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Analgesics & Anesthetics
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Prescribing Dilaudid®
Indication
Management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Can be used for severe post-operative pain following ocular surgery
Mechanism of Action
Hydromorphone is an opioid agonist and works by changing the way the brain and nervous system respond to pain
Available Quantities
Tablets: 2 mg, 4 mg, 8 mg; Oral Solution: 5 mg/5 mL
Dosage/Instructions
Dosage individualized; use lowest effective dosage for shortest duration consistent with individual patient treatment goalsSafety Info for Dilaudid®
Pregnancy & Nursing
Use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Caution should be exercised when administered to a nursing woman
Pediatric Use
≥2 years
Contraindications, side effects, etc.
Contraindications: Avoid in patients with gastrointestinal blockage, paralytic ileus, or recent use of MAO inhibitors (within 14 days). Warnings/Precautions: Monitor for respiratory depression, particularly in elderly or debilitated patients. Be cautious in patients with a history of head injury, seizures, drug or alcohol addiction, or mental illness. Risk of serotonin syndrome when combined with certain medications. Not recommended for pregnant or breastfeeding women due to the risk of dependency in the newborn and potential harm to the nursing baby. Common Side Effects: May include constipation, nausea, vomiting, dizziness, drowsiness, headache, mood changes, itching, dry mouth, and flushing.Hydromorphone Hydrochlorideoral solution, oral tablet - Analgesics & Anesthetics
Prescribing Lortab®
Indication
Narcotic for moderate to moderately severe pain relief. Can be used for pain management following ocular procedures like corneal abrasion or iritisMechanism of Action
Hydrocodone is a semisynthetic opioid agonist that primarily acts on the mu-opioid receptors in the central nervous system, producing analgesia, respiratory depression, and sedation. Acetaminophen is a non-opioid, non-salicylate analgesic and antipyretic. It works by inhibiting the synthesis of prostaglandins in the central nervous system and peripherally blocking pain impulse generation, producing antipyresis from inhibition of the hypothalamic heat-regulating centerAvailable Quantities
5mg, 7.5mg, or 10mg hydrocodone and 325mg or 500 mg acetaminophenDosage/Instructions
5/325mg: 1 or 2 tabs every 4 to 6 hrs. Do not exceed 12 tablets. 7.5/325mg: 1 tablet every 4 to 6 hrs. Do not exceed 6 tablets. 10/325mg: 1 tablet every 4 to 6 hrs. Do not exceed 6 tabletsSafety Info for Lortab®
Pregnancy & Nursing
Use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Caution should be exercised when administered to a nursing womanPediatric Use
≥18 yearsContraindications, side effects, etc.
Contraindications: Avoid use in patients allergic to acetaminophen or hydrocodone, those who have recently used alcohol, sedatives, tranquilizers, other narcotic medications, or MAO inhibitors within the last 14 days. Warnings/Precautions: Be cautious in patients with liver disease, history of alcoholism or drug addiction, bowel issues, low blood pressure, dehydration, head injury, brain tumor, stroke, or respiratory disorders. Older adults and those who are severely ill or malnourished are at increased risk of breathing problems. Use during pregnancy can lead to neonatal withdrawal symptoms. The drug is excreted into breast milk and may harm a nursing baby. Common Side Effects: Include drowsiness, headache, upset stomach, constipation, blurred vision, and dry mouth. More serious effects can include shallow breathing, slow heartbeat, confusion, unusual thoughts or behavior, seizure, easy bruising or bleeding, liver problems, and low cortisol levels.Hydrocodone and Acetaminophenoral tablet - Analgesics & Anesthetics
Prescribing Tylenol 3®
Indication
Management of mild to moderate pain, including post-operative pain following ocular surgeryMechanism of Action
Acetaminophen is thought to work by reducing the production of prostaglandins in the brain. Codeine is an opioid that alters the perception and response to pain by binding to opioid receptors in the CNSAvailable Quantities
VariesDosage/Instructions
The usual adult dosage is 1 or 2 tablets every 4 to 6 hours as needed for pain. Do not exceed 4 grams of acetaminophen per daySafety Info for Tylenol 3®
Pregnancy & Nursing
Use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Caution should be exercised when administered to a nursing womanPediatric Use
≥12 yearsContraindications, side effects, etc.
Contraindications: Not suitable for those with a hypersensitivity to any of the ingredients. Warnings/Precautions: Risk of opioid addiction, abuse, and misuse; life-threatening respiratory depression; ultra-rapid metabolism of codeine, particularly in children and post-tonsillectomy/adenoidectomy patients; neonatal opioid withdrawal syndrome when used during pregnancy. Common Side Effects: Drowsiness, dizziness, nausea, vomiting, constipation, abdominal pain, and respiratory depression.Acetaminophen 300 mg, Codeine 30 mgoral tablet - Analgesics & Anesthetics
Prescribing Ultracet®
Indication
Short-term (five days or less) management of acute painMechanism of Action
Tramadol is a centrally acting synthetic opioid analgesic that binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin, which may contribute to its analgesic effects. Acetaminophen is a non-opioid, non-salicylate analgesic and antipyretic. It works by inhibiting the synthesis of prostaglandins in the central nervous system and peripherally blocking pain impulse generation, producing antipyresis from inhibition of the hypothalamic heat-regulating centerAvailable Quantities
37.5mg tramadol and 325mg acetaminophenDosage/Instructions
2 tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per daySafety Info for Ultracet®
Pregnancy & Nursing
Use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Caution should be exercised when administered to a nursing womanPediatric Use
≥12 yearsContraindications, side effects, etc.
Contraindications: Allergies to tramadol or acetaminophen, severe respiratory issues, drug dependence, concurrent use of MAOIs, and gastrointestinal blockage. Warnings/Precautions: Doctors should be aware of potential addiction risks, respiratory depression, and the need for liver function monitoring. Patients with a history of seizures or those at risk should be closely monitored. Be cautious about potential serotonin syndrome when used with other serotonin-increasing medications. Common Side Effects: Nausea, dizziness, constipation, headache, and drowsiness are common side effects of Ultracet.Tramadol and Acetaminophenoral tablet - Analgesics & Anesthetics
Prescribing Ultram®
Indication
Management of moderate to moderately severe pain, including post-operative pain following ocular surgeryMechanism of Action
Tramadol and its active metabolite bind to μ-opioid receptors. Tramadol also affects the reuptake of norepinephrine and serotoninAvailable Quantities
VariesDosage/Instructions
Start at 25 mg/day and titrate in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg four times a day). Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg four times a day). For ophthalmic applications such as iritis and corneal abrasion, 25 to 50mg every 4 to 6 hours, not to exceed 400mg daily. May be increased to 100mg every 6 hoursSafety Info for Ultram®
Pregnancy & Nursing
Use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Caution should be exercised when administered to a nursing womanPediatric Use
≥12 yearsContraindications, side effects, etc.
Contraindications: Severe breathing problems, blockages in the stomach or intestines, recent use of alcohol, sedatives, tranquilizers, narcotic medication, or MAO inhibitors. Warnings/Precautions: Risk of addiction, abuse, misuse, and life-threatening respiratory depression. Avoid using in patients with increased intracranial pressure, head injury, or in those prone to seizure. Caution advised in patients with renal or hepatic impairment, and those with a history of drug or alcohol dependence. Common Side Effects: Constipation, nausea, vomiting, dizziness, drowsiness, and headache.Tramadol Hydrochlorideoral tablet
