Analgesia & Patients with Special Considerations

Question 1

Plasma proteins in geriatric pts and bound drugs

Answer 1

Diminished plasma protein concentration means more drug reaches receptor site with age. Typically want to decrease med dose w age

Question 2

Liver and Renal Function in Geriatric Pts

Answer 2

Decreased liver=prolonged metabolism
Decreased renal= prolong excretion

Question 3

DimenhydrinATE Directive

Answer 3

65yo> or 25kg=+, unaltered,
Contra- all/sens, od on antihistamines or other anticholinergics or tcas, administration of benadryl
25-50kg = 25mg
50<= = 50mg
Dilute 1:9 for IV

Question 4

Ondansetron Directive

Answer 4

25kg=+, unaltered
Contra- all/sens, prolonged qt syndrome, apomorphine use (Parkinsons tx)
4mg po 1x

Question 5

Adrenal Crisis

Answer 5

Caused by deficiency of cortisol due to Addison’s, congenital adrenal hyperplasia or pituitary disorders

Question 6

S/S of Adrenal Crisis

Answer 6

Syncope, fever, severe v/d, hypoglycemia, hypovolemia, hypotension

Question 7

Adrenal Crisis Directive

Answer 7

Presented with hydrocortisone for pt and 1 of: age related hypoglycemia, gi sym, syncope, temp 38+, aloa, tachy, hypotension
Contra- all/sens
Dose 2mg/kg max single dose 100mg rounded to nearest 10mg 1x

Question 8

Pain Classifications

Answer 8

Nociceptive- normal response (sprained ankle, burns etc)
Neuropathic- caused by primary lesion or disease in somatosensory nervous system

Question 9

Nociceptive Pain S/S

Answer 9

Vaso-vagal = bradycardia, hypotension, brief loc

Question 10

Neuropathic Pain S/S

Answer 10

Sympathetic response (tachy, hypertensive), tachy dysrhythmias, pvcs

Question 11

NSAIDs

Answer 11

ASA, ibuprofen, ketorolac

Question 12

Is Acetaminophen an NSAID?

Answer 12

No its a synthetic compound

Question 13

Acetaminophen Directive

Answer 13

Pain (mild-mod), 12<=, unaltered
Contra- used w/i 4 hrs, all/sens, hx liver disease, active vomiting, unable to tolerate oral meds, ischemic cp, 12-18 =650 mg, 18<= 1000mg

Question 14

Ibuprofen Directive

Answer 14

Pain, 12<=, unaltered
Contra- NSAID use w/i 6 hr,all/sens to NSAIDS, is asthmatic no prior use of ASA/NSAIDS, cva/tbi 24 hrs, current active bleed, peptic ulcer disease/gi bleed, on anticoagulation therapy renal impairment, pregnant, active vomiting, unable to tolerate oral meds, cp
400mg max 1 dose po

Question 15

Ketorolac

Answer 15

Pain, 12<=, unaltered
Contra- NSAID use w/i 6 hr,all/sens to NSAIDS, is asthmatic no prior use of ASA/NSAIDS, cva/tbi 24 hrs, current active bleed, peptic ulcer disease/gi bleed, on anticoagulation therapy renal impairment, pregnant, cp
15mg 1x