Humerus Fracture Medication

Updated: Nov 07, 2019
  • Author: Adarsh K Srivastava, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Drugs used to treat fractures are generally NSAIDs, analgesics, and anxiolytics.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

These agents are used most commonly for the relief of mild to moderately severe pain. Effects of NSAIDs in the treatment of pain tend to be patient specific, yet ibuprofen is usually DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

Ibuprofen (Addaprin, Advil, Caldolor, Dyspel, Motrin IB, NeoProfen, Provil)

Usually DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which inhibits prostaglandin synthesis.

Ketoprofen (Active-Ketoprofen, Ketophene Rapidpaq)

Used for relief of mild to moderately severe pain and inflammation.

Administer small dosages initially to patients with small bodies, older persons, and those with renal or liver disease.

Doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.

Naproxen (Aleve, Mediproxen, Naprelan, Naprosyn)

Relieves mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which decreases prostaglandin synthesis.

Flurbiprofen

Has analgesic, antipyretic, and anti-inflammatory effects. May inhibit cyclooxygenase enzyme, inhibiting prostaglandin biosynthesis.

Diclofenac (Cambia, Cataflam, Dyloject, Zipsor, Zorvolex)

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

Indomethacin (Indocin, Tivorbex)

Indomethacin is thought to be the most effective NSAID for the treatment of AS, although no scientific evidence supports this claim. It is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures.

Acetaminophen (Tylenol, Acephen, Cetafen, Ofirmev, Aspirin-free Anacin, Valorin)

DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs and in those with upper GI disease or taking oral anticoagulants.

Acetaminophen and codeine (Tylenol with Codeine #3, Tylenol with Codeine #4, Capital/Codeine)

Drug combination indicated for treatment of mild to moderately severe pain.

Hydrocodone bitartrate and acetaminophen (Vicodin ES, Hycet, Lortab, Norco, Zamicet)

Drug combination indicated for relief of moderately severe to severe pain.

Oxycodone and acetaminophen (Percocet, Endocet, Primlev, Xartemis XR)

Drug combination indicated for relief of moderately severe to severe pain. DOC for aspirin-hypersensitive patients.

Morphine sulfate (Duramorph, Kadian, Infumorph, MS Contin)

DOC for narcotic analgesia because of its reliable and predictable effects, safety, and ease of reversibility with naloxone.

Morphine sulfate administered IV may be dosed in a number of ways and commonly is titrated until desired effect obtained.

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Anxiolytics

Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow a smaller analgesic dose to achieve same effect.

Lorazepam (Ativan)

Sedative hypnotic in benzodiazepine class with short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation.

Excellent for sedating patients for >24 h.

Monitor patient's BP after administering dose and adjust as necessary.

Diazepam (Diastat Pediatric, Diastat AcuDial, Valium)

Diazepam modulates postsynaptic effects of gamma amino-butyric acid A (GABA-A) transmission, resulting in an increase in presynaptic inhibition. It appears to act on part of the limbic system, as well as on the thalamus and hypothalamus, to induce a calming effect. Individualize dosage and increase cautiously to avoid adverse effects.

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