Analgesic Agents Flashcards
What are the two categories of analgesics
Opioid and nonopioid
Naturally occurring opioid agents
opium alkaloids
Synthetic opioids
codeine, oxycodone, methadone, morphine, hydromorphone, meperidine, fentanyl
Mechanism of action of opioids
activation of receptors within the CNS and/or dorsal root ganglia and peripheral terminals of primary afferent neurons
WHO analgesic ladder guidelines
mild pain: acetaminophen, non steroidals
moderate: weaker opioids, combo
severe: stronger agents
Common analgesics used in NICU
fentanyl and morphine
Adverse effects of analgesics
respiratory depression, hypotension, glottic and chest wall rigidity, constipation, urinary retention, seizures, sedation, bradycardia
Naloxone mechanism of action
competes for CNS narcotic receptor sites
When should naloxone be used?
as adjunct therapy to resuscitative efforts for narcotic induced resp. depression
Precautions to giving naloxone in delivery room
Normal heart rate and color should be restored through PPV before given
Which patient should NOT receive naloxone?
Chronically exposed to opioids in utero
Morphine solubility
water soluble, metabolites cleared by kidneys. Impaired renal function can lead to accumulation
Morphine clearance
improves with age, adult levels at 6-12 months.
Side effects of rapid administration of Morphine
hypotension, bradycardia and flushing (histamine response). blood pressure effects prob dependent on dose and GA
Morphine peak and duration
Peak 45-90 minutes
duration 4-5 hours
Methadone treatment
opioid withdrawal in neonates, rapid distribution and slower elimination than morphine.
Methadone tolerance
3-5 days as opposed to morphine at 2 weeks
Fentanyl potency
50-100 fold greater than morphine
Fentanyl onset and duration
3-4 minutes, shorter duration at 30 minutes. INCREASED LIPID SOLUBILITY SO EFFICIENT PENETRATION OF BBB.
Fentanyl preferred for what type of patient
hemodynamically unstable, symptoms related to histamine release during morphine admin or with morphine tolerance
Where is fentanyl metabolized?
Liver. Infants with decreased hepatic blood flow or function may have decreased clearance.
Midazolam is what kind of drug
benzodiazepine that offers sedation, anxiolysis, hypnosis, amnesia NOT ANALGESIA
Why is the onset of action so rapid for midazolam?
penetrates the BBB rapidly
Side effect of rapid administration of Versed?
respiratory depression
Less common side effects of Versed
hypotension, seizure like myoclonus with continuous infusion
Common side effect of Fentanyl
Muscle/chest wall rigidity
Acetaminophen
management of pain, no anti-inflammatory effects
NSAIDS
antipyretic, analgesic and anti-inflammatory
NSAIDS complication
can interfere with platelet aggregation, is reversible`
Non pharmacological interventions for pain
sucrose, nonnutritive sucking, kangaroo care, facilitated tucking, music therapy, breast milk,
