Controlling Inflammation: The Role of NSAIDS/Cortisone Kevin E. Elder, MD, FAAFP

Size: px
Start display at page:

Download "Controlling Inflammation: The Role of NSAIDS/Cortisone Kevin E. Elder, MD, FAAFP"

Transcription

1 Controlling Inflammation: The Role of NSAIDS/Cortisone Kevin E. Elder, MD, FAAFP I. Introduction II. Overview of NSAIDS a. Classes of NSAIDS/dosing i. Cox-2 Selective 1. Celecoxib (Celebrex) 100 mg-200 mg po qd to BID po ii. Salicylates 1. ASA 325 mg-650 mg po QID 2. Choline-Mg-trisaliscylate (Trilisate) 1500 mg po BID (liquid avail) 3. Diflunisal (Dolobid) mg init. then 500 mg po BID 4. Salsalate (Disalcid) 3000 mg/days divided TID iii. Proprionic Acids 1. Ibuprofen (Motrin, etc) mg po TID; 10 mg/kg/dose (liquid and chewable available) 2. Naproxen (Naprosyn, Anaprox DS) mg po BID; 5 mg/kg/dose (liquid avail.) 3. Ketoprofen (Orudis, Oruvail) mg po TID/SR Oruvail 200 mg po qd 4. Flubiprofen (Ansaid) 1000 mg po BID-TID 5. Oxaprozin (Daypro) 1200 mg po qd iv. Heteroaryl Acetic Acids 1. Diclofenac (Voltaren, Cataflam, Arthrotec-diclofenac + misoprosotol) mg po BID; XR 100 mg po qd; Arthrotec = 50/200 or 75/200 mg po qd 2. Ketorolac (Toradol) 10 mg po QID X 5 days; mg IV/IM 3. Tolmetin (Tolectin) mg po TID v. Indole and Indene Acetic Acids 1. Indomethacin (Indocin) mg po TID; SR 75 mg qd-bid; liquid available 2. Sulindac (Clinoril) mg po BID vi. Naphthylakones/Alkanaones 1. Nabumetone (Relafen) mg po qd vii. Oxicams (Enolic acids) 1. Piroxicam (Feldene) mg po qd 2. Meloxicam (Mobic) mg po qd viii. Pyranocarboxylic Acids 1. Etodolac (Lodine) mg po BID-TID; (XL) 400,500,600 po qd-bid ix. Femates 1. Meclofenamic Acid (Meclomen) mg po TID-QID

2 2. Mefanamic Acid (Ponstel) 500 mg initially, then 250 mg po QID; duration not to exceed 1 week x. Natural NSAIDS 1. Wobenzym N a. Proprietary type medication 2. Arnica Gel (Arnica Montana-perennial Plant) a. Applied topically 3. Fish oil 4. Glucosamine + Chondroitin a. Timing taking medication b. Manufacturer specific? 5. Traumeel a. Fixed combination of diluted plant/mineral extracts b. Po/inj/oint/gel c. Research on CAM not providing highest level of evidence re: efficacy 6. Cold packs 7. Others? b. Risks of NSAIDS/Safety i. CV: MI and Stroke ii. Renal iii. Hepatic iv. GI Bleed v. Allergy/Skin Reactions vi. Exacerbate bleeding/acute injury vii. Impaired Healing/Fracture Healing? c. Mechanism of Action i. Inhibition of Prostaglandins: Cyclooxygenase 1. COX 1 2. COX 2 ii. Pain relief iii. Decreased Inflammation iv. Smooth Muscle relaxation d. Practical Uses/Considerations i. Patient selective factors 1. Convenience/compliance 2. Allergies ii. Patient/athlete perception 1. Actively injured/rehabbing injury 2. Avoid prophylaxis 3. Sports media = TMZ iii. Dosing selective

3 III. 1. Treat condition 2. Duration specific iv. Other medications being taken/ co morbidities v. Risks of alternative medication classes 1. Narcotics a. Addiction b. Safety c. Controlled substance d. Positive drug test/ suspended athlete 2. Tylenol a. Efficacy? b. Hepatotoxicity 3. Tramadol a. Addiction b. Safety/side effects vi. Duty to patient/athlete to provide best care 1. Care by medical staff of team most familiar with athlete best Overview of Cortisone (Glucocorticoids) a. History i. Intrart injection 1 st by Thorn in 1940 ii. Hollander in 1951 established the practice b. Types/ choices of medication i. Injectable 1. Methylprednisolone (Solumedrol) mg a. Intermediate acting 2. Triamcinolone Acetonide (Kenalog) mg a. Intermediate acting 3. Betamethasone (Celestone) 1-12 mg a. Celestone Soluspan = Combination of betamethasone ester and Betamethasone salt= quick and long acting 4. Dexamethasone a. Long acting b. Very water soluble, may increase uptake ii. Topical 1. Dexamethasone for iontophoresis iii. Oral prednisone 1. Systemic absorption a. Multiple joints involved b. Practicality of injection (facet) c. Inflammatory arthropathy d. Taper c. Differences between meds

4 i. Particulate/nonparticluate 1. Table reference ii. Water solubility iii. Half-lives of medications 1. Table reference iv. Other chemical ingredients 1. Benzyl EtOH 2. Polyethylene Glycol (drug vehicle) v. Efficacy 1. Training/experience with particular joint/condition/scenario 2. Seems to be no statistically sig difference between meds d. Actions of cortisone i. Decreased accumulation of inflammatory PMN Leukocytes and macrophages ii. Reduce release of vasoactive kinins iii. Inhibition of release of destructive enzymes that attack injury and destroy normal tissue indiscriminately iv. Decreased inflammatory reaction by limiting capillary dilation and permeability of vascular structures v. Needle effect 1. Drainage of fluid before injecting med 2. Release pressure and disrupt scar tissue vi. May inhibit release of arachidonic acid from phospholipids, which contribute to inflammatory process e. Risks of cortisone i. Reaction/allergy ii. Osteopenia/joint destruction iii. Tendon rupture iv. Vitiligo v. Infection from injection vi. steroid flare vii. Subcutaneous atrophy viii. Systemic effects 1. Elevation of glucose- Diabetics f. Practical factors i. May require more than 1 injection ii. Mixture of medications/ physician practice pattern- experience iii. Risk vs benefit iv. No more than 3 injections/joint/year v. Patient perception: getting a shot vi. Drainage/release of pressure/ fluid analysis vii. MSK U/S Guidance 1. Studies show increased likelihood of injection in joint

5 2. Not as good data regarding outcomes being superior viii. Physician experience with injections ix. Timing/ Play considerations REFERENCES 1. Conaghan PG. A turbulent decade for NSAIDS: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int. 2012;Jun;32;32(6): European Medicines Agency. European Medicines Agency finalizes review of recent published data on cardiovascular safety of NSAIDS. October 19, Gabriel SE, Jaakkimainen L, and Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A metaanalysis. Ann Intern Med. 1991;115: Gross C, Dhawan A, Harwood D, Gochanour E, and Romeo A. Glenohumeral joint injections: A review. Sports Health: A Multidisciplinary Approach. March/April 2013;5(2): Kaeding C and Best TM. Tendinosis: Pathophysiology and nonoperative treatment. Sports Health: A Multidisciplinary Approach. July/Aug 2009; 1(4): MacMahon PJ, Eustace SJ, and Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: A review for radiologists. Radiology. Sept 2009; 252(3): Magellan Medicaid Administration. Nonsteroidal anti-inflammatory drugs (NSAIDS): Therapeutic class review (TCR). June 30, Monteleone G. Classes of NSAID's collated by Guy Monteleone. monteleneg@wvuh.com. 9. Nepple JJ and Matava MJ. Soft tissue injections in the athlete. Sports Health: A Multidisciplinary Approach. Sept/Oct 2009; 1(5): Ong CKS, Lirk P, Tan CH, and Seymour RA. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res March; 5(1): Petering RC and Webb C. Treatment options for low back pain in athletes. Sports Health: A Multidisciplinary Approach. Nov/Dec 2011; 3(6): Rainsford KD. Anti-inflammatory drugs in the 21st century. Subcell Biochem. 2007;42: Rang HP, Dale MM, Ritter JM, and Moore PK. Analgesic drugs. In: Rang HP, editor. Pharmacology. 5th Ed. New York: Churchill Livingstone: p Rao P, Knaus EE. Evolution of nonsteroidal anti-inflammatory drugs NSAIDs): Cyclooxygenase (COX) inhibition and beyond. J Pharm Pharm Sci. 2008; 11(2): 81s-110s. 15. Saag KG, Furst D. Major side effects of glucocorticoids. In: Rose BD editor. UpToDate. Wellesley, MA Salerno A. Efficacy and safety of steroid use for postoperative pain relief: Update and review of the medical literature. J Bone Joint Surg Am. 2006; 88(6):

6

NSAIDs. NSAIDs are important but they can have side effects.

NSAIDs. NSAIDs are important but they can have side effects. NSAIDs Pain Treatment Nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended for initial treatment of pain and can be added to more powerful drugs to treat worse pain. Acetaminophen, such

More information

I. Mechanisms of action the role of prostaglandins a. Mediators of inflammation b. and much more

I. Mechanisms of action the role of prostaglandins a. Mediators of inflammation b. and much more NSAID steroid update Leo Semes, OD, FAAO I. Mechanisms of action the role of prostaglandins a. Mediators of inflammation b. and much more II. Topical NSAIDS ophthalmic application III. Oral NSAIDs a. Precautions

More information

MUSCULOSKELETAL PHARMACOLOGY. A story of the inflamed

MUSCULOSKELETAL PHARMACOLOGY. A story of the inflamed MUSCULOSKELETAL PHARMACOLOGY A story of the inflamed 1 INFLAMMATION Pathophysiology Inflammation Reaction to tissue injury Caused by release of chemical mediators Leads to a vascular response Fluid and

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: potassium (Zipsor), (Zorvolex) Reference Number: CP.CPA.280 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Celebrex) Reference Number: CP.CPA.239 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy

More information

Acetaminophen and NSAIDS. James Moriarity MD University of Notre Dame

Acetaminophen and NSAIDS. James Moriarity MD University of Notre Dame Acetaminophen and NSAIDS James Moriarity MD University of Notre Dame Lecture Goals Understand the indications for acetaminophen and NSAID use in musculoskeletal medicine Understand the role of Eicosanoids

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: ER Injection (Zilretta) Reference Number: CP.PHAR.371 Effective Date: 01.09.18 Last Review Date: 02.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Duexis) Reference Number: CP.PMN.120 Effective Date: 06.01.18 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Celebrex) Reference Number: CP.PMN.122 Effective Date: 01.01.07 Last Review Date: 05.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end of this

More information

FDA strengthens warning that non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) can cause heart attacks or strokes

FDA strengthens warning that non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) can cause heart attacks or strokes FDA strengthens warning that non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) can cause heart attacks or strokes Safety Announcement [7-9-2015] The U.S. Food and Drug Administration (FDA) is strengthening

More information

**If pre-procedure instructions are not followed, it is likely we will have to cancel or reschedule this injection**

**If pre-procedure instructions are not followed, it is likely we will have to cancel or reschedule this injection** Procedure Date: Procedure Check-in Time: Procedure Start Time: Check In at Diagnostic Imaging on the 2 nd Floor of the Madison Center PRE-PROCEDURE INSTRUCTIONS Please make sure to read over these instructions

More information

Clinical Policy: Hyaluronate Derivatives Reference Number: ERX.SPA.175 Effective Date:

Clinical Policy: Hyaluronate Derivatives Reference Number: ERX.SPA.175 Effective Date: Clinical Policy: Reference Number: ERX.SPA.175 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information.

More information

Carmina F. Angeles MD/PhD 74 B Centennial Loop, Suite 100 Eugene, OR Ph (541) Fax (541)

Carmina F. Angeles MD/PhD 74 B Centennial Loop, Suite 100 Eugene, OR Ph (541) Fax (541) Carmina F. Angeles MD/PhD 74 B Centennial Loop, Suite 100 Eugene, OR 97401 Ph (541) 686.3791 Fax (541) 686.3795 DISCHARGE INSTRUCTIONS FOR ANTERIOR CERVICAL DISCECTOMY AND FUSION It is important to me

More information

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs)

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Final Update 4 Report November 2010 The purpose of the is to summarize key information contained in the Drug Effectiveness Review Project

More information

in people who have heart disease

in people who have heart disease Medication Guide DUEXIS (due ex is) (ibuprofen and famotidine) tablets Read this Medication Guide before you start taking DUEXIS and each time you get a refill. There may be new information. This information

More information

Clinical Policy: Toremifene (Fareston) Reference Number: CP.PMN.126 Effective Date: Last Review Date: Line of Business: Medicaid

Clinical Policy: Toremifene (Fareston) Reference Number: CP.PMN.126 Effective Date: Last Review Date: Line of Business: Medicaid Clinical Policy: (Fareston) Reference Number: CP.PMN.126 Effective Date: 04.01.10 Last Review Date: 05.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important

More information

Clinical Policy: Hyaluronate Derivatives Reference Number: CP.CPA.## Effective Date: Last Review Date: Line of Business: Commercial

Clinical Policy: Hyaluronate Derivatives Reference Number: CP.CPA.## Effective Date: Last Review Date: Line of Business: Commercial Clinical Policy: Reference Number: CP.CPA.## Effective Date: 07.11.17 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory

More information

Optometric indications. Pain Management in the Optometric Practice. Optometric indications. Before treatment. Before treatment.

Optometric indications. Pain Management in the Optometric Practice. Optometric indications. Before treatment. Before treatment. Optometric indications Pain Management in the Optometric Practice Steven Ferrucci, OD, FAAO Chief, Optometry; Sepulveda VA Professor; SCCO For ocular pain, process is usually acute Need for pain relief

More information

Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) PATIENT & CAREGIVER EDUCATION Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) This information will help you identify medications that contain aspirin and

More information

Available Strengths. Cost per Rx 325 mg tablet - $ mg tablet - $ mg ER tablet - $ mg capsule - $ mg chewable tablet

Available Strengths. Cost per Rx 325 mg tablet - $ mg tablet - $ mg ER tablet - $ mg capsule - $ mg chewable tablet MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY Non-Opioids LAST REVIEW 5/9/2017 THERAPEUTIC CLASS Pain REVIEW HISTORY 2/16, 5/15 LOB AFFECTED Medi-Cal (MONTH/YEAR) This

More information

Oral Pain Medications in Your Practice Scot Morris, OD, FAAO

Oral Pain Medications in Your Practice Scot Morris, OD, FAAO Oral Pain Medications in Your Practice Scot Morris, OD, FAAO COURSE DESCRIPTION This course addresses common oral pharmaceuticals used as analgesics as well as their effect on the ocular system and overall

More information

You May Be at Risk. You are currently taking a non-steroidal anti-inflammatory drug (NSAID):

You May Be at Risk. You are currently taking a non-steroidal anti-inflammatory drug (NSAID): NSAIDS You May Be at Risk You are currently taking a non-steroidal anti-inflammatory drug (NSAID): Aspirin Diclofenac (Voltaren ) Diflunisal (Dolobid ) Etodolac (Lodine ) Ibuprofen (Advil ) Ketoprofen

More information

VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain* PROVIDER REFERENCE CARDS Low Back Pain.

VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain* PROVIDER REFERENCE CARDS Low Back Pain. VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain* PROVIDER REFERECE CARDS Low Back Pain (Update 2007) L B P *Developed by the American College of Physicians and the American

More information

Rheumatoid Arthritis

Rheumatoid Arthritis Rheumatoid Arthritis Rheumatoid Arthritis (RA) is a form of arthritis characterized by swelling and pain in the joints. If severe enough RA can also affect people s internal organs. RA is considered an

More information

Clinical Policy: Hyaluronate Derivatives Reference Number: ERX.SPA.175 Effective Date:

Clinical Policy: Hyaluronate Derivatives Reference Number: ERX.SPA.175 Effective Date: Clinical Policy: Reference Number: ERX.SPA.175 Effective Date: 01.11.17 Last Review Date: 05.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information.

More information

Month/Year of Review: January 2012 Date of Last Review: February 2007

Month/Year of Review: January 2012 Date of Last Review: February 2007 Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Month/Year of Review: January 2012 Date of Last Review:

More information

Anti-inflammatory drugs

Anti-inflammatory drugs Anti-inflammatory drugs 1 Inflammatory process 1. stimulus (cut) 2. Initial local vasoconstriction( blood loss) 3. vasodilation, local immune/inflammatory reaction (heat, redness) 4. swelling and pain

More information

NSAID all (Warner-Schmidt) includes all (NSAIDs, Salicytes, and Cox-2 inhibitors)

NSAID all (Warner-Schmidt) includes all (NSAIDs, Salicytes, and Cox-2 inhibitors) Table S1. Medications categorized as s all (Warner-Schmidt) includes all (s, Salicytes, and Cox-2 inhibitors) Nonsteroidal anti-inflammatory agents Bromfenac Diclofenac Diclofenac-misoprostol Etodolac

More information

Trinity Mother Frances Orthopedics and Sports Medicine. With the help of your doctor, you have made the decision to have surgery.

Trinity Mother Frances Orthopedics and Sports Medicine. With the help of your doctor, you have made the decision to have surgery. Trinity Mother Frances Orthopedics and Sports Medicine With the help of your doctor, you have made the decision to have surgery. = APPOINTMENT PROCESS INFORMATION = You might need several different appointments

More information

COLCRYS-PST. Products Affected Step 1: Mitigare 0.6 mg capsule. Details. Step 2: Colcrys 0.6 mg tablet

COLCRYS-PST. Products Affected Step 1: Mitigare 0.6 mg capsule. Details. Step 2: Colcrys 0.6 mg tablet COLCRYS-PST Mitigare 0.6 mg capsule Colcrys 0.6 mg tablet Criteria If the patient has tried one Step 1 product, authorization for a Step 2 product may be given. Exceptions can be made for a step 2 drug

More information

Drug Class Review on Cyclo-oxygenase (COX)-2 Inhibitors and Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Drug Class Review on Cyclo-oxygenase (COX)-2 Inhibitors and Non-steroidal Anti-inflammatory Drugs (NSAIDs) Drug Class Review on Cyclo-oxygenase (COX)-2 Inhibitors and Non-steroidal Anti-inflammatory Drugs (NSAIDs) Final Report Update 3 Evidence Tables November 2006 Original Report Date: May 2002 Update 1 Report

More information

Medial Branch Blocks

Medial Branch Blocks Medial Branch Blocks What are medial branch blocks? Medial branch nerves are locates on the back of the spine on each side next to each facet joints. They send sensory signals to the brain regarding the

More information

Available Strengths Limits. 10 mg tablet -- $ mg tablet -- $ mg tablet -- $ mg tablet -- $72.41 Avoid use in members over

Available Strengths Limits. 10 mg tablet -- $ mg tablet -- $ mg tablet -- $ mg tablet -- $72.41 Avoid use in members over MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Fibromyalgia P&T DATE: 5/9/2017 CLASS: Pain Management REVIEW HISTORY 9/15, 5/14, 11/12, 9/12, LOB: Medi-Cal (MONTH/YEAR)

More information

These programs and quantity limitations may not apply. Check your certificate or other plan information for benefit details.

These programs and quantity limitations may not apply. Check your certificate or other plan information for benefit details. FlexRx Standard Utilization Management (PA, QL,) Updates January 1, 2018 How to use this drug list This drug list includes updates to Utilization Management (UM) programs. UM may include a prior authorization

More information

Musculoskeletal corticosteroid use:

Musculoskeletal corticosteroid use: Musculoskeletal corticosteroid use: Types, Indications, Contraindications, Equivalent doses, Frequency of use and Adverse effects. Dr Jide Olubaniyi MBBS, FRCR Dr Sean Crowther MB BCh, MRCS, FRCR Dr Sukhvinder

More information

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs)

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Final Update 4 Report November 2010 The purpose of reports is to make available information regarding the comparative clinical effectiveness

More information

Nucleoplasty What is Nucleoplasty? Why do I need a Nucleoplasty? What is the typical procedure? not Is this procedure effective?

Nucleoplasty What is Nucleoplasty? Why do I need a Nucleoplasty? What is the typical procedure? not Is this procedure effective? Nucleoplasty What is Nucleoplasty? Nucleoplasty is a minimally invasive procedure for percutaneous disc decompression that uses radiofrequency based technology to ablate and coagulate soft tissue to decompress

More information

Non-Opioid Treatment Options in Workers Compensation

Non-Opioid Treatment Options in Workers Compensation Non-Opioid Treatment Options in Workers Compensation January 21, 2016 1 ADMINISTRATIVE DETAILS 2 To Receive Continuing Education Credit 1. Remain logged on for the entire webinar 3 To Receive Continuing

More information

Managing Osteoarthritis Pain With Medicines. A Review of the Research for Adults

Managing Osteoarthritis Pain With Medicines. A Review of the Research for Adults Managing Osteoarthritis Pain With Medicines A Review of the Research for Adults Is This Summary Right for Me? Yes, if: A doctor* said you have osteoarthritis (pronounced ah-stee-oharth-rye-tis). Osteoarthritis

More information

Patient History Form

Patient History Form Patient History Form of first appointment: / / Time of appointment: Cell Phone: MONTH DA Y YEAR Name: Birthdate: / / LAST FIRST MIDDLE INITIAL MAIDEN MONTH DAY YEAR Address: Age: Sex: F M STREET APT# CITY

More information

COLCRYS-PST. Products Affected Step 1: Mitigare 0.6 mg capsule. Details. Step 2: Colcrys 0.6 mg tablet

COLCRYS-PST. Products Affected Step 1: Mitigare 0.6 mg capsule. Details. Step 2: Colcrys 0.6 mg tablet COLCRYS-PST Mitigare 0.6 mg capsule Colcrys 0.6 mg tablet Criteria If the patient has tried one Step 1 product, authorization for a Step 2 product may be given. Exceptions can be made for a step 2 drug

More information

Etodolac versus meloxicam

Etodolac versus meloxicam Etodolac versus meloxicam The Borg System is 100 % Etodolac versus meloxicam Etodolac versus meloxicam -- 722 75051 1991 Wainwright Not Specific Enough. The store also now says majority of Irish willing

More information

Selective Nerve Root Block

Selective Nerve Root Block Selective Nerve Root Block What is a selective nerve root block? Selective nerve root blocks is similar to epidural injections, as the preparation and approach is identical. Epidural refers to the space

More information

2018 WPS MedicareRx Plan (PDP) Step Therapy

2018 WPS MedicareRx Plan (PDP) Step Therapy 2018 WPS MedicareRx Plan (PDP) Step Therapy In some cases, the WPS MedicareRx Plan (PDP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that

More information

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina 29202-8206 Pharmacy and Therapeutics (P&T) Committee Meeting MINUTES 1. Call To Order A meeting of the

More information

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina 29202-8206 Pharmacy and Therapeutics (P&T) Committee Meeting MINUTES 1. Call To Order A meeting of the

More information

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs)

Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Drug Class Review Nonsteroidal Antiinflammatory Drugs (NSAIDs) Preliminary Scan Report #2 May 2014 Last Report: Update #4 (November 2010) Last Preliminary Scan: July 2013 The purpose of reports is to make

More information

Literature Scan: NSAIDs

Literature Scan: NSAIDs Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

Guide to Perioperative Medication Bleed and Thromboembolism Management Considerations

Guide to Perioperative Medication Bleed and Thromboembolism Management Considerations Guide to Perioperative Medication Bleed and Thromboembolism Management Considerations Start Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 7 10 days prior to Perform Medication Reconciliation Table 1:

More information

Advances in Dental Pain Management kbaker 2019

Advances in Dental Pain Management kbaker 2019 Advances in Dental Pain Management kbaker 2019 I. AMBULATORY DENTAL PAIN CONTROL STRATEGY II. WHO ANALGESIC LADDER RELATES TO CANCER PAIN 1 III. ACETAMINOPHEN (APAP, Tylenol, g) Maximum daily dosage: ACUTE

More information

Information for Vermont Prescribers of Prescription Drugs

Information for Vermont Prescribers of Prescription Drugs Information for Vermont Prescribers of Prescription Drugs ARTHROTEC (diclofenac sodium/misoprostol) tablets This list does not imply that the products on this chart are interchangeable or have the same

More information

Texas Prior Authorization Program Clinical Edit Criteria

Texas Prior Authorization Program Clinical Edit Criteria Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class COX-2 Inhibitors Clinical Edit Information Included in this Document COX-2 Inhibitors Celebrex Drugs requiring prior authorization:

More information

Diclofenac Potassium Tablets, USP. 50 mg. Rx Only

Diclofenac Potassium Tablets, USP. 50 mg. Rx Only Diclofenac Potassium Tablets, USP 50 mg Rx Only Cardiovascular Risk NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal.

More information

Non-steroidal Anti-Inflammatory Drugs (Oral/Rectal)

Non-steroidal Anti-Inflammatory Drugs (Oral/Rectal) About Information on indications for use or diagnosis is assumed to be unavailable. All criteria may be applied retrospectively; prospective application is indicated with an asterisk [*]. The information

More information

Objectives. Chronic Pain Management. History of Pain. Definition of Pain 11/8/2016. Jill Duffy, ARNP. I have no disclosures to make.

Objectives. Chronic Pain Management. History of Pain. Definition of Pain 11/8/2016. Jill Duffy, ARNP. I have no disclosures to make. Objectives 1. Describe the prescribing guidelines created by the CDC and the impact on treatment of pain. Chronic Pain Management Jill Duffy, ARNP 2. Explain the importance of establishing a clear diagnosis

More information

Pharmacologic Management of Pain

Pharmacologic Management of Pain Pharmacologic Management of Pain Natalie Keil, Pharm.D. NMCSD PGY1 Pharmacy Practice Resident Palliative Care Nursing Symposium October 14, 2011 The views expressed in this presentation are those of the

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: Reference Number: CP.PHAR.05 Effective Date: 10.01.08 Last Review Date: 02.19 Line of Business: Commercial, Medicaid, HIM-Medical Benefit Coding Implications Revision Log See Important

More information

ABDOMINOPLASTY (TUMMY TUCK) SURGERY INSTRUCTIONS

ABDOMINOPLASTY (TUMMY TUCK) SURGERY INSTRUCTIONS ABDOMINOPLASTY (TUMMY TUCK) SURGERY INSTRUCTIONS *FAILURE TO FOLLOW THESE INSTRUCTIONS MAY LEAD TO CANCELLATION OF SURGERY AND FURTHER FEES WILL APPLY BEFORE YOUR SURGERY Before taking any medication READ

More information

Mary Lynn McPherson, PharmD, BCPS, CDE

Mary Lynn McPherson, PharmD, BCPS, CDE Appendix Analgesics in Older Adults Mary Lynn McPherson, PharmD, BCPS, CDE From: Aging Medicine: Handbook of Pain Relief in Older Adults: An Evidence-Based Approach Edited by: F. M. Gloth, III Humana Press

More information

Texas Prior Authorization Program Clinical Edit Criteria

Texas Prior Authorization Program Clinical Edit Criteria Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Oral Drugs requiring prior authorization: the list of drugs requiring prior

More information

Objectives. Understanding Pharmacologic Properties of Analgesics in the Treatment of Acute Pain. Nociceptive/Acute/ Physiologic Pain.

Objectives. Understanding Pharmacologic Properties of Analgesics in the Treatment of Acute Pain. Nociceptive/Acute/ Physiologic Pain. Understanding Pharmacologic Properties of Analgesics in the Treatment of Acute Pain Irene Zamora, MSN, RN, CNS Certified Pain Management Nurse Hospital of the University of Pennsylvania Philadelphia, PA

More information

RxBlue 2010 ST Criteria

RxBlue 2010 ST Criteria RxBlue 2010 ST Criteria ANTIDEPRESSANTS - SARAFEM... 10 FLUOXETINE HCL... 10 SARAFEM... 10 SELFEMRA... 10 ANTIDEPRESSANTS- SSRI, SNRI... 11 CELEXA... 11 CITALOPRAM... 11 CYMBALTA... 11 EFFEXOR XR... 11

More information

HOSPITAL ADMISSION SURGERY PACKET. Pre Operative Diagnosis: Pre Scheduled Surgery for: Name: Birthdate: On the day of your surgery report to:

HOSPITAL ADMISSION SURGERY PACKET. Pre Operative Diagnosis: Pre Scheduled Surgery for: Name: Birthdate: On the day of your surgery report to: HOSPITAL ADMISSION SURGERY PACKET Pre Operative Diagnosis: Pre Scheduled Surgery for: Name: Birthdate: Physician: Allergies: (Procedure) On the day of your surgery report to: A.M. ADMISSIONS: DO NOT EAT

More information

Vaughn Lawrence. Naturopath & Herbalist PAIN I. PAIN - DEFINITIONS

Vaughn Lawrence. Naturopath & Herbalist PAIN I. PAIN - DEFINITIONS Vaughn Lawrence Naturopath & Herbalist PAIN I. PAIN - DEFINITIONS A. Localized physical suffering associated with bodily disorder (as a disease or an injury); also : a basic bodily sensation induced by

More information

NSAIDS - non-salicylates

NSAIDS - non-salicylates NSAIDS - non-salicylates Sandra P. Welch, Ph.D. Professor Pharmacology & Toxicology McGuire Hall Room 505, 828-8424, swelch@hsc.vcu.edu Learning Objectives: 1. Learn the main differentiating property,

More information

Nonopioid Analgesics

Nonopioid Analgesics Med Clin N Am 91 (2007) 97 111 Nonopioid Analgesics Muhammad A. Munir, MD*, Nasr Enany, MD, Jun-Ming Zhang, MSc, MD Department of Anesthesiology, University of Cincinnati College of Medicine, 231 Albert

More information

Pre-Operative Surgical Instructions

Pre-Operative Surgical Instructions Shifflettspine.com Pre-Operative Surgical Instructions Do NOT eat, drink, or smoke after MIDNIGHT the day before your surgery! This includes gum, mints, water, candy and cigarettes. Any stomach contents

More information

SUFFERING FROM INJURIES THAT JUST WON T HEAL? DO YOU SUFFER FROM ANY OF THE FOLLOWING CONDITIONS?

SUFFERING FROM INJURIES THAT JUST WON T HEAL? DO YOU SUFFER FROM ANY OF THE FOLLOWING CONDITIONS? SUFFERING FROM INJURIES THAT JUST WON T HEAL? If you are one of the many people suffering from pain caused by injured tendons, muscles, ligaments, and joints that heal at a remarkably slow pace or not

More information

5060 South Syracuse Street Denver, CO Phone (303) Date: Check in Time: Surgery Time:

5060 South Syracuse Street Denver, CO Phone (303) Date: Check in Time: Surgery Time: Date: Check in Time: Surgery Time: 5060 South Syracuse Street Denver, CO 80237 *Reminder: Please bring your insurance information, photo ID, and medication list Phone (303) 770 1056 Preparing For Your

More information

A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse

A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse INVESTIGATIVE TEAM: STEERING COMMITTEE FOR THE TUFTS HEALTH CARE INSTITUTE ON OPIOID RISK MANAGEMENT

More information

Effective Health Care Program

Effective Health Care Program Comparative Effectiveness Review Number 38 Effective Health Care Program Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review Executive Summary Background Osteoarthritis

More information

Celecoxib Powder, Diclofenac Powder, Flurbiprofen Powder, Ibuprofen Powder, Ketoprofen Powder, Meloxicam Powder, Tramadol Powder

Celecoxib Powder, Diclofenac Powder, Flurbiprofen Powder, Ibuprofen Powder, Ketoprofen Powder, Meloxicam Powder, Tramadol Powder Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.26 Subject: Anti-Inflammatory Pain Powders Page: 1 of 5 Last Review Date: December 3, 2015 Anti-Inflammatory

More information

eappendix A. Opioids and Nonsteroidal Anti-Inflammatory Drugs

eappendix A. Opioids and Nonsteroidal Anti-Inflammatory Drugs eappendix A. Opioids and Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs Nonselective nonsteroidal anti-inflammatory drugs Diclofenac, etodolac, flurbiprofen, ketorolac, ibuprofen,

More information

Patient History Form

Patient History Form Date of first appointment: / / MONTH DA Y YEAR Name: Address: LAST STREET CITY MARITAL STATUS: Never Married Spouse/Significant Alive/Age EDUCATION (circle highest level attended): Time of appointment:

More information

Hughston Health Alert

Hughston Health Alert Hughston Health Alert 6262 Veterans Parkway PO Box 9517 Columbus, GA 31908-9517 www.hughston.com/hha OSTEOARTHRITIS AND YOU Inside... Drug Therapy and Arthritis NSAIDS Chart Osteoarthritis Pain Glucosamine

More information

Information for Vermont Prescribers of Prescription Drugs

Information for Vermont Prescribers of Prescription Drugs Information for Vermont Prescribers of Prescription Drugs ARTHROTEC (diclofenac sodium/misoprostol) tablets This list does not imply that the products on this chart are interchangeable or have the same

More information

disease or in clients who consume alcohol on a regular basis. bilirubin

disease or in clients who consume alcohol on a regular basis. bilirubin NON-OPIOID Acetaminophen(Tylenol) Therapeutic class: Analgesic, antipyretic Aspirin (ASA, Acetylsalicylic Acid) Analgesic, NSAID, antipyretic Non-Opioid Analgesics COMMON USES WHAT I NEED TO KNOW AS A

More information

Patient History Form Date of first appointment: / / Time of appointment: Birthplace: mm dd yyyy Name: Birthdate: / / LAST FIRST MIDDLE MAIDEN mm dd yyyy Address: STREET APT# Age: Sex: F M Telephone: H

More information

Non-Steroidal Anti- Inflammatory Drugs. ATPE 410 Chapter 6

Non-Steroidal Anti- Inflammatory Drugs. ATPE 410 Chapter 6 Non-Steroidal Anti- Inflammatory Drugs ATPE 410 Chapter 6 Inflammatory Process A normal, beneficial process that begins immediately after injury to facilitate repair and return the tissue to normal function

More information

For more information about how to cite these materials visit

For more information about how to cite these materials visit Project: Ghana Emergency Medicine Collaborative Document Title: Toxicology of Analgesic Agents Author(s): Hernan Gomez (Hurley Medical Center) License: Unless otherwise noted, this material is made available

More information

Content on this page requires a newer version of Adobe Flash Player.

Content on this page requires a newer version of Adobe Flash Player. Content on this page requires a newer version of Adobe Flash Player. Does Aleve Interact with other Medications? Severe Interactions. These medications are not usually taken together. Consult your healthcare

More information

Panel discussion: treatment approaches to control gastrointestinal risk and balance cardiovascular risks and benefits: proposals and recommendations

Panel discussion: treatment approaches to control gastrointestinal risk and balance cardiovascular risks and benefits: proposals and recommendations Aliment Pharmacol Ther symp ser 2005; 1: 26 32. Panel discussion: treatment approaches to control gastrointestinal risk and balance cardiovascular risks and benefits: proposals and recommendations CHAIRED

More information

Why do ortho PTs need to know about pharmacology? Pharmacology for Orthopedic Physical Therapists. Pharmacology Defined: Pharmacology Defined:

Why do ortho PTs need to know about pharmacology? Pharmacology for Orthopedic Physical Therapists. Pharmacology Defined: Pharmacology Defined: Pharmacology for Orthopedic Physical Therapists Julie DeVahl, PT, MS Assistant Professor Department of Physical Therapy Why do ortho PTs need to know about pharmacology? Collaborative medical model Assist

More information

Interventions REHABILITATION. The restoration of structure and function. Benefits of mobilization/immobilization. Overloading.

Interventions REHABILITATION. The restoration of structure and function. Benefits of mobilization/immobilization. Overloading. Use and Misuse of Rehabilitation Modalities Walter R. Frontera, MD, PhD - Professor and Chair REHABILITATION The restoration of structure and function Department of Physical Medicine and Rehabilitation

More information

New Patient History Form Today s Date:

New Patient History Form Today s Date: New Patient History Form Today s Date: MICHAEL L. MAWBY, MD MARIANNE PEACOCK, CNP 1115 S. Union Street Traverse City, MI 49684 Form Revised 1/18/2016 Name: Birthdate: (Last) (First) (MI) (Maiden) (MM/DD/YYYY)

More information

The first stop for professional medicines advice. Community Pharmacy NSAID Gastro-Intestinal Safety Audit

The first stop for professional medicines advice. Community Pharmacy NSAID Gastro-Intestinal Safety Audit Community Pharmacy NSAID Gastro-Intestinal Safety Audit Working with Primary Care Commissioning, Strategy and Innovation Directorate The first stop for professional medicines advice www.sps.nhs.uk Community

More information

Latest Press Release. doubledown casino active chips

Latest Press Release. doubledown casino active chips corp@stantec.com Latest Press Release doubledown casino active chips S Nov 1, 2017. Ibuprofen (Advil, Motrin) and meloxicam (Mobic) are drugs used to manage mild to moderate pain, inflammation, and fever.

More information

Dr. Gina Del Giudice, M.D., FACR, FACP Michael J. Froncek, M.D., MS, FACP, FACR INITIAL PATIENT HISTORY AND HEALTH ASSESMENTS

Dr. Gina Del Giudice, M.D., FACR, FACP Michael J. Froncek, M.D., MS, FACP, FACR INITIAL PATIENT HISTORY AND HEALTH ASSESMENTS Dr. Gina Del Giudice, M.D., FACR, FACP Michael J. Froncek, M.D., MS, FACP, FACR INITIAL PATIENT HISTORY AND HEALTH ASSESMENTS Please take a few minutes to fill out the information on all six pages as completely

More information

Medications for Persistent Pain

Medications for Persistent Pain Medications for Persistent Pain An Older Adult s Guide to Safe Use of Pain Medications THE AGS FOUNDATION FOR HEALTH IN AGING What is persistent pain? Introduction Persistent, or chronic pain, is pain

More information

Community Pharmacy NSAID Audit on Gastrointestinal Safety

Community Pharmacy NSAID Audit on Gastrointestinal Safety East & outh East England pecialist Pharmacy ervices East of England, London, outh Central & outh East Coast Medicines Use and afety Community Pharmacy NAID Audit on Gastrointestinal afety Introduction

More information

Effects and Prevention of Chronic NSAID Use on the Stomach

Effects and Prevention of Chronic NSAID Use on the Stomach Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects 8-2008 Effects and Prevention of Chronic NSAID Use on the Stomach Martha K. Braun Pacific

More information

Osteoarthritis is the most common type of. Review Article

Osteoarthritis is the most common type of. Review Article December 2008 JIMA:38486-IMANA.qxd 12/28/2008 10:10 PM Page 166 Review Article Osteoarthritis: Pathophysiology, Treatment, and What Muslims Need to Know Prior to Joint Replacement Surgery Asif M. Ilyas,

More information

Patient History Form

Patient History Form Patient History Form Date of first appointment: / / Time of appointment: Birthplace: MONTH DA Y YEAR Name: Birthdate: / / LAST FIRST MIDDLE INITIAL MAIDEN MONTH DAY YEAR Address: Age: Sex: F M STREET APT#

More information

ALZHEIMER'S DRUGS. Details. Step 2: Exelon Patch 13.3 mg/24 hour transdermal Exelon Patch 4.6 mg/24 hr transdermal

ALZHEIMER'S DRUGS. Details. Step 2: Exelon Patch 13.3 mg/24 hour transdermal Exelon Patch 4.6 mg/24 hr transdermal ALZHEIMER'S DRUGS Products Affected Step 1: donepezil 10 mg disintegrating tablet donepezil 10 mg tablet donepezil 23 mg tablet donepezil 5 mg disintegrating tablet donepezil 5 mg tablet galantamine 12

More information

CHAPTER 4 PAIN AND ITS MANAGEMENT

CHAPTER 4 PAIN AND ITS MANAGEMENT CHAPTER 4 PAIN AND ITS MANAGEMENT Pain Definition: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Types of Pain

More information

HOSPITAL ADMISSION SURGERY PACKET

HOSPITAL ADMISSION SURGERY PACKET 1719 East 19 th Avenue Denver, Colorado 80218 (303)-839-6000 Name: Birthdate: Physician: Allergies: HOSPITAL ADMISSION SURGERY PACKET Pre-Operative Diagnosis: Pre-Scheduled Surgery for: (Procedure) At

More information

Covers_07 9/7/07 3:33 AM Page 1 R e f e r e n c e G u i d e

Covers_07 9/7/07 3:33 AM Page 1 R e f e r e n c e G u i d e Reference Guide Contents About Hospice................................... 1 Medical Indicators for Hospice............... 4 Cancer.......................................... 5 Congestive Heart Failure (CHF)..............

More information

Gastrointestinal Safety of Coxibs and Outcomes Studies: What s the Verdict?

Gastrointestinal Safety of Coxibs and Outcomes Studies: What s the Verdict? Vol. 23 No. 4S April 2002 Journal of Pain and Symptom Management S5 Proceedings from the Symposium The Evolution of Anti-Inflammatory Treatments in Arthritis: Current and Future Perspectives Gastrointestinal

More information

Please Read This Entire Packet

Please Read This Entire Packet Please Read This Entire Packet 3900 Lakeville Hwy Petaluma, Ca. 94954 415-444-2988 Dear, MR# An appointment has been scheduled for you in the Outpatient Procedure Suite, Interventional Physiatry, in Petaluma

More information