PAIN DRUGS HANDBOOK TABLE
OF CONTENTS
About the
Author
About
the Handbook
Acknowledgments
Forward
to 2rd Edition
Forward
to 1st Edition
DRUGS (Alphabetical Order)
TOPICAL AGENTS
Amitriptyline
Baclofen
Clonidine
Cyclobenzaprine
2-deoxy-d-glucose
Dexamethasone
Dextromethorphan
Diclofenac
Doxepin
DMSO
Gabapentin
Ketamine
Ketoprofen
NEUROLYTIC AGENT
Phenol
APPENDICES
Appendix 1: World Health Organization
Three-step Ladder
Appendix 2: Drug Tables
Appendix 3: Infusion Tables
Appendix 4: Relative Potencies of
Opioids Effects
Appendix 5: Relative Potencies of Steroids
Appendix 6: Intravenous PCA
Standard Orders
Appendix 7: Patient Controlled Analgesia Flow Sheet
Appendix 8: Relative Potencies of Opioids
Appendix 9: Epidural Analgesia Monitoring Orders
Appendix 10: Pain Rating Scales
Appendix 11: Multiplication Factors for Converting the
Daily Dose of a Prior Opioid to the Daily Dose of Oxycontin
Appendix 12: CPR Algorithms
Appendix 13: Pediatric CPR Algorithms
Appendix 14: Trade Name Table
BIBLIOGRAPHY
|
post
to message board
|
Sota
Omoigui's
Pain Drug Handbook
2nd Edition:
Levorphanol
|
Click here to order |
SECTION
ONE:
Class,
Uses, Dosing,
Elimination
SECTION TWO:
Preparation, Pharmacology, Pharmacokinetics
SECTION THREE:
Interactions, Toxicity
Guidelines/Precautions
Principal Adverse Reactions
|
|
|
Class
(NARCOTIC AGONIST)
Uses
treatment of acute, chronic and cancer pain
Dosing
Analgesia: PO/SC 2-4 mg every 4-6 hours
Slow IV 1 mg (0.02 mg/kg)
Administer analgesic regularly (not prn). Due to impaired elimination, accumulation and excess sedation may occur in patients with renal or hepatic dysfunction. Analgesia may be enhanced by addition of adjuvant drugs e.g. NSAIDs, antidepressant agents (see front matter for drug combinations) and use of non-drug therapies e.g. TENS.
Elimination
hepatic, renal
Preparation
Levorphanol (Levo-Dromoran)
Tablets: 2 mg
Injection: 2 mg/ml
Pharmacology
A synthetic morphinan derivative which is structurally related to the phenanthrene derivative opiate agonists. Levorphanol exerts its potent analgesic actions on the central nervous system. 1 mg of parenteral levorphanol is equivalent in analgesic efficacy to 5 mg of parenteral morphine sulfate. Levorphanol produces less nausea, vomiting, constipation and more sedation and smooth muscle stimulation than equianalgesic doses of morphine sulfate. Levorphanol crosses the placental barrier and may produce depression in the neonate. The drug may appear in breast milk and should be used with caution in nursing mothers.
Pharmacokinetics
ONSET OF ACTION: IV 10-15 mins
PEAK EFFECT: IV < 20 mins SC 60-90 minutes
DURATION OF ACTION: IV/SC 6-8 hours
Interactions
potentiates CNS and circulatory depressant effects of other narcotic analgesics, volatile anesthetics, phenothiazines, sedative-hypnotics, alcohol, tricyclic antidepressants; analgesia enhanced and prolonged by narcotic and non-narcotic analgesics (e.g. aspirin, acetaminophen), alpha-2 agonists e.g. clonidine
Toxicity
Toxic Range:
Not routinely monitored
Manifestations:
Somnolence
Coma
Respiratory Arrest
Apnea
Cardiac Arrhythmias
Combined respiratory and metabolic acidosis
Circulatory Collapse
Cardiac Arrest
Death
Antidote:
Naloxone 0.4-2 mg IV/IM/SC. Repeat dose every 2 to 3 minutes to a maximum of 10-20 mg.
Management:
Discontinue or reduce medication
Support ventilation and circulation (Patent Airway, Oxygen, IV Fluids, Vasopressors)
Administer antidote
Monitor blood gases, pH and electrolytes
Correct acidosis and electrolyte disturbance (lactic acidosis may require IV sodium bicarbonate 1-2 mEq/kg)
Symptomatic treatment
Airway protected - ipecac syrup induced emesis (30 mls or 0.5 mls/kg ipecac syrup followed by 200 mls or 4 mls/kg of water or clear fluid) or gastric lavage (with drug ingestion) followed by administration of activated charcoal (PO 50-100 grams or 1-2 gram/kg)
Guidelines
(1) Reduce dosage in elderly patients and with concomitant use of narcotics and sedative hypnotics.
(2) The drug formulation may contain sodium metabisulfite, which may cause allergic reactions or anaphylaxis in susceptible individuals
(3) Prescribe or supply an antiemetic e.g. metoclopramide for use in the event of nausea and/or vomiting.
(4) Constipation may be more difficult to control than pain. Prevent and/or treat by daily administration of laxatives and stool softeners e.g. Colace (docusate sodium) 100-300 mg/day. Do not administer bulk forming agents that contain methylcellulose, psyllium or polycarbophil. Temporary arrest in the passage through the gastrointestinal tract may lead to fecal impaction or bowel obstruction.
(5) Tolerance is manifested by decreased duration of effect and increasing need for the drug. In these cases, add adjuvant drugs (e.g. NSAIDs, antidepressant agents) or switch to alternative opioids (starting at one-half the equi-analgesic dose) or supplement with non-drug therapies (e.g. TENS).
(6) Abrupt discontinuation of opioids in patients with physical dependence may manifest with withdrawal symptoms. To avoid withdrawal, doses should be reduced slowly (e.g. dose reduction of 75% every 2 days). Withdrawal should be treated symptomatically.
(7) Addiction occurs rarely (frequency of less than 1:3000) and should not be considered in deciding the proper dose and schedule of levorphanol.
(8) Drug combinations with adjuvant drugs enhance analgesia (see front section )
(9) Adjuvant drug therapies also include regional blockade, trigger point injections (with local anesthetics and steroids) and intravenous regional anesthesia.
(10) Adjuvant non-drug therapies include transcutaneous electrical nerve stimulation (TENS) and modalities such as ice or heat application, ultrasound and soft tissue mobilization.
(11) Patients should be warned that levorphanol may impair their ability to perform hazardous tasks requiring mental alertness or physical coordination (e.g. driving a motor vehicle, operating heavy machinery).
(12) Levorphanol is subject to control under the Controlled Substances Act of 1970 as a schedule II (C-II) drug.
Adverse
CVS: hypotension, circulatory depression, bradycardia, syncope
PULM: respiratory depression
CNS: sedation, somnolence, euphoria, dysphoria, disorientation
GU: urinary retention
GI: nausea, vomiting, abdominal pain, biliary tract spasm, constipation,
anorexia, hepatic dysfunction
EYE: miosis
ALLERGIC: rash, pruritus, urticaria
Reactions
|
|
|
Address:
4019 W. Rosecrans Ave., Hawthorne, CA 90250-7913
Toll-Free: (800) 9-MEDIC-9, Phone: (310) 675-9121,
Fax: 310 675-7989, E-mail: medicinechief@aol.com
NOTICE:
Every effort has been made to ensure that the drug dosage schedules
herein are accurate and in accord with the standards accepted
at the time of publication. As new research and experience broaden
our knowledge, changes in treatment and drug therapy occur. The
medications described do not necessarily have specific approval
by the Food and Drug Administration for use in the situations
and the dosages for which they are recommended. This information
is advisory only. The package insert should be consulted for use
and dosage as approved by the FDA, for any changes in indications
and dosages and for added warnings and precautions. The ultimate
responsibility lies with the prescribing physician.
No part of this information may be reproduced or transmitted electronically
in any information storage or retrieval system, or within any
monitoring system without prior permission in writing from S.O.T.A.
Technologies (Electronic Publishers).
The Universal Drug Infusion Slide Ruler (patent pending) is now
available. It incorporates an infusion data guide and enables
infusion calculations for any drug at any dose and at any concentration.
It may be obtained by calling S.O.T.A Technologies (800 9-MEDIC-9)
|
 |
COMPOUNDED
TOPICAL MEDICATIONS MAY BE ORDERED (BY PRESCRIPTION ONLY) FROM L.A.
PAIN CLINIC. CALL 310 675-9121 or 1 800 9-MEDIC-9. |
Copyright 2000. Sota Omoigui, M.D. All rights reserved.
|
