4. Pain Management Flashcards
When should be be evaluated and documented
every appointment
What considerations should be kept in mind when deciding what pain management meds should be used
- Individual patient/familt
- Extent of treatment
- Duration of procedure
- Psychological factors
- Medical history/ physiologic factors (bleeding disorders, liver, and kidney problems)
What are the first line drug therapy for pre and post op pain
non-opiod analgesics (esp. NSAIDs)
Which have anti-inflammatory properties
- Tylenol
- Motrin
- Codeine
- Advil
Motrin and advil (also ibprophen)– only NSAIDs
Why should caution be used with opiods
respiratory depression- most common cause of death with opiod use
Properties of NSAIDs
Antipyretic
Anti-inflammatory
Analgesic
Dosing for children less than 12 (ibprofen)
4-10 mg/kg/dose every 6-8 hrs
Max= 40 mg/kg/24 hrs
Dosing for children >12 Ibprofen
200 mg every 4-6 hrs
Max=1.2g/24 hr
Dosing for adult ibprofen
200-400mg every 4-6 hr
Max=1.2 g/24hr
MOA of NSAIDs
- Inhibition of COX (cyclooxygenase) enzymes
- Prevents the formation of prostaglandins
Caution should be used with NSAIDs in what patients
- GI disease
- Bleeding disorders (affects platelet aggregation- increases bleeding time)
- Impaired renal function
Why is aspirin avoided in kids
linked to reye’s syndrome
Properties of acetaminophen
antipyretic and analgesic
Dosing for tylenol in kids <12
10-15 mg/kg every 4-6hr
Max= 90mg/kg/24 hr – not exceeded 2.6g/24hr
Dosing for tylenol in kids <12
325-650mg every 4-6 hr or 1000mg 3-4 times a day
Max= 4g/24hrs
MOA of tylenol
not fully understood (thought to act through COX inhibition
T/F Caution should be taken when using tylenol in kids with bleeding disorders
F- tylenol doesn’t disrubte platelet aggregation and clotting time
OD of tylenol can lead to
acute liver failure
Name the metabolic substrate that causes acetaminophen toxicity
NAPQI
When detoxifies NAPQI
glutithione
What is the antidote for tylenol OD and how does it work
NAC (N-acetylcysteine) acts by bumping up glutithione
Initial symptoms of acetaminophen toxicity are
- Nausea
- Vomiting
- Drowsniness
- Lethargy
- Malaise
progression of tylenol toxicity can lead to
- Upper right quadrant pain
- Tachycardia
- Hypotension
- Hepatic disfunction
- Multi-organ failure
Look at chart on slide 11
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State the amount of acetaminophen in #2,3, and 4 acetaminopen with codeine
2= 300 mg acetaminophen and 15mg codeine 3= 300mg acetaminophen and 30 mg codeine 4= 300 mg acetaminopen and 60 mg codeine
How much acetaminophen and codeine present in liquid tylenol and codeine
120mg acetaminophen +12 mg codeine (5mL suspension)
Dosing for child <12 for tylenol with codeine
0.5-1mg codeine/kg/dose every 4-6 hrs
10-15mg acetaminophen/kg/dose every 4-6 hr
Max
-90 mg/kg acetaminophen in 24 hr (not to exceed 2.6 mg acetaminophen in 24 hrs)
Codeine has the potential for _ if OD
respiratory depression (it’s a narcotic)
Codeine is metabolized into what by what organ
morphine by the liver
Describe ultra-fast and slow metabolizers
Ultra-fast
-Require higher doses for effect (easy to OD)
Slow
-Takes a long time for effect to kick in (impatience –> OD)
Why is there little potential for addiction with codeine
short course of administration
Analgesics for mild/moderate pain should recommend
OTC
Moderate/Severe pain- recommend what analgesics
acetaminophen and ibprofen
- Don’t exceed to max dose per day for each
- As one med wears off the other is peaking
What should you do if you expect there to be post op pain
- I.e exo or SSC
- Give pre-op analgesics or recommend dose before anesthesia wears off.
Antibiotics should be used when
Acute infection
- Facial swelling
- Tooth painful to palpation
- Pain wakes kid up at night
Perscribe AB for acute infection then ask to return how long later for exo
5-10 days
Purpose of perscribing AB then Exo
- May not be able to get tissue fully numb
- Get child out of acute pain (better cooperation for exo)
T/F analgesics can be used with ABs
t
Dosing of amoxicillin in kids <12 or <40 kg
20-40 mg/kg/day Dosing every 8 hrs
25-45mg/kg/day divided into doses every 12 hrs
Dosing for kids >12 amoxicillin or >40kg
250-450mg every 8 hr
OR
500-875mg every 12 hr
Forms of amoxicillin
Liquid (250 mg.5mL) or (125mg/5mL)
Chewable tab (250mg)
Tab (500mg)
Dosing for child clindamycin
8-20 mg/kg/day in 3-4 doses
Dosing for adults clindamycin
150-450 mg every 6 hrs
Forms of clindamycin
Liquid (75mg/5mL)
Capsule (150mg and 300 mg)
dosing for kids is based on (age/weight)
age- not every kid falls in average weights
1 tsp= _mL
5
Most meds given to kids are in (liquid/tab) form
liquid
Review calculations and script writing
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