Analgesics

Question 1

Morphine Sulfate:

• Functional Class

Answer 1

• Narcotic analgesic

Question 2

Morphine Sulfate:

• Mechanism Of Action

Answer 2

• Naturally occurring opiate
• Works on opiate receptors in the brain
• Also has vasodilatory properties due to mast cell degranulation and histamine release, increasing peripheral vascular capacity and decreasing preload. Reducing/decreasing cardiac workload, myo/O2 demand and pulm venous congestion.

Question 3

Morphine Sulfate:

• Indications

Answer 3

• C/P associated with ACS
• Pulm Edema
• CHF
• Pain management

Question 4

Morphine Sulfate:

• Contraindications

Answer 4

• Hypersensitivity
• Undiagnosed head injury
• hypovolemia
• hypotension
• acute asthma
• COPD
• Resp depression

Question 5

Morphine Sulfate:

• Precautions

Answer 5

• Administer slowly and titrate to effect

- Undiagnosed abd pain

Question 6

Morphine Sulfate:

• Side Effects

Answer 6

• Dizz, h/a, N/V, Cramps, Blurred Vision
• AMS
• Miosis
• Seizures
• Drowsiness
• Bradycardia
• Resp Depression
• Syncope
• Palps
• Hypotension

Question 7

Morphine Sulfate:

• Interactions

Answer 7

• Enhanced CNS depression when administered with antihistamines, sedatives, barbiturates, and alcohol.
• TCA and MAOI’s may precipitate hypotensive crisis.

Question 8

Morphine Sulfate:

• Dosage/Route

Answer 8

• Adult: 1-5 mg slow IVP/IM q 5 min, max of 15.
  Titrate to pain level and systolic BP >100
• Pedi: 0.1 mg/kg IV may repeat once in 10 min

Question 9

Morphine Sulfate:

• Pharmacokinetics

Answer 9

• Onset = Immediate IV

- Duration = 2-7 hours IV

Question 10

Morphine Sulfate:

• Note:

Answer 10

• Naloxone antidote

Question 11

Fentanyl Citrate (Sublimaze):

• Functional Class

Answer 11

• Narcotic agonist, analgesic

Question 12

Fentanyl Citrate (Sublimaze):

• Mechanism of Action:

Answer 12

• Potent, short-acting, synthetic narcotic agonist analgesic.
• Principle actions are analgesia and sedation.
• Inhibits ascending pain pathways in CNS, increases pain threshold, and alters pain perception by binding to opiate receptors.

Question 13

Fentanyl Citrate (Sublimaze):

• Indications

Answer 13

• Pain management

Question 14

Fentanyl Citrate (Sublimaze):

• Contraindication

Answer 14

• Myasthenia gravis
• Hypersensitivity to opiates
• MAOI use

Question 15

Fentanyl Citrate (Sublimaze):

• Precautions

Answer 15

• Increased ICP
• Severe resp disorder
• Hypotension
• Bradydysrhythmias

Question 16

Fentanyl Citrate (Sublimaze):

• Side Effects

Answer 16

• Severe resp depression
• Bronchoconstriction
• Chest wall rigidity
• Sedation
• Bradycardia
• CA
• Hypotension
• Diaphoresis, NV, Blurred Vision, miosos

Question 17

Fentanyl Citrate (Sublimaze):

• Interactions

Answer 17

• Increased effects with other CNS depressants such as alcohol, narcotics, and sedatives/hypnotics.
• MAOI use may cause hypotension.

Question 18

Fentanyl Citrate (Sublimaze):

• Dosage/Route

Answer 18

• Adult: 25-50 mcg slow IVP/IM q 5 minutes, max 150 mcg.

- Pedi: 0.5 mcg/kg slow IVP q 5 minutes, max dose of 1.5 mcg/kg

Question 19

Fentanyl Citrate (Sublimaze):

• Pharmacokinetics

Answer 19

• Absorbtion: Immediate
• Duration: 30-60 minutes
• Half-Life: 1.5-6 hrs

Question 20

Ketorolac (Toradol):

• Functional Class:

Answer 20

• Analgesic

- NSAID

Question 21

Ketorolac (Toradol):

• Mechanism

Answer 21

• Reversibly blocks the action of Cyclooxygenase preventing the formation of prostaglandins.
• Analgesia caused is equivalent to morphine.

Question 22

Ketorolac (Toradol):

• Indications

Answer 22

• Acute moderate-severe pain.

Question 23

Ketorolac (Toradol):

• Contraindications

Answer 23

• NSAID allergy
• ASA sensitive asthma
• Peptic Ulcer disease
• Recent GI bleed
• Renal failure
• CVA
• Recent CABG
• Pregnancy

Question 24

Ketorolac (Toradol):

• Precautions

Answer 24

• CHF and Cirrhosis pt due to renal failure

Question 25

Ketorolac (Toradol): - Side Effects

Answer 25

- GI bleed - Acute Renal Failure (ARF) - Inhibition of platelet aggregation - N/V/D - Upset Stomach

Question 26

Ketorolac (Toradol): - Interactions

Answer 26

- Potentiates platelet aggregation inhibitors

Question 27

Ketorolac (Toradol): - Dosage/Route

Answer 27

- Adult: 15-30mg IVP or 30-60 mg IM (Single dose only)

Question 28

Proparacaine (Alcaine): - Functional Class

Answer 28

- Local anesthetic

Question 29

Proparacaine (Alcaine): - Mechanism of Action

Answer 29

- Provides topical anesthesia to the eye by inhibiting the transmission of nerve impulses by inhibiting Na channels along the nerve pathway, interrupting action potential.

Question 30

Proparacaine (Alcaine): - Indications

Answer 30

- Chemical injury to eye(s) w/o associated foreign body.

Question 31

Proparacaine (Alcaine): - Contraindications:

Answer 31

- hypersensitivity

Question 32

Proparacaine (Alcaine): - Precautions

Answer 32

- Remove contact lenses prior to application. | - Use longer than two hrs may result in corneal ulcerations

Question 33

Proparacaine (Alcaine): - Side Effects

Answer 33

- Blurred vision - Eye sensitivity - Corneal irritation

Question 34

Proparacaine (Alcaine): - Interactions

Answer 34

- None

Question 35

Proparacaine (Alcaine): - Dosage/Route

Answer 35

- 1-2 drops of a 0.5% solution per eye affected q 5 minutes prn