nsaids prior to surgery lioresal

IFIS may increase the risk of eye complications during and after surgery. Muscle relaxers are indicated for short-term use only and should not be used longer than two weeks for acute musculoskeletal conditions.

Doctors give trusted answers on uses, effects, side-effects, and cautions: Dr. Linville II on advil baclofen ibuprofen lioresal: Baclofen may be taken with advil (ibuprofen). Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual Do not take NSAIDs right before or after a heart surgery called a “coronary artery bypass graft (CABG)." However, NSAIDs do this without using steroids. It is commonly used to treat spasticity - which is a constant "muscle spasm" commonly associated with prior brain be fatal. Overdose can Analgesic efficacy of individual drug interventions in ACUTE postoperative pain:Ibuprofen 200 mg + Acetaminophen (Tylenol) 500 mg (Highest efficacy)Analgesic efficacy of drugs with 8 hours or more ANALGESIA EFFECT:Per Cochrane review excellent evidence exists on the following:Analgesic efficacy of single dose oral analgesics & fast acting formulations Analgesics used for relief of postoperative pain include:'Mild' or step 1 Analgesics: Acetaminophen & NSAIDs (Ibuprofen and Celecoxib) Opioids bind to specific CNS receptors reducing pain perception, reaction to pain, and Multimodal analgesia is the 'Standard of Care' for preventing pain following proceduresacute & chronic pain relief by targeting pain transmission at Stepwise Multimodal Acute Post-op Analgesia AlgorithmStart oral or IV Acetaminophen + NSAID prior to surgery in ATC dosing + an AdjuvantNon-opioids + Adjuvants with PRN short-acting opioid Percocet or Codeine or Vicodin or Topical analgesics: Diclofenac (Voltaren) gel or Lidocaine patch 5% (Lidoderm) or Capsaicin gelOpioid metabolism is a SAFETY issue in Older & Medically Complex Patients (MCP) because:Medically complex patients (MCPs) are typically taking multiple medications: ~ 4-7In Younger patients the provider is more concerned with:Opioid metabolism & occurrence of tolerance, impairment of skills & mental functionWhat safety concerns exist for the medically complex patient (MCP)?As kidney function decreases, the serum creatinine levels riseGFR is used to determine the severity of kidney disease Pharmacokinetics of analgesics rely heavily on liver & renal functionCLEARANCE OF DRUG METABOLITES DECREASES WITH LIVER DISEASEThis results in ALTERED PARENT DRUG or METABOLITE BIOAVAILABILITY Typically dispensed daily at Methadone Clinics to heroin or other narcotic addictsMeperidine is metabolized by CYP2B6 and CYP3A4 to nor-meperidineBoth NORMALLY have HIGH hepatic extraction/first-pass metabolism & LOW bioavailability Metabolic Pathways influencing Clinical decision-makingIn patients on multiple drugs it is best to use an opioid that is not metabolized by CYPsMetabolic Pathways influencing Clinical decision-making: Metabolic Pathways influencing Clinical decision-making: Metabolic Pathways influencing Clinical decision-making: OxycodoneOxycodone: Central opioid effect of Oxycodone is governed primarily by the parent drugMetabolic Pathways influencing Clinical decision-making: Oxymorphone & HydrocodoneMetabolic Pathways influencing Clinical decision-making: Hydromorphone, FentanylFentanyl, Oxymorphone & Methadone have no active metabolites complicating careMetabolic Pathways influencing Clinical decision-making: TramadolPro-drug Tramadol converts to active metabolite, O-des-methyl-tramadol (M1) Metabolic Pathways influencing Clinical decision-making: Tramadol contTramadol is the more potent inhibitor of serotonin & norepinephrine reuptake Metabolic Pathways influencing Clinical decision-making: MethadoneMethadone is metabolized by 6 CYPs: CYP3A4 (main), 2B6, 2C8, 2C9, 2C19 & 2D6 (main) Metabolic Pathways influencing Clinical decision-making: Methadone contWHEN PAIN MEDICATION IS NEEDED FOR A METHADONE USER:2D6 is entirely responsible for Phase I metabolism of :Recap: CYP2D6 & CYP3A4 dependent Opioids (no red on this slide)In addition to 2D6, Oxycodone, Tramadol & Methadone are also metabolized by 3A4 SEVERE COMPLICATIONS from ANALGESIA in Cirrhotics include:With ASYMPTOMATIC chronic liver disease WITHOUT Cirrhosis: long-term Acetaminophen dose in Cirrhotics (not actively drinking alcohol): ≤ 2 g/dOpioids slow down ______________ & are __________ substrates↓ the natural protective mucus lining of the stomach more than COX-2sdo not prevent strokes/heart attacks in those at ↑ risk for CV disease analgesia/dose ceiling effect: No more pain relief with ↑in dose NSAIDs have many SE, including an ↑ risk of adverse CV effectsPatient with hypertension & diastolic dysfunction develop HF more easilyNSAIDs should be used with CAUTION in patients with Hypertension (HTN)Chronic NSAIDs can raise the BP & cause new onset HTN or worsening of existing HTN*Diclofenac & Celebrex are associated with increased CV side effects An increased risk of MI/stroke may be seen at LOWER DOSES of Naproxen (220 mg bid)1st choice: Best to dispense Naproxen for short-term or intermittent useIbuprofen competes with Aspirin for a common binding site on COX-1 and prevents Aspirin from bindingWhen needed (and safe to use) the above NSAIDs are prescribed as follows:can also cause stomach and intestinal adverse reactionsPregnancy Category: B: Pregnancy precautions same as outlined for ibuprofenNaproxen 250 mg to 500 mg/tab for pain can also be used:Dose: Start with 500 mg PO once, then 250 mg PO q6-8h or 500 mg PO q12h PRN 220 mg PO q8-12h while symptoms persist: Used for mild-moderate painPregnancy Category: C; changes to D with chronic use or high dosageCategory B OXIDANT drug: Also known as N-acetyl-p-aminophenol (APAP)FDA approved for postoperative pain in adults & kids: Very rapid onset NSAID + Acetaminophen provides greater pain control than does either drug alone: Avoid all NSAIDs for pain control due to ↑ bleeding risk & worsening of any anemia Asthmatics are at higher risk for experiencing serious allergic reactions to NSAIDsFacts to consider prior to writing an Analgesic Prescription:Have a "_____________" approach to opioid titrationHave a "start low & go slow" approach to opioid titration Opioids should not be prescribed if alcohol is being consumedAlways prescribe ________ of ___________ for acute painAlways prescribe lowest effective dose of immediate-release opioids for acute painMore than a few days of exposure to unnecessary opioid use Use non-opioid therapies like non-opioid meds, behavioral intervention, physical activity Preoperatively check PMP (prescription monitoring program) & assess risk for over-sedation & difficult to-control painGiven the longer ________ with ER/LA opioids like (list of 5 opioids)half-lives & longer duration of effects such as respiratory depression Patients with anxiety disorders and other mental health conditions are more likely to receive Benzodiazepines, which can exacerbate opioid-induced respiratory depression and increase risk for overdoseUse state prescription drug monitoring program (PDMP) datato determine if the patient is receiving opioid dosages elsewhere as this puts the patient at high risk for overdose20 mg Cortisol is released in a normal healthy patient daily between 2-8amEndogenous secretion is inhibited if Steroids taken for 2 weeks or longer in past 2 yearsAlternate day steroid use causes less inhibition of endogenous steroid secretion The step-up step-down protocol in a patient on 0-5-0 mg alternate day Steroids:
Due to the risk of side effects, drug interactions and addiction, muscle relaxants should not be used alone as treatment for acute musculoskeletal conditions. Osteoarthritis, rheumatoid arthritis, and headaches, are common conditions that NSAIDs … If taken long-term, steroids have side effects, such as weight gain and osteoporosis Your body also gets used to the steroids, so you have to gradually stop taking them.

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