All Pharmacy Pearls

Introduction

    visit the emergency department (ED)

  • 2. It is estimated that at least 30,000 people die in the

    • United States as a direct result of the use of opioids

    each year

  • 3. Although it seems that no specific specialty has been

    • primarily responsible for the opioid epidemic, clinicians

    in the ED are uniquely positioned on the front lines to

    be able to combat the ongoing crisis

  • 4. An expanding body of research is beginning to

    • emerge that suggests that nonopioid medications such

    as acetaminophen or nonsteroidal anti-inflammatories

Pharmacology

decrease the reliance of emergency clinicians on
opioids
Non-Opioid
Agents
Drug info
Acetaminophen
-
Dose: 325-1000 mg PO/Rectal/IV*
-
Onset: PO 10-30 min; IV ~5 min
-
Duration: PO ~4.5 hr; IV ~3 hr
-
Indication: mild to moderate pain
Ibuprofen
-
Dose: 400-800 mg PO
-
Onset: 15-30 min
-
Duration: ~6hrs
-
Indication: mild to moderate pain
Ketorolac
-
Dose: 10-30 mg PO /IV/IM
-
Onset: ~ 30 min
-
Duration: 4-6 hours
-
Indication: acute flank, abdominal, MSK,
headache, fractures
Ketamine*
-
Dose: 0.15-0.30 mg/kg +/- 0.15-0.25 mg/kg/hr
infusion IV/IM/IN
-
Onset: 10-30 min
-
Duration: 30-60 min
-
Indication: Moderate to severe MSK pain, flank
pain,
Lidocaine*
-
Dose: 1.5 mg/kg IV 5% Patch 12hr out of 24hr
IV/transdermal
-
Onset: IV 1-5 min Patch ~ 4 hr
-
Duration: IV 0.5-1 hr Patch ~12 hr
-
Indication: Renal Colic, mild MSK pain
Metoclopramide/
prochlorperazine
+
diphenhydramine
-
Dose: 10 mg+ 25-50 mg Benadryl IV/PO
-
Onset 5-10 min
-
Duration: 3-5 hr
-
Indication: Migraine
* limited access or nonformulary at GHS
Pharmacy
Friday's
Opioid
Alternatives
Author, Year
Design/ sample size/
type of pain
Nonopioid
Intervention
Comparator
Outcome
Chang,
2017

Evidence











Conclusions












References


1.
Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics. Retrieved September 6, 2018, from
http://www.micromedexsolutions.com/
2.
Motov S. The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American
Academy of Emergency Medicine. J Emerg Med. 2018 May;54(5):731-736.
3.
Chang AK. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A
Randomized Clinical Trial. JAMA. 2017 Nov 7;318(17):1661-1667
4.
Rainer TH. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind
randomised controlled trial. BMJ. 2000 Nov 18;321(7271):1247-51.
5.
Motov S. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A
randomized controlled trial. Am J Emerg Med. 2018 May 16. pii: S0735-6757(18)30407-8.
6.
Soleimanpour H. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency
department. BMC Urol. 2012 May 4;12:13. doi: 10.1186/1471-2490-12-13.
7.
Kostic MA. A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine
therapy in the emergency department. Ann Emerg Med. 2010 Jul;56(1):1-6.









Tags:
acetaminophen ibuprofen NSAIDs opioids





Source PDF

Opioid alternatives in mild to moderate pain- pharmacy friday- 09212018 (2).pdf