Analgesia Medical Directive

Question 1

What are the indications for the analgesia directive?

Answer 1

Pain

Question 2

What are the conditions for acetaminophen?

Answer 2

Age ≥12 years
LOA - Unaltered

Question 3

What are the conditions for ibuprofen?

Answer 3

Age ≥ 12 years
LOA - Unaltered

Question 4

What are the conditions for Ketorolac?

Answer 4

Age ≥ 12 years
LOA - Unaltered
SBP - Normotension

Question 5

What are the contraindications for acetaminophen?

Answer 5

• Acetaminophen use within the previous 4 hours
• Allergy or sensitivity to acetaminophen
• Hx of liver disease
• Active vomiting
• Unable to tolerate oral medication
• Suspected ischemic chest pain

Question 6

What are the contraindications for ibuprofen?

Answer 6

• NSAID use within previous 6 hours
• Allergy or sensitivity to ibuprofen
• Pt on anticoagulation therapy
• Current active bleeding
• Hx of peptic ulcer disease or GI bleed
• Pregnant
• If asthmatic, no prior use of ASA or other NSAIDs
• CVA or TBI in the previous 24 hours
• Known renal impairment
• Active vomiting
• Unable to tolerate oral medication
• Suspected ischemic chest pain

Question 7

What are the contraindications for ketorolac?

Answer 7

• NSAID use within previous 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 other NSAIDs
• CVA or TBI in the previous 24 hours
• Known renal impairment
• Suspected ischemic chest pain.

Question 8

What is the dose of acetaminophen for patients ≥12 years to <18 years old?

Answer 8

PO
500-650 mg, max dose 650 mg. Max 1 dose.

Question 9

What is the dose of acetaminophen for patients ≥18 years old?

Answer 9

PO
960-1000 mg, max dose 1000 mg. Max 1 dose.

Question 10

What is the dose for ibuprofen?

Answer 10

PO
400 mg, max 1 dose.

Question 11

What is the dose for ketorolac?

Answer 11

IM/IV
10-15 mg, max dose 15 mg. Max 1 dose.

Question 12

What are the clinical considerations of the analgesia MD?

Answer 12

• Whenever possible, consider co-administration of acetaminophen and ibuprofen.
• Suspected renal colic patients should routinely be considered for NSAIDs, either ibuprofen or ketorolac.
• IV administration of ketorolac applies only to PCPs authorized for PCP Autonomous IV.