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Codeine - Indications: Mild to moderate pain (> 2 and < 8). Intermediate onset of action in 30 min. Also
used for cough suppression. Contraindications: Allergy. Routes: Oral. Dose: 7.5 to 30 mg (i.e., Tylenol with
Codeine #1-3) every 3 to 4 hours, 30 mg every 6 hours for cough suppression. Side Effects: Respiratory
depression, sedation, constipation, diaphoresis.
Oxycodone - Indications: Moderate pain (>5). Contraindications: Allergy, known drug abuser. Routes:
Oral. Dose: 5 mg every 3 hours. Available combined with acetaminophen in 2.5mg/325mg; 5mg/325mg;
7.5mg/500mg and 10mg/650mg. Side Effects: Respiratory depression, sedation, bradycardia, nausea,
vomiting.
Meperidine - Indications: Moderate pain (>5 needing rapid onset in minutes). Contraindications: Allergy,
MAO inhibitors. Routes: IM, PO. Dose: 75 to 150 mg, PO/IM every 2 to 4 hours. Side Effects: Reduced
cardiac contractility, CNS toxicity, respiratory depression.
Fentanyl - Indications: Short term severe pain relief (>8). Short surgical procedures. Contraindications:
Need for long-term pain control. Routes: IV, IM. Dose: 0.05 to 0.1 mg/kg IM or IV (slow). Usually
given with midazolam for muscle relaxation. Side Effects: Muscle rigidity if given rapidly IV, arrhythmias,
CNS toxicity, respiratory depression.
Nalbuphine - Indications: Moderate to severe pain (between 5-10). Contraindications: Cannot be used
for surgical procedures. Not approved for use in children. Routes: IV, IM. Dose: IM/IV 10 to 15 mg every
3 to 4 hours. Side Effects: Acute withdrawal in persons addicted to opiates, respiratory depression,
sedation, bradycardia.
Butorphanol - Indications: Moderate to severe pain (5-10). Contraindications: Same as Nalbuphine.
Routes: IM, IV, Nasal. Dose: 1 to 2 mg every 2 to 4 hours IV/IM. 1 spray (1mg) every 4 hours for migraine.
Side Effects: Same as nalbuphine
b. NSAIDs:
Ibuprofen - Indications: Mild to moderate pain (1-4). Fever reduction. Contraindications: Allergy. Gastritis,
Renal disease. Routes: Oral. Dose: Adult: 400 to 800 mg every 6 to 8 hours with food, Children: 5 to 10
mg/kg every 6 to 8 hours with food. Side Effects: Gastric irritation or bleeding.
Aspirin - Indications: Mild to moderate pain (1-4). Fever reducer. Antiplatelet activity in cardiac ischemia.
Contraindications: Use in children and teenagers. Allergy. Bleeding disorders. Patients on Digoxin, lithium,
phenytoin. Routes: Oral, Rectal. Dose: Adults: 325 to 650 mg every 4 to 6 hours. Side Effects: Acute
asthma attacks in aspirin allergic patients, Reyes Syndrome in children and teenagers with certain viral
illnesses. GI upset.
Ketorolac - Indications: Mild to moderate pain (1-5). Nephrolithiasis. Contraindications: Allergy, GI
disease, hepatic/renal disease. Patients on lithium, phenytoin, Digoxin. Routes: IV, IM. Dose: IV: 30 mg
every 4 to 6 hours IM: 60 mg every 4 to 6 hours. Side Effects: Gastric irritation, arrhythmias.
c. Benzodiazepines:
Diazepam - Indications: Muscle relaxation, Sedation. Contraindications: Respiratory depression. Routes:
Oral, IV, IM, Rectal. Dose: Oral: 5 to 10 mg every 8 hours for sedation, IV: 5 to 10 mg, IM: 10 mg, Rectal:
10mg (1 day only). Side Effects: Respiratory depression, cardiovascular collapse, paradoxic excitation.
Midazolam - Indications: Same as diazepam. Contraindications: Same as diazepam. Routes: IV, IM. Dose:
IV: 1 to 2 mg; IM: 5 to 10 mg, Side Effects: Respiratory depression.
Lorazepam - Indications: Sedation in acute psychotic agitation. Contraindications: Same as diazepam.
Routes: IV, IM. Dose: 0.05 to 0.1 mg/kg over 2 to 4 minutes. Maximum dose 8 mg in 12 hours. Usually
mixed with haloperidol 10 mg IM for the treatment of acute psychotic agitation. Side Effects: Same as
diazepam.
d. Local Anesthetics - Indications: Local or regional anesthesia. Contraindications: Allergy.
Routes: Local infiltration subcutaneously. Dose: Lidocaine: 3 mg /kg, Mepivacaine: 8 mg/kg,
Bupivacaine: 1.5 mg/kg. Side Effects: CNS toxicity if injected intravascularly. If mixed with epinephrine,
intravascular injection can cause severe hypertension, tachycardia, distal vasoconstriction.