many other types of LA
are on the market and can be tailored to the patient’s needs, such as Bupivicaine (Marcaine)
which causes anesthesia for 8-10 hours
o ABSOLUTE CONTRAINDICATIONS to LA use with EPI: TCA’s, MAOIs, cocaine
use, MI within 3 months
o RELATIVE CONTRAINDICATIONS to LA use with EPI: significant cardiovascular
history, MI within 6 months
o In light of the recent opioid epidemic, orthopedic surgeons and oral surgeons
are utilizing lipid-solubilized Marcaine for regional/local anesthesia, which lasts up to 3-4
days – called Exparel. As the peak inflammation occurs at 48-72 hours following surgery,
peak pain is experienced during this time. The use of Exparel and other, long-lasting local
anesthetics reduces the need for opioid use following joint/jaw surgeries. Exparel
(bupivacaine) is now FDA approved for use throughout the body.
Triptans
• Don’t use more than 2 pills in a day but wait at least 2 hours before giving second
dose
• This can lead to dependence which will result in a worse headache
o Pills are significantly cheaper than nasal sprays
• Nasal sprays are only brand name and pills are mainly generic
• Therefore, start with pills if these don’t work then move to nasal sprays
Preventative
• Personally I have seen propranolol and metoprolol used for prevention purposes, but
remember these do lower blood pressure, so make sure that these will not do more harm to
patient then prevention of HA
• Counsel patient about signs and symptoms of hypotension
• Lightheadedness and dizziness
Clinical Pearls for lecture 11
Opioids Adverse Effects
• Constipation is the biggest complaint I hear about
• Make sure to always think “pushy and mushy”
• Suggest Colace (stool softener) and docusate (stimulate)
▪ Combo pill -- dulcolax
o Nausea and vomiting
• Important to stay ahead of issue, suggest eating before taking medication
• Food on the stomach will decrease chance of having N/V
o Drowsiness is also very common
• Make sure patient doesn’t take medication and plan on driving anywhere or
isn’t planning on returning to work
o Recently, I have noticed lots of Medicare part D plans are limiting patients to
only 7 day supplies.
, •
▪ Trying to prevent opioid crisis
Norco/Percocet (Hydrocodone/APAP, Oxycodone/ APAP)
• This has APAP in it!!
• Do not allow the patient to take any OTC Tylenol, this can cause them to go above the
daily recommended amount
• Can suggest they use aleve or advil or other NSAIDS if patient needs to
supplement with something
Duragesic (Fentanyl)
• Most commonly comes in Patches that are used every 3 days
• Make sure they remove the old patch before adding a new one
• Apply to areas that don’t have a lot of hair, this prevents it from falling off early
• Rotate spots every time!
• Can be used when taking a shower, should not fall off with water
Narcan (naloxone)
• Can be prescribed to known drug abuser/friends or family of a drug abuser for
prevention of overdose
• Walgreens and CVS provide this without a prescription at select locations
Ultram (tramadol)
• Do not exceed more than 8 tablets a day
• Increases the risk of seizure
o Claim to fame – doesn’t cause as much drowsiness or upset stomach as the
opioids
Meds Bran Administr Morph Advers Pearls sched
d ation ine e ule
name poten effects
cy
Morphine Avinza IV, PO Standa Hives Accumula II
Kadian rd Constipa tion of
Oramo tion active
rph Respirat metabolit
ory es leads
depressi to
on increased
Mental confusion
issues ,
agitation,
delirium
Oxymorphon Opana PO, IM, IV 3x Similar SSS- II
e strong to above brand
er name
Hydromorph Dilaudi PO, IV 10 x Similar II
one d strong to above
Exalgo er
Hydrocodone Norco PO similar Similar II
/APAP Vicodi to above
n
Meperidine Demer PO, IM, IV Decrea Avoid Metabolit II
ol se MAOI e
potenc increase normeper
