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Analgesics Flashcards

1
Q

T/F: They used to think Neonates could not feel pain

A

True :-(

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2
Q

Name the 2 categories of Analgesics

A

Opioid

Non-Opioid

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3
Q

There are 2 types of Opioids. What are they?

A

Naturally Occurring Agents (Opium Alkaloids)

Synthetic Opioid Agonists

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4
Q

What do Synthetic Opioid Agonists do?

A

Elicit Morphine-like activity

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5
Q

Name the 7 Synthetic Opioid Agonists mentioned in lecture

A
  1. Codeine
  2. Oxycodone
  3. Methadone
  4. Morphine
  5. Hydromorphone
  6. Meperidine
  7. Fentanyl
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6
Q

What is the Mechanism of Action of Analgesics?

A

Activation of receptors within the CNS.

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7
Q

How is Analgesia Obtained?

A

By spinal or Supraspinal activation of Opioid Receptors—>Decreased Neurotransmitter release from Nociceptive/Sensory Neurons (Altering perception and response to pain).

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8
Q

Do Opioid Receptors exist outside the CNS?

A

Yes

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9
Q

Where are Opioid Receptors outside of the CNS?

A

The Dorsal Root Ganglia and in the terminals of Primary Afferent Neurons

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10
Q

What was the WHO Analgesic Ladder developed for originally?

A

Developed for the Tx of CA pain

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11
Q

How do you treat Mild Pain?

A

W/non-Opioid Analgesics

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12
Q

Name some non-Opioid Analgesics

A

Acetaminophen

NSAIDS

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13
Q

How do you treat Moderate Pain?

According to WHO Analgesic Ladder

A

W/Weaker Opioids or Combination Products

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14
Q

How do you treat Severe Pain?
(According to WHO Analgesic Ladder)

What are the 2 most common agents used
in the NICU to tx severe pain?

A

Stronger Agents

  1. Morphine
  2. Fentanyl
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15
Q

In Neonates, Opioids are reserved to treat _____ to _____ pain

A

Moderate to Severe

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16
Q

What are the Side effects of Opioids (8)?

A
  1. Respiratory Depression
  2. Hypotension
  3. Glottic and Chest wall rigidity
  4. Constipation
  5. Urinary Retention
  6. Seizures
  7. Sedation
  8. Bradycardia
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17
Q

How can Side effects be minimized when prescribing Opioids?

A

Appropriate Drug Selection

Appropriate Drug Dosing

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18
Q

What should be monitored during Opioid Administration?

A

Conitnuous Cardiac Monitoring &

Frequent VS

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19
Q

What is Naloxone?

What does it do?

A

(Narcan)
Competitive Opioid Receptor agonist
Reverses many side-effects of Opioids

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20
Q

In addition to reversal of side effects, what else does Naloxone do?

A

Antagonizes the Endorphin Effects (Increases pain perception)

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21
Q

Which patients should Not receive Naloxone?

Why?

A

Infants with Long-term, Chronic exposure of Opioids in Utero

Seizures

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22
Q

What are the long-term side-effects of Naloxone?

A

We don’t know.

They are not studied.

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23
Q

What is the T 1/2 of Naloxone in a NB?

Why could this be a problem?

A

~70 minutes

It could be shorter than the T 1/2 of the Opioid

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24
Q

What is the onset of action of Naloxone?

A

Variable,
IV administration-within minutes
IM administration-within 30 minutes

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25
What might Naloxone be used for? What is Naloxone NOT used for? If necessary in the DR, what must be restored 1st?
Narcotic induced Respiratory Depression In the DR for initial Respiratory Depression Restore Proper HR and Ventilation
26
What is the most common Opioid used in NICU?
Morphine
27
Morphine is soluble in _____ but has poor ______ solubility
Water | Lipid
28
Morphine metabolites are cleared by the ________ and partly by _____ ________
Kidneys | Biliary Excretion
29
Is there a difference in Analgestic effect between continuous and intermittent Morphine dosing?
No
30
What can happen in infants with impaired Renal function receiving Morphine?
Accumulation of Morphine
31
How is Morphine mainly administered for Analgesia?
IV Can be used IM (but is painful) Rectal-exists but wide variability
32
Morphine clearance improves with?
Postconceptual Age
33
What 3 signs are A/W the Histamine response from Morphine administration?
Hypotension, Bradycardia, & Flushing
34
The Histamine response from Morphine is a/w?
Rapid Administration
35
Morphine may have effects on b/p but are probably dependent on ______ & _______ ___.
Dosing | Gestational Age
36
What is the Peak of Morphine?
45-90 minutes
37
What is the Duration of Morphine
4-5 hours
38
Methadone is a synthetic Opioid with an analgesic potency similar to ______.
Morphine
39
What medication is Widely used for the tx of Opioid withdrawal in Neonates?
Methadone
40
Methadone has a Slower/more Rapid distrubution and a more Rapid/Slower elimination than Morphine.
More rapid Distribution | Slower elimination
41
What medication is used in addicted adults to avoid withdrawl?
Methadone
42
What medication has a propensity toward muscle rigidity?
Fentanyl
43
Fentanyl has ___ - ____ fold potency of Morphine
50-100 fold
44
There is a Narrow/Wide margin of safety with Fentanyl
Wide
45
What is the onset of Fentanyl?
3-4 minutes
46
What is the Duration of action of Fentanyl?
30 minutes
47
Fentanyl is metabolized by _______
Liver
48
What makes Fentanyl a good choice for precedural pain?
It has a shorter duration (30 minutes)-probably due to increased lipid solubility & molecular confirmation enabling efficient penetration of the BBB
49
Is the tolerance of a synthetic opioid like Fentanyl faster or slower?
Faster (3-5 days) vs. MsO4 (2 wks) or Heroin (2 wks)
50
Clearance of Fentanyl may be impaired with what?
Decreased Liver blood flow or function
51
What agent may be the preferred agent for: Critically ill pt w/hemodynamic instability; Symptoms of Histamine release w/Morphine administration; or pts with Morphine tolerance?
Fentanyl
52
Name the Benzodiazepine most often used in NICU
Midazolam (Versed)
53
Is a Benzodiazepine an Analgesic?
No
54
What does a Benzodiazepine do?
Sedation, Anxiolysis, Hypnosis, and Amnesia
55
Do Benzodiazepines cross the BBB rapidly?
Yes, accounting for rapid onset of action
56
Can Benzodiazepines cause respiratory depression?
Yes, especially when administered rapidly
57
Besides respiratory depression, what else can Benzodiazepines cause?
Hypotension | Seizure-like myoclonus (in premature infants w/continuous infusions)
58
What medication is widely used for management of pain and fever, but lacks anti-inflammatory effects?
Acetaminophen
59
When is Acetaminophen used?
Mild discomfort | 1st immunizations & 24 hours past
60
NSAID's have what effects?
Antipyretic, Analgesic, Anti-inflammatory
61
What side effect do NSAID's have? Is it reversible?
Interfere w/Platelet aggregation Yes, it's reversible
62
When can non-pharmacologic interventions be used?
Any time appropriate
63
What are the non-pharmacologic interventions for pain?
``` Sucrose NNS Sucrose + NNS KC Facilitated tucking Music Therapy Breastmilk Breastfeeding Multi-sensorial stimulation ```

Neonatal Pharmacology (17 decks)

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