Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications. In general, antibiotics are not required for prophylaxis against infection unless there is an open fracture or the fracture is associated with a bite wound. Tetanus prophylaxis should be considered for those whose immunization is questionable. [2]
Analgesics
Class Summary
Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained injuries.
Ibuprofen (Motrin, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Acetaminophen (Feverall, Tylenol, Aspirin Free Anacin)
DOC for pain in patients with a documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking PO anticoagulants.
Acetaminophen and hydrocodone (Lortab, Norcet, Vicodin, Lorcet HD)
Drug combination indicated for moderate to severe pain.
Aspirin and oxycodone (Percodan, Roxiprin, Codoxy)
Drug combination indicated for the relief of moderate to severe pain.
Ketorolac (Toradol)
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors.
Morphine (Duramorph, Astramorph, MS Contin)
DOC for analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone.
Various IV doses are used; commonly titrated until desired effect is obtained.
Antiemetics
Class Summary
Antiemetics are useful in the treatment of symptomatic nausea.
Promethazine (Phenergan, Anergan, Prorex, Phenazine)
Anti-dopaminergic agent that is effective in treating emesis. Blocks postsynaptic mesolimbic dopaminergic receptors in the brain and reduces stimuli to the brainstem reticular system.
Ondansetron (Zofran)
Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin) and complete body radiotherapy.
Antibiotics
Class Summary
The antibiotic should be selected based on the normal bacterial flora associated with the affected site. (Ref 29)
Immunization
Class Summary
Tetanus prophylaxis should be considered for management of open fractures. (Ref 29)
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The bony walls of the orbit.
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Le Fort fractures.
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Mandibular fractures.
