High Yield NSGY
Analgesia
Tylenol
| Drug | Dosing | Notes |
| APAP | 1g q6 hours, standing | unless liver concerns or patient is also on Norco (which has tylenol), no reason to not max someone in pain out on standing 4g of tylenol daily |
Narcotics / Narcotic Drips
limit these for obvious reasons, but also high risk of ileus, epsecially in post-op spine patients
| Drug | Dosing | Notes |
| Oxycodone IR | 2.5 mg 5.0 mg prn moderate 4-6 pain 10 mg prn severe 7-10 pain | For discharge Rx: generally, ordering 5mg tabs x 28 will be the most painless for you, as more will require insurance authorization. |
| Oxycontin | generally | |
| Norco | ||
| Suboxone (Buprenorphine) | Addiction medicine consult | never dose this on your own, this is Addiction medicine's bread and butter. They also can do the dosing verification documentation. |
| Dilaudid | IV: 0.2 or 0.5 mg q5 | make sure monitored with pulse ox at least |
| Dilaudid PCA | pt dose 0.1 mg, RN bolus (breakthrough dose) 0.2 mg 1 hour limit: 1 | Ordered as "PCA Dilaudid Powerplan" D/c loading dose that comes with powerplan |
| Morphine PCA |
Drips (ok for floor)
generally very little harm, non-addictive, little reason to not put in an AIPSS consult for every multi-level post-op spine
| Drug | Dosing | Notes |
| Ketamine | per AIPSS | c/i if hallucinates |
| Lidocaine | per AIPSS |
4. NSAIDs
| Drug | Dosing | Notes |
| Toradol | ||
| Ultram | ||
| Motrin |
5. Muscle Relaxers
imperative to have a standing muscle relaxer with big spine whacks, especially posterior cervicals
| Drug | Dosing | Notes |
| Flexeril | ||
| Robaxin | ||
| Valium |
6. Neuropathic Pain
| Drug | Dosing | Notes |
| Gabapentin (neurontin) | ||
| Lyrica | Nitin loves this |
7. Topical
| Drug | Dosing | Notes |
| Lidocaine patches | use powerplan in Powerchart up to 3-4, more for larger patients | generally harmless |
| Capsaicin | do NOT use over incision | |
| Diclofenac | do NOT use over incision |
8. Other
| Drug | Dosing | Notes |
| Dexamethasone | 1) 4q6, tapered over 1 week or whatever attending decides 2) Medrol dosepak
| - this is often the only thing that works for intractable subarachnoid hemorrhage headache - often only thing that works for radicular pain |
Analgesia with Impaired Kidney Function
Antiepileptics / Anti-seizure medicines (AEDs/ASMs)
Antihypertensives
IV
| Drug | Dosing | Notes |
| IV Hydralazine | ABRUPTLY STOPPING CAN CAUSE REBOUND HYPERTENSION! body adapts to vasodilatory effects by increasing SNS activity, renin release (excessive vasoconstriction) |
PO
Antiemetics
standard
| Drug | Dosing | Notes |
| Zofran | not cheap, send home with only ~10 pills unless strong reason to think will need more | |
| Reglan |
escalate
| Drug | Dosing | Notes |
| Granisetron | ||
Bowel
standard
| Drug | Dosing | Notes |
escalate
| Drug | Dosing | Notes |
|
must poop in next hour
| Drug | Dosing | Notes |
Electrolytes
| Drug | Dosing | Notes |
| Potassium | ||
| Magnesium | ||
| Phosphate | ||
| Calcium |
Miscellaneous
| Drug | Dosing | Notes |
IV Caffeine | can be very helpful for CSF leak headache | |
Migraine Cocktail | do not give the Toradol part of it if someone is post-op (especially if cranial) |
Intrathecal Drugs
Moossy Pain Pumps
Adult Baclofen Dosing
Intraventricular nicardipine
It's somewhat experimental, but intrathecal nicardipine has been used for spasm. Reasonable dose that has been used is 4mg q8H. delivered intraventricularly.
Intraventricular tPA
Pediatric
This is not a straightforward dosing and very weight-dependent, you will have to contact pharmacy. In the past we have emailed the pharmacist below. She doses it based on 1990s studies and on NICU babies. We have previously used 0.5mg daily then titrated up to 1.0 on a NICU baby that was 14 mos/8.5kg.
- Alteplase 0.5 mg, MSIC, Q 24 hours (schedule for 0700) x 5 days – 1mg/ml concentration – 0.5 mg (0.5 ml) via the external ventricular drain to be administered by Neurosurgery at the bedside
Elizabeth D. Ferguson, Pharm.D., BCPPS
Clinical Pharmacist- General Pediatrics, Pulmonology
UPMC Children’s Hospital of Pittsburgh
4401 Penn Ave.
Pittsburgh, PA 15224
T 412-692-7118
F 412-692-6566
P 412-949-0372, in house pager 8694
Adult
- reasonable doses that have been used are 1 mg intraventricularly q8h