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Acetaminophen. Ibuprofen. Hydrocodone. Ketorolac. Morphine. Hydromorphone.
Oral Acetaminophen (Tylenol)
- Give every 4-6 hours
- Regular strength – 325mg
- Extra strength – 500mg
- Maximum Daily Dose – 3000mg
Oral Ibuprofen (Advil)
- NSAID
- Give every 4-6 hours
- Regular strength – 200mg
- Therapeutic Ceiling – 400mg
Oral Hydrocodone-Acetaminophen (Vicodin, Norco)
- Give ever 4-6 hours
- Common doses – 5-325mg, 7.5-325mg, and 10-325mg
IV/IM Ketorolac (Toradol)
- NSAID
- Common dosing – 15-30mg
- Therapeutic ceiling – 10mg
IV/IM morphine
- Classic dose (0.1mg/kg)
- This would be 7-10mg in adults!
- More COMMON dosing is 4mg
- Repeat as needed
IV/IM Hydromorphone (Dilaudid)
- COMMON dosing – 0.5-1mg
- This drug is notorious for bringing you to peer-review/MM conference
- Be careful!
Contraindications to NSAIDS
- Pregnant patients
- Elderly patients
- Renal disease patients
- Cardiac patients
- GI/ulcer patients
Side Effects of Opiates
- Sedation
- No driving
- Do not mix with alcohol
- Do not mix with other sedatives
- Constipation
- Opiate dependency/addiction
Additional Reading
- Pain Management In the Emergency Department: A Review (PubMed)
- Myths in EM: The Anti-Inflammatory Properties of NSAIDS (ACEP Now)
Hey! Love the website and how mobile friendly it is. I noticed Ketorolac has a therapeutic ceiling of 10mg listed, Epocrates mentions 120mg/day (or max 60mg/day in older or lower weight populations) Is that or something close to it what you meant or am I totally confused?
NSAIDS are commonly given in doses that are higher than have actually been shown to be effective. These medicines have a “therapeutic ceiling” beyond which there is minimal additional benefit and significant increase in side effects. The therapeutic ceiling for ketorolac is approximately 10-15mg IV/IM.