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Strong Opioids +/- adjuvant therapy - page 9 / 38

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75 mg repeated if necessary after 4–6 hours for max. 2 days

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Prevention of postoperative pain, initially after surgery 25–50 mg over 15–60 minutes then 5 mg/hour for max. 2 days

PR (suppositories)

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75–150 mg daily in divided doses

Max total daily dose by any route, 150mg

Child 1–12 year

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Juvenile arthritis, by mouth or by rectum, 1–3 mg/kg daily in divided doses (25 mg e/c tablets, 12.5 mg and 25 mg suppositories only)

Child 6–12 years

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Postoperative pain, by rectum, 1–2 mg/kg daily in divided doses (12.5 mg and 25 mg suppositories only) for max. 4 days

Celecoxib (CELEBREX) by Cat Tucson

Mode of operation:

Selective COX-2 (Cyclo-oxegenase 2 isozyme) inhibitor

PGE-2 increases vascular permeability, increases pain sensitivity, is pyrogenic, and suppresses lymphocyte transformation, release of mediators from mast cells, and cell-mediated cytotoxic

PGI-2 (prostacyclin) acts chiefly to prevent platelet formation and clumping involved in blood clotting. It is also an effective vasodilator.

Ability to selectively inhibit COX-2 as compared to COX-1 less GI disturbance by not disrupting gastroprotective prostaglandin PGE-2 (only significant in those withdrawn from market)

ROFECOXIB and VALDECOXIB withdrawn from market in 2004 due to risk of CVD

Binds to albumin (97%)

T1/2 = 11hours

Hepatic metabolism

1/3 renally excreted, 2/3 faecal.

Side effects:

GI dyspepsia/bleeding

flatulence

insomnia

pharyngitis

sinusitis

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