ALS Analgesia Med Directive

Question 1

What is indication for analgesics

Answer 1

Pain

Question 2

What does indication mean

Answer 2

Why you use this directive

Question 3

What does conditions mean

Answer 3

Criteria pt must meet

Question 4

What does contraindications mean

Answer 4

Reasons pt can’t use directive; must screen for these

Question 5

Conditions to use acetaminophen

Answer 5

Pt must be
12 years or older
Unaltered LOA

Question 6

Conditions to use ibuprofen

Answer 6

Pt must be :
12 years or older
Unaltered LOA

Question 7

Conditions to use ketorolac

Answer 7

Pt must be:
12 years or older
Unaltered LOA 
Normotension (at least 100 systolic)
Restricted to pt who cant tolerate oral meds

Question 8

Contraindications of acetaminophen

Answer 8

Do not give acetaminophen if:

• Acetaminophen use in last 4 hours
• Allergy or sensitivity to acetaminophen
• Hx of liver disease
• Active vomiting
• Unable to tolerate oral meds
• Suspected ischemic CP

Question 9

Contraindications of ibuprofen

Answer 9

Do not give ibuprofen if:

• NSAID or ibuprofen use in last 6 hours
• Allergy or sensitivity to ASA or NSAIDs
• PT on anticoagulation therapy
• Current active bleeding
• Hx of peptic ulcer disease or GI bleed
• Pregnant
• If asthmatic, no prior use of ASA or NSAIDs
• CVA or TBI in last 24hrs
• Know renal impairment
• Active vomiting
• Unable to tolerate oral meds
• Suspected ischemic CP

Question 10

Contraindications of ketorolac

Answer 10

Do not give ibuprofen if:

• NSAID or ibuprofen use in last 6 hours
• Allergy or sensitivity to ASA or NSAIDs
• PT on anticoagulation therapy
• Current active bleeding
• Hx of peptic ulcer disease or GI bleed
• Pregnant
• If asthmatic, no prior use of ASA or NSAIDs
• CVA or TBI in last 24hrs
• Know renal impairment
• Suspected ischemic CP

Question 11

Treatment with acetaminophen for pt age 12 to 17

Answer 11

Route PO
Dose 500 -650 mg
Max single dose 650 mg
No dosing intervals 
Max # of doses 1

Question 12

Treatment with acetaminophen for pts aged over 18 y/o

Answer 12

Route PO
Dose 960- 1000 mg
Max single dose 1000 mg
No dosing intervals 
Max # of doses 1

Question 13

Treatment with ibuprofen for pts aged 12 and older

Answer 13

Route PO
Dose 400 mg
Max single dose 400 mg
No dosing intervals 
Max # of doses 1

Question 14

Treatment with ketorolac for pts aged 12 and older

Answer 14

Route IM/IV
Dose 10 -15  mg
Max single dose 15 mg
No dosing intervals 
Max # of doses 1

Question 15

Clinical considerations for acetaminophen and ibuprofen

Answer 15

Whenever possible co-administration of both together

Question 16

Clinical considerations for renal colic pts

Answer 16

Should routinely be considered for ketorolac

Question 17

Clinical considerations for IV administration

Answer 17

Ketorolac administration applies only to PCPs authorized for PCP Autonomous IV

Question 18

Ketorolac is restricted to pts who

Answer 18

Are unable to tolerate oral meds

Question 19

Why should renal colic pts be considered for NSAIDs

Answer 19

Because of anti-inflammatory action and smooth muscle relaxant effects (reduces glomerular filtration rate which reduces renal pelvic pressure and stimulation of stretch receptors)
- also inhibits prostaglandin production

Question 20

What is active bleeding definition

Answer 20

If external trauma dressed and controlled it’s not active bleed

• occult bleeding is active bleeding (hematouria/GI bleed)
• trace blood in urine with suspected renal colic is not considered active bleed

Question 21

Definition of unable to tolerate oral meds

Answer 21

• pt must remain supine (on a backboard)
• pt vomiting or nauseous
• pt has difficulty swallowing or has a feeding tube in place