APRN Ebook Continuing Education

Table 7. Oral Opioids for Acute Pain in Opioid-Naïve Adults continued Medication Available Oral Strengths Moderate Pain

Severe Pain

Clinical Considerations

Ibuprofen- oxycodone (Only available as generic)

Tablets: 5 mg/400 mg

1 tablet PO every 6 hours

Do not exceed four tablets/24 hours.

The duration of therapy should not exceed seven days. A decrease in incremental efficacy and an increase in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed 360 mg codeine/24 hours. Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. Used only for severe, acute pain, not as a first-line acute pain agent. Start with a low dose and titrate carefully. Utilized only for severe, acute pain; not a first-line acute pain agent. Start with a low dose and titrate carefully.

Codeine (Only available as generic)

Tablets: 15 mg, 30 mg, 60 mg

15 to 60 mg PO every four hours as needed

Hydromorphone Dilaudid

Tablets: 2 mg, 4 mg, 8 mg

2 to 4 mg PO every 4 to 6 hours as needed

Oral solution: 5 mg/5 mL Tablets: 15 mg, 30 mg Oral solution: 10 mg/0.5 mL 10 mg/5 mL 20 mg/5 mL 20 mg/5 mL 100 mg/5 mL

Morphine* (Only available as generic)

10 to 30 mg PO every 4 hours as needed

Oxycodone* • Oxaydo • Roxicodone • Roxybond

Capsules : 5 mg

5 to 15 mg PO every 4 to 6 hours

Utilized only for severe, acute pain; not a first-line acute pain agent. Start with low a dose and titrate carefully.

5 mg 7.5 mg 10 mg 15 mg 20 mg 30 mg Oral solution: 5 mg/5 mL 20 mg/5 mL 100 mg/5 mL

Tramadol (Ultram)

Tablets: 50 mg

1 to 2 tablets PO every 4 to 6 hours as needed

Maximum dose (<75 years): 400 mg/day Maximum dose (75 years and older): 300 mg/day

* Note : Avoid extended-release formulations and long-acting opioids in acute pain.

The following are physical indicators that a patient may be experiencing pain (AAFP, 2021). ● Restlessness or pacing ● Groaning, moaning ● Crying ● Gasping, grunting ● Nausea, vomiting ● Diaphoresis ● Clenching of teeth and facial expressions (e.g., grimacing)

NP Consideration: Assessment of acute or chronic pain should be multidimensional. Consideration should be given to several domains, including the physiological features of pain and its contributing factors, with physicians and other clinicians assessing patients for function, quality of life, mental health, and emotional health. In addition to a complete medical and medication history typically obtained at an office visit, document pain intensity, location, duration, and factors that aggravate or alleviate pain (AAFP, 2021).

● Tachycardia or blood pressure changes ● Clutching or protecting a part of the body ● Unable to speak or open eyes

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Book Code: AUS3024

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