1. Adjuvant Medications for Pain Medications for Pain & Inflammation ADN 110/cohort 131

2. OVERVIEW O Used with primary pain medication to increase pain relief while reducing the dosage of the primary pain medication O Reduces adverse reactions O Categories O TCAs O Anticonvulsants O CNS stimulants O Antihistamines O Glucocorticoids O Bisphosphonates O NSAIDs ADN 110/cohort 132

3. Purpose ADN 110/cohort 133 O Expected Action O Enhanced effect of opioids O Therapeutic Use O NSAIDs – inflammation O TCA – depression, neuropathic pain O Anticonvulsants – augment analgesia, decrease sedation O Antihistamines - decrease anxiety, prevent insomnia, relieve nausea O Glucocorticoids – decrease pain from intracranial pressure & spinal cord compression O Bisphosphonates – Hypercalcemia & bone pain

4. Complications O TCA – Amitriptyline O Orthostatic hypotension O Sedation O Anticholinergic effects O Contraindications/Precautions O Contraindicated – recovering MI, MAOIs O Caution – seizure disorder, urinary retention, prostatic hyperplasia, angle closure glaucoma, hyperthyroidism, liver disease, kidney disease ADN 110/cohort 134

5. Complications O Anticonvulsants – Carbamazepine, gabapentin O Bone marrow suppression O GI distress O Contraindications/Precautions O Contraindicated – bone marrow suppression, MAOIs, O Caution – seizure disorder ADN 110/cohort 135 continued

6. Complications O CNS stimulants – Methylphenidate O Weight loss O Insomnia O Contraindications/Precautions O Contraindicated – hyperthyroidism & HTN, MAOIs O Caution – agitation or tics O Antihistamines – Hydroxyzine O Sedation O Dry mouth O Contraindications/Precautions O Contraindicated – hypersensitivity O Caution - geriatrics ADN 110/cohort 136 continued

7. Complications O Glucocorticoids – Dexamethasone O Adrenal insufficiency O Osteoporosis O Hypokalemia O Glucose intolerance O PUD O Contraindications/Precautions O Contraindicated – fungal infection O Caution – seizure disorder, PUD, HTN, hypothyroidism, DM, liver disorder ADN 110/cohort 137 continued

8. Complications O Bisphosphonates – Etidronate, Pamidronate O Transient flu symptoms O Venous irritation at injection site O hypocalcemia O Contraindications/Precautions O Contraindicated – hypersensitive O Caution – kidney disease ADN 110/cohort 138 continued

9. Complications O NSAID- Ibuprofen O Bone marrow suppression O GI distress O Contraindications/Precautions O Contraindicated – hx of bronchospasms with ASA or NSAIDs O Caution – peptic ulcers, HTN, liver or kidney disease ADN 110/cohort 139 continued

10. Interactions O TCA – barbiturates, CNS depressants O Anticonvulsants – oral contraceptives, warfarin, grapefruit juice, phenytoin, phenobarbital O CNS stimulants – alkalizing medications, acidifying medications, insulin, oral antidiabetic medications, MAOIs, caffeine, O Antihistamines – barbiturates, CNS depressants ADN 110/cohort 1310

11. Interactions O Glucocorticoids – insulin, oral hypoglycemics, salicylates, NSAIDs, digoxin, diuretics that promote K+ loss O Bisphosphonates – calcium, iron, high calcium O NSAIDs – antihypertensive, furosemide, thiazide diuretics, ASA, corticosteroids, lithium, oral anticoagulants ADN 110/cohort 1311 continued