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MEDICATION

Drug Category: Analgesics - Pain control is essential to quality patient care. They ensure patient comfort, promotes pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or have painful lesions.

Drug Name	Morphine sulfate (Duramorph, Astramorph, and MS Contin) - It is the DOC for narcotic analgesia due to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Morphine sulfate administered IV may be dosed in a number of ways and is commonly titrated until the desired effect is obtained.
Adult Dose	Starting dose: 0.1-0.2 mg/kg IV, IM, SC Maintenance dose: 5-20 mg/70 kg q4h IV, IM, SC Relatively hypovolemic patients: Start with 2 mg IV, IM, SC and reassess the hemodynamic effects of the dose.
Pediatric Dose	Children: 0.1-0.2 mg/kg dose q2-4h prn Neonates: 0.05-0.2 mg/kg dose prn
Contraindications	Avoid use in patients with documented hypersensitivity to morphine and those diagnosed with hypotension or a potentially compromised airway where establishing rapid airway control would be difficult.
Interactions	Phenothiazines may antagonize the analgesic effects of opiate agonists. Tricyclic antidepressants, MAO inhibitors, and other CNS depressants may potentiate the adverse effects of morphine when used concurrently.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Avoid using this drug in patients diagnosed with hypotension, respiratory depression, nausea, emesis, constipation, and urinary retention. Exercise caution in patients diagnosed with atrial flutter and other supraventricular tachycardias. Morphine has vagolytic action and may increase the ventricular response rate.

Drug Name	Meperidine (Demerol) - It is a narcotic analgesic with multiple actions similar to those of morphine. However, it may produce less constipation, smooth muscle spasm, and depression of the cough reflex than similar analgesic doses of morphine.
Adult Dose	IM/IV/SC/PO: 25 to 75 mg q3-4h prn
Pediatric Dose	IM/SC/IV/PO: 1 to 1.8 mg/kg (0.5 to 0.8 mg/lb) q3-4h prn Do not exceed adult dose.
Contraindications	Avoid use in patients with documented hypersensitivity to this medication or related products and those diagnosed with upper airway obstruction, significant respiratory depression, or during labor when delivery of a premature infant is anticipated. It is contraindicated in patients taking MAO inhibitors or in those who have received such agents within the previous 14 d.
Interactions	Monitor for increased respiratory and CNS depression when taking meperidine concurrently with cimetidine. Hydantoins may decrease the pharmacologic effects of meperidine, possibly by increasing the hepatic metabolism of the narcotic. Avoid the concurrent administration of meperidine and protease inhibitors.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Exercise caution if administering narcotics to patients with head injuries since meperidine may increase respiratory depression, and CSF pressure. Administer in such patients only if absolutely necessary. If the dose is substantially increased above the recommended levels, due to tolerance, seizures may be aggravated or may occur even in individuals that do not have a history of convulsive disorders. Patients should be observed closely for morphine-induced seizure activity if they have a prior history of seizures. Exercise caution when using narcotic analgesics postoperatively and in patients with a history of pulmonary disease. This medication may suppress the cough reflex.

Drug Name	Hydrocodone bitartrate and acetaminophen (Vicodin ES) - It is a drug combination indicated for the relief of moderate to severe pain.
Adult Dose	1-2 tabs or caps PO q4-6h prn pain
Pediatric Dose	Over 12 y: 750 mg acetaminophen q4h A single dose should not exceed 10 mg of hydrocodone bitartrate. Do not exceed 5 doses in 24h. Under 12 y: 10-15 mg/kg/dose acetaminophen q4-6h prn Do not exceed 2.6 g/d of acetaminophen.
Contraindications	Avoid use in patients with documented hypersensitivity to acetaminophen or hydrocodone bitartrate and patients with elevated intracranial pressure.
Interactions	Phenothiazines may decrease its analgesic effects. Conversely, the toxicity of this drug increases when administered concurrently with CNS depressants or tricyclic antidepressants.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	The tablets contain metabisulfite which may cause allergic reactions. Administer with caution in patients dependent on opiates since this substitution may result in acute opiate withdrawal symptoms. Exercise caution when patients have severe renal or hepatic dysfunction.

Drug Category: Nonsteroidal Anti-inflammatory agents (NSAIDS) - These agents are most commonly used for the relief of mild to moderate pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for the initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.  

Drug Name	Ibuprofen (Ibuprin, Advil, and Motrin) - It is usually the DOC for the treatment of mild to moderate pain, if there are no contraindications. It inhibits inflammatory reactions and pain probably by decreasing the activity of the enzyme cyclo-oxygenase, which results in the inhibition of prostaglandin synthesis.
Adult Dose	200 to 400 mg q4-6h PO while symptoms persist Do not exceed 3.2 g/d.
Pediatric Dose	6 mo to 12 y: 20-40 mg/kg/d divided tid or qid Over 12 y: The same regimen as in adults.
Contraindications	Avoid use in patients with documented hypersensitivity to ibuprofen. Because of potential cross-sensitivity to other NSAIDs, do not give these agents to patients whom aspirin, iodides or other NSAIDs induce hypersensitivity. Do not administer to patients diagnosed with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and those at high risk of bleeding.
Interactions	Probenecid may increase the concentrations and possibly the toxicity of NSAIDs. Ibuprofen may decrease the effect of loop diuretics when administered concurrently. Prothrombin time (PT) may increase when ibuprofen is administered concurrently with anticoagulants. Monitor PT closely and instruct patients to watch for signs and symptoms of bleeding. Ibuprofen and other NSAIDs may increase serum lithium levels and the risk of methotrexate toxicity.
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Use with caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function.

Drug Name	Flurbiprofen (Ansaid) - It has analgesic, antipyretic and anti-inflammatory effects. It may inhibit cyclo-oxygenase enzyme, causing the inhibition of prostaglandin biosynthesis that may in turn result in analgesic and anti-inflammatory activities.
Adult Dose	200-300 mg/d PO divided bid-qid
Pediatric Dose	Safety and efficacy in children have not been established.
Contraindications	Avoid use in patients with documented hypersensitivity to this drug or related products.
Interactions	Probenecid and lithium, may increase the concentrations, and possibly, the toxicity of NSAIDs. Conversely, the effect of loop diuretics may decrease when administered concurrently with this drug. Coadministration with anticoagulants may prolong prothrombin time. Monitor PT and patients closely, and instruct them to watch for signs and symptoms of bleeding. Nephrotoxicity of both cyclosporine and flurbiprofen may be increased. Concurrent administration with phenytoin may increase the pharmacologic and toxic effects of phenytoin.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Severe GI tract ulceration and bleeding can occur. Monitor patients closely when administering prolonged treatments. NSAIDs can inhibit platelet aggregation, but at a lower degree than that seen with aspirin. Exercise caution in patients that have anticoagulation defects or are receiving anticoagulant therapy. Low white blood cell counts can occur but usually return to normal as therapy continues. Re-evaluate the therapy if persistent leukopenia, granulocytopenia or thrombocytopenia occur.

Drug Name	Ketoprofen (Oruvail, Orudis, and Actron) - It is used for the relief of mild to moderate pain and inflammation. Administer small dosages initially to patients with a small body size, the elderly and those with renal or liver disease. When administering this medication, doses higher than 75 mg do not increase its therapeutic effects. Administer high doses with caution and closely observe the patient for response.
Adult Dose	25 to 50 mg q6-8h prn Do not exceed 300 mg/d.
Pediatric Dose	3 mo to 14 y: 0.1–1 mg/kg q6-8h Over 12 y: The same regimen as in adults.
Contraindications	Avoid use in patients with documented hypersensitivity to this drug or related products.
Interactions	Probenecid and lithium, may increase the concentrations, and possibly, the toxicity of NSAIDs. Conversely, the effect of loop diuretics may decrease when administered concurrently with this drug. Prothrombin time (PT) may increase when ketoprofen is administered concurrently with anticoagulants. Monitor PT closely and instruct patients to watch for signs and symptoms of bleeding. Concurrent administration with phenytoin may increase the pharmacologic and toxic effects of phenytoin.
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Avoid use in patients diagnosed with GI disease, cardiovascular disease, renal or hepatic impairment, and patients receiving anticoagulants.

Drug Name	Naproxen (Anaprox, Naprelan, and Naprosyn) - It is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclo-oxygenase which results in a decrease of prostaglandin synthesis.
Adult Dose	500 mg, followed by 250 mg q6-8h Do not exceed a 1.25 g/d.
Pediatric Dose	Over 2 y: 2.5 mg/kg/dose Do not exceed 10 mg/kg/d. Under 2 y: Safety and efficacy have not been established.
Contraindications	Avoid use in patients with documented hypersensitivity to this drug or related products. Do not administer to patients diagnosed with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and those at high risk of bleeding.
Interactions	Probenecid and lithium, may increase the concentrations, and possibly, the toxicity of NSAIDs. Conversely, the effect of loop diuretics may decrease when administered concurrently with this drug. Prothrombin time (PT) may increase when naproxen is administered concurrently with anticoagulants. Monitor PT closely and instruct patients to watch for signs and symptoms of bleeding. Concurrent administration with phenytoin may increase the pharmacologic and toxic effects of phenytoin.
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur. It increases the risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion. Low white blood cell counts occur rarely, and usually return to normal in ongoing therapy. Discontinuation of the therapy may be necessary if there is persistent leukopenia, granulocytopenia, or thrombocytopenia.

Drug Category: Topical antibiotics - Prophylaxis is given topically to patients with burns.

Drug Name	Neomycin and Polymyxin B (Neosporin) - It is used to treat minor infections. It inhibits bacterial protein synthesis and thus bacterial growth. Polymyxin B disrupts the bacterial cytoplasmic membrane permitting the leak of intracellular constituents thus causing the inhibition of bacterial growth.
Adult Dose	Apply 1-4 times/d to the affected areas
Pediatric Dose	The same regimen as in adults.
Contraindications	Avoid use in patients with documented hypersensitivity to this drug combination or related products.
Interactions	No significant drug interactions have been reported with this product.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Exercise caution in patients diagnosed with renal impairment.

Drug Name	Silver sulfadiazine (Silvadene) - Although it is expensive, Silvadene has antipseudomonal properties in addition to coverage for most gram positive organisms. Avoid use on face. It is useful in the prevention of infections from second or third degree burns. It has bactericidal activity against many gram-positive and gram-negative bacteria including yeast.
Adult Dose	Apply using sterile technique to affected areas bid. Prior to application, the burn should be washed to remove previously applied agent.
Pediatric Dose	Administer the same regimen as in adults.
Contraindications	Do not use in newborns or late pregnancy because of risk of kernicterus. Avoid use in patients with documented hypersensitivity to this medication or related products, neonates and infants younger than 2 y.
Interactions	The effect of proteolytic enzymes is reduced when used concomitantly with this product.
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Exercise caution in patients with G-6-PD deficiency and renal insufficiency.