1. Q&A Summary for Analgesics

1.1. When should Acetaminophen be used?

• For mild to moderate somatic and visceral pain.
• Treats fever, headache, muscle, and general pain.
• Available in oral, liquid, rectal, and intravenous forms.

1.2. When should Acetaminophen be avoided?

• Patients with liver impairment.
• Avoid exceeding 4 grams/day (monitored) or 3 grams/day (unmonitored) due to risk of hepatic necrosis.

1.3. When should NSAIDs be used?

• For mild to moderate pain associated with inflammation (musculoskeletal).
• Available in oral, liquid, topical, and intravenous forms.

1.4. When should NSAIDs be avoided?

• In patients with bleeding risks (e.g., on anticoagulants, low platelets, prior GI bleeding).
• Avoid in renal dysfunction, diabetes, CHF, or concurrent corticosteroid use.

1.5. When should Opioids be used?

• For moderate to severe somatic, visceral, and neuropathic pain.
• Essential for cancer pain management.
• Available in oral, liquid, transdermal, intravenous, and rectal forms.

1.6. When should Opioids be avoided?

• Persistent non-cancer pain without serious illness unless managed by a pain specialist.

1.7. When should Antiepileptics be used?

• For moderate to severe neuropathic pain (e.g., gabapentin, pregabalin).
• Adjust dose in renal failure patients.

1.8. When should Antidepressants be used?

• For neuropathic pain and mood disorders, especially tricyclic antidepressants (TCA) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

1.9. When should Antidepressants be avoided?

• Use TCAs with caution in older patients or those with cardiac disease.

1.10. When should Corticosteroids be used?

• For moderate to severe pain, including capsular stretch pain, bone pain, or raised intracranial pressure.
• Also helps with appetite and fatigue.

1.11. When should Corticosteroids be avoided?

• Avoid combining with NSAIDs due to increased GI bleeding risk.

Now with dosages

2. Q&A Summary for Analgesics (with Dosages)

2.1. When should Acetaminophen be used, and what is the recommended dosage?

• Use: For mild to moderate somatic and visceral pain, fever, headache, muscle, and general pain.
• Dosage:
  • Standard dose: 325–650 mg every 4–6 hours or 1,000 mg every 6–8 hours.
  • Maximum dose: 4 g/day (monitored) or 3 g/day (unmonitored).

2.2. When should Acetaminophen be avoided?

• Avoid in patients with liver impairment or when exceeding recommended daily doses due to hepatotoxicity risks.

2.3. When should NSAIDs be used, and what are common dosages?

• Use: For pain with inflammation, e.g., arthritis or musculoskeletal conditions.
• Dosages:
  • Ibuprofen: 200–800 mg every 6–8 hours (max 3.2 g/day).
  • Naproxen: 250–500 mg twice daily (max 1,500 mg/day).
  • Celecoxib (Cox-2 inhibitor): 100–200 mg once or twice daily (max 400 mg/day).

2.4. When should NSAIDs be avoided?

• Avoid in patients with GI bleeding, renal dysfunction, CHF, or concurrent corticosteroid use.

2.5. When should Opioids be used, and what are appropriate dosages?

• Use: For moderate to severe somatic, visceral, or neuropathic pain.
• Dosages:
  • Morphine: 5–10 mg IV every 4 hours as needed; 15–30 mg oral every 4 hours as needed.
  • Hydrocodone/Acetaminophen (e.g., Norco): 5–10 mg hydrocodone every 4–6 hours (acetaminophen included counts toward the daily max).
  • Oxycodone: 5–15 mg oral every 4–6 hours as needed.
  • Fentanyl (transdermal): 12–100 mcg/hour, changed every 72 hours.

2.6. When should Opioids be avoided?

• Avoid in long-term non-cancer pain without specialist oversight.

2.7. When should Antiepileptics be used, and what are common dosages?

• Use: For moderate to severe neuropathic pain, e.g., diabetic neuropathy.
• Dosages:
  • Gabapentin: Initial dose 300 mg at bedtime, titrate to 300–600 mg three times daily (max 3,600 mg/day).
  • Pregabalin: 75 mg twice daily, titrate to 150 mg twice daily (max 600 mg/day).

2.8. When should Antidepressants be used, and what are common dosages?

• Use: For neuropathic pain and mood disorders.
• Dosages:
  • Amitriptyline (TCA): Start at 10–25 mg at bedtime, increase to 75–150 mg/day as tolerated.
  • Duloxetine (SNRI): 30 mg daily, titrate to 60 mg daily.

2.9. When should Antidepressants be avoided?

• Use caution with TCAs in older adults or those with cardiac disease due to QT prolongation.

2.10. When should Corticosteroids be used, and what are appropriate dosages?

• Use: For severe pain (e.g., capsular stretch, bone pain, or raised intracranial pressure).
• Dosages:
  • Dexamethasone: 4–10 mg daily (long-acting).
  • Prednisone: 10–40 mg daily (varies based on indication).

2.11. When should Corticosteroids be avoided?

• Avoid combining with NSAIDs due to increased GI bleeding risk.