Analgesia Flashcards
Fentanyl/Sublimaze/Duragesic
P-Dyn
Combines with brain receptor sites to produce analgesia
-Decreased pain perception (mu, kappa, delta)
Mostly Mu
Decreased emetic effect
Fentanyl/Sublimaze/Duragesic
Class
Opioid analgesic
Fentanyl/Sublimaze/Duragesic
Indications
Analgesia
Sedation for airway (combo with other agents)
Fentanyl/Sublimaze/Duragesic
Adverse/Side Effects
Triad (MBP)
Brady
Hypotension
N/V, constipation
Fentanyl/Sublimaze/Duragesic
Contraindications
Allergy
Head injury/CNS depression/ICP
Myasthenia gravis
MAO inhibitors within 14 days
Fentanyl/Sublimaze/Duragesic
Precautions
Old, respiratory, seizures, cardiac
Fentanyl/Sublimaze/Duragesic
Interactions
CNS depressants
Potentiated by benzos
MAO inhibitors precipitate HTN crisis
Fentanyl/Sublimaze/Duragesic
Dose
May dilute
25-200 mcg slow IV
50-100 mcg IM q 30-60 min PRN
1-2 mcg/kg slow IV/IM q 5-15 min PRN
Fentanyl/Sublimaze/Duragesic
Peds dose
1-2 mcg/kg slow IV q 5-15 min PRN
1-2 mcg/kg IM q 15-60 min PRN
Meperidine/Demerol
Class
Narcotic analgesic
Opioid
Meperidine/Demerol
P-Dyn
Analgesia (pain perception, catecholamine production)
Decreased myocardial O2 demand
Lacks hemodynamic morphine effects
Meperidine/Demerol
Indications
CP suggestive of AMI, unresponsive to nitrates
Mod/severe musculoskeletal pain
Meperidine/Demerol
A/S
Triad
Hypotension
N/V
Constipation
Meperidine/Demerol
Contraindications
MAOIs (Nardil, Parnate)
SSRI (Paxil,Prozac, Zoloft, Luvox)
Allergy
Hypovolemia, hypotension
Head injury, CNS depression, ICP
Abd pain
Meperidine/Demerol
Interactions
Increased effects with CNS depressants
Dilantin/Phenytoin blunts effects
Enhanced with lots of meds
Meperidine/Demerol
Dose
25-50 mg slow IV q 1 hr PRN
50-100 mg IM q3-4h PRN
Meperidine/Demerol
Peds Dose
1-2 mg/kg slow IV/IM
Hydromorphone/Dilaudid
Class
Opioid analgesic
Hydromorphone/Dilaudid
P-Dyn
Combines with Mu receptors in brain to produce analgesia
Decreases perception of pain
Hydromorphone/Dilaudid
Indications
Mod/severe pain
Antitussive
Hydromorphone/Dilaudid
A/S
Triad
Brady
Hypotension
N/V, constipation
Hydromorphone/Dilaudid
Contraindications
Allergy
Head injury, CNS depression, ICP
Asthma
Hydromorphone/Dilaudid
Precautions
7-10 x morphine
Old, resp, seizure disorders
Hydromorphone/Dilaudid
Interactions
Increased with CNS depressants, TCAs, phenothiazines, benzos
Hydromorphone/Dilaudid
Dose
1-2 mg slow q 6-8 hrs
Toradol/Ketorolac Tromethamine
Class
NSAID
Toradol/Ketorolac Tromethamine
P-Dyn
Non-opiate analgesia
- inhibits prostaglandin synthesis
- decreases responsiveness of pain receptors in inflamed tissue
- peripheral acting
Toradol/Ketorolac Tromethamine
Indications
Mod/Severe pain
Toradol/Ketorolac Tromethamine
A/S
Bleeding, abd pain, diarrhea, nausea
Swelling, anaphylaxis
Increased BP
Drowsiness
Toradol/Ketorolac Tromethamine
Contraindications
Allergy (incl. ASA NSAIDs)
Active ulcers/GI bleed
Renal failure
Head bleed
Toradol/Ketorolac Tromethamine
Precautions
IM typical route, single dose
Caution in renal/hepatic impairment
Reduced dose in above and elderly
Toradol/Ketorolac Tromethamine
Interactions
Increased bleeding with anticoagulants
Increased lithium levels
Reduces Lasix effectiveness
Toradol/Ketorolac Tromethamine
Dose
IM 60 mg (normal) 30 mg (over 65, renal, less than 50 kg) IV 30 mg (normal) 15 mg (over 65, renal, less than 50 kg) No peds
Adjuvant analgesic
Enhance efficacy of opioids
Treat underlying causes
Reduce side effects
Nalmefene/Revex
Class
Narcotic/opiate antagonist
Competitive antagonist
Nalmefene/Revex
P-Dyn
Competes for narcotic/opiate receptors
Reverses narcotic effects
Nalmefene/Revex
Indications
Narcotic OD
Nalmefene/Revex
A/S
Withdrawal -HTN, tachycardia, violent behavior, tremors, seizures
Arrhythmias
N/V
Nalmefene/Revex
Contraindications
Allergy
Nalmefene/Revex
Interactions
Poss. increased risk of seizures if used with Flumazenil
Nalmefene/Revex
Dose
1st 0.5 mg/70 kg
2nd q2-5, 1 mg/70 kg
With addicts start with 0.1 mg/70 kg
No peds
