Analgesic Agents

Question 1

What are the two categories of analgesics

Answer 1

Opioid and nonopioid

Question 2

Naturally occurring opioid agents

Answer 2

opium alkaloids

Question 3

Synthetic opioids

Answer 3

codeine, oxycodone, methadone, morphine, hydromorphone, meperidine, fentanyl

Question 4

Mechanism of action of opioids

Answer 4

activation of receptors within the CNS and/or dorsal root ganglia and peripheral terminals of primary afferent neurons

Question 5

WHO analgesic ladder guidelines

Answer 5

mild pain: acetaminophen, non steroidals

moderate: weaker opioids, combo
severe: stronger agents

Question 6

Common analgesics used in NICU

Answer 6

fentanyl and morphine

Question 7

Adverse effects of analgesics

Answer 7

respiratory depression, hypotension, glottic and chest wall rigidity, constipation, urinary retention, seizures, sedation, bradycardia

Question 8

Naloxone mechanism of action

Answer 8

competes for CNS narcotic receptor sites

Question 9

When should naloxone be used?

Answer 9

as adjunct therapy to resuscitative efforts for narcotic induced resp. depression

Question 10

Precautions to giving naloxone in delivery room

Answer 10

Normal heart rate and color should be restored through PPV before given

Question 11

Which patient should NOT receive naloxone?

Answer 11

Chronically exposed to opioids in utero

Question 12

Morphine solubility

Answer 12

water soluble, metabolites cleared by kidneys. Impaired renal function can lead to accumulation

Question 13

Morphine clearance

Answer 13

improves with age, adult levels at 6-12 months.

Question 14

Side effects of rapid administration of Morphine

Answer 14

hypotension, bradycardia and flushing (histamine response). blood pressure effects prob dependent on dose and GA

Question 15

Morphine peak and duration

Answer 15

Peak 45-90 minutes

duration 4-5 hours

Question 16

Methadone treatment

Answer 16

opioid withdrawal in neonates, rapid distribution and slower elimination than morphine.

Question 17

Methadone tolerance

Answer 17

3-5 days as opposed to morphine at 2 weeks

Question 18

Fentanyl potency

Answer 18

50-100 fold greater than morphine

Question 19

Fentanyl onset and duration

Answer 19

3-4 minutes, shorter duration at 30 minutes. INCREASED LIPID SOLUBILITY SO EFFICIENT PENETRATION OF BBB.

Question 20

Fentanyl preferred for what type of patient

Answer 20

hemodynamically unstable, symptoms related to histamine release during morphine admin or with morphine tolerance

Question 21

Where is fentanyl metabolized?

Answer 21

Liver. Infants with decreased hepatic blood flow or function may have decreased clearance.

Question 22

Midazolam is what kind of drug

Answer 22

benzodiazepine that offers sedation, anxiolysis, hypnosis, amnesia NOT ANALGESIA

Question 23

Why is the onset of action so rapid for midazolam?

Answer 23

penetrates the BBB rapidly

Question 24

Side effect of rapid administration of Versed?

Answer 24

respiratory depression

Question 25

Less common side effects of Versed

Answer 25

hypotension, seizure like myoclonus with continuous infusion

Question 26

Common side effect of Fentanyl

Answer 26

Muscle/chest wall rigidity

Question 27

Acetaminophen

Answer 27

management of pain, no anti-inflammatory effects

Question 28

NSAIDS

Answer 28

antipyretic, analgesic and anti-inflammatory

Question 29

NSAIDS complication

Answer 29

can interfere with platelet aggregation, is reversible`

Question 30

Non pharmacological interventions for pain

Answer 30

sucrose, nonnutritive sucking, kangaroo care, facilitated tucking, music therapy, breast milk,