regarding choosing pain killer in ccs - usmleprep4

[ArchivalUser]

for severe pain we give morphine.. for mild pain.. tylenol.. for inpatient setting how to chose a pain killer for pain inbetween severe and mild?.. like percocet, oxycodone, ketorolac, and others because UW seems to use all ?

[ArchivalUser]

PERCOCET is indicated for the relief of moderate to moderately severe pain
Dosage should be adjusted according to the severity of the pain and the response of the patient. It may occasionally be necessary to exceed the usual dosage recommended below in cases of more severe pain or in those patients who have become tolerant to the analgesic effect of opioids. If pain is constant, the opioid analgesic should be given at regular intervals on an around-the-clock schedule. PERCOCET tablets are given orally.
Cessation of Therapy

In patients treated with PERCOCET tablets for more than a few weeks who no longer require therapy, doses should be tapered gradually to prevent signs and symptoms of withdrawal in the physically dependent patient

Oxycodone oral medications are generally prescribed for the relief of moderate to severe pain
In a 2008 review written by authors who "are members of advisory boards and speaker panels for Mundipharma," prolonged-release oxycodone (i.e., OxyContin) was found to be superior to placebo in randomized controlled trials concerning diabetic neuropathy, postherpetic neuralgia, osteoarthritis, ambulatory laparoscopic tubal ligation surgery, unilateral total knee arthroplasty, and abdominal/gynaecological surgery.[47]
In 2001, the European Association for Palliative Care recommended that oral hydromorphone or oxycodone, "if available in both normal release and modified release formulations for oral administration," be second-line alternatives to oral morphine for cancer pain.[48] There is no evidence that any opioids are superior to morphine in relieving the pain of cancer, and no controlled trials have shown oxycodone to be superior to morphine.[49] However, switching to an alternative opioid can be useful if adverse effects are troublesome, although the switch can be in either direction, i.e. some patients have fewer adverse effects on switching from morphine to oxycodone and vice versa.
Oxycodone can be administered orally, intranasally, via intravenous/intramuscular/subcutaneous injection or rectally. The bioavailability of oral administration of OxyContin averages 60–87%, with rectal administration yielding the same results; intranasal varies between individuals with a mean of 46%.[60]
Oxycodone is approximately 1.5–2 times as potent as morphine when administered orally.[61][62] However, 10–15 mg of oxycodone produces an analgesic effect similar to 10 mg of morphine when administered intramuscularly.[63] Therefore, as a parenteral dose, morphine is approximately up to 50% more potent than oxycodone.
There are no comparative trials showing that oxycodone is more effective than any other opioid. In palliative care, morphine remains the gold standard;[49] however, oxycodone can be useful as an alternative opioid if a patient has troublesome adverse effects with morphine.
here is a high risk of experiencing severe withdrawal symptoms if a patient discontinues oxycodone abruptly. Therefore therapy should be gradually discontinued rather than abruptly discontinued

Ketorolac or ketorolac tromethamine (marketed under the trademarks Toradol and Acular in the US, where generics have also been approved, and various other brand names around the world) is a non-steroidal anti-inflammatory drug (NSAID) in the family of heterocyclic acetic acid derivative, often used as an analgesic, antipyretic (fever reducer), and anti-inflammatory. Ketorolac acts by inhibiting the bodily synthesis of prostaglandins. Ketorolac in its oral (tablet or capsule) and intramuscular (injected) preparations is a racemic mixture of both (S)-(−-ketorolac, the active isomer, and ®-(+)-ketorolac. An ophthalmic (i.e., eye-drop) solution of ketorolac is available and is used to treat eye pain and to relieve the itchiness and burning of seasonal allergies.The FDA has approved an intranasal formulation of ketorolac tromethamine (Sprix Nasal Spray) for short-term management of moderate to moderately severe pain requiring analgesia at the opioid
Ketorolac is indicated for short-term management of moderate to severe postoperative pain.
Maximum duration of treatment should not exceed 5 days for tablets (per package insert), or 2 days for continuous daily dosing with intravenous or intramuscular formulations[2]. The ophthalmic formulation can be used instead of steroidal anti inflammatories in cases where a raised intraocular pressure (Glaucoma) is to be avoided.



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