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Neonatal Pharmacology > Analgesics > Flashcards

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
Q

What might Naloxone be used for?

What is Naloxone NOT used for?
If necessary in the DR, what must be restored 1st?

A

Narcotic induced Respiratory Depression

In the DR for initial Respiratory Depression
Restore Proper HR and Ventilation

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26
Q

What is the most common Opioid used in NICU?

A

Morphine

27
Q

Morphine is soluble in _____ but has poor ______ solubility

A

Water

Lipid

28
Q

Morphine metabolites are cleared by the ________ and partly by _____ ________

A

Kidneys

Biliary Excretion

29
Q

Is there a difference in Analgestic effect between continuous and intermittent Morphine dosing?

A

No

30
Q

What can happen in infants with impaired Renal function receiving Morphine?

A

Accumulation of Morphine

31
Q

How is Morphine mainly administered for Analgesia?

A

IV
Can be used IM (but is painful)
Rectal-exists but wide variability

32
Q

Morphine clearance improves with?

A

Postconceptual Age

33
Q

What 3 signs are A/W the Histamine response from Morphine administration?

A

Hypotension, Bradycardia, & Flushing

34
Q

The Histamine response from Morphine is a/w?

A

Rapid Administration

35
Q

Morphine may have effects on b/p but are probably dependent on ______ & _______ ___.

A

Dosing

Gestational Age

36
Q

What is the Peak of Morphine?

A

45-90 minutes

37
Q

What is the Duration of Morphine

A

4-5 hours

38
Q

Methadone is a synthetic Opioid with an analgesic potency similar to ______.

A

Morphine

39
Q

What medication is Widely used for the tx of Opioid withdrawal in Neonates?

A

Methadone

40
Q

Methadone has a Slower/more Rapid distrubution and a more Rapid/Slower elimination than Morphine.

A

More rapid Distribution

Slower elimination

41
Q

What medication is used in addicted adults to avoid withdrawl?

A

Methadone

42
Q

What medication has a propensity toward muscle rigidity?

A

Fentanyl

43
Q

Fentanyl has ___ - ____ fold potency of Morphine

A

50-100 fold

44
Q

There is a Narrow/Wide margin of safety with Fentanyl

A

Wide

45
Q

What is the onset of Fentanyl?

A

3-4 minutes

46
Q

What is the Duration of action of Fentanyl?

A

30 minutes

47
Q

Fentanyl is metabolized by _______

A

Liver

48
Q

What makes Fentanyl a good choice for precedural pain?

A

It has a shorter duration (30 minutes)-probably due to increased lipid solubility & molecular confirmation enabling efficient penetration of the BBB

49
Q

Is the tolerance of a synthetic opioid like Fentanyl faster or slower?

A

Faster (3-5 days) vs. MsO4 (2 wks) or Heroin (2 wks)

50
Q

Clearance of Fentanyl may be impaired with what?

A

Decreased Liver blood flow or function

51
Q

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?

A

Fentanyl

52
Q

Name the Benzodiazepine most often used in NICU

A

Midazolam (Versed)

53
Q

Is a Benzodiazepine an Analgesic?

A

No

54
Q

What does a Benzodiazepine do?

A

Sedation, Anxiolysis, Hypnosis, and Amnesia

55
Q

Do Benzodiazepines cross the BBB rapidly?

A

Yes, accounting for rapid onset of action

56
Q

Can Benzodiazepines cause respiratory depression?

A

Yes, especially when administered rapidly

57
Q

Besides respiratory depression, what else can Benzodiazepines cause?

A

Hypotension

Seizure-like myoclonus (in premature infants w/continuous infusions)

58
Q

What medication is widely used for management of pain and fever, but lacks anti-inflammatory effects?

A

Acetaminophen

59
Q

When is Acetaminophen used?

A

Mild discomfort

1st immunizations & 24 hours past

60
Q

NSAID’s have what effects?

A

Antipyretic, Analgesic, Anti-inflammatory

61
Q

What side effect do NSAID’s have?

Is it reversible?

A

Interfere w/Platelet aggregation

Yes, it’s reversible

62
Q

When can non-pharmacologic interventions be used?

A

Any time appropriate

63
Q

What are the non-pharmacologic interventions for pain?

A 
Sucrose
NNS
Sucrose + NNS
KC
Facilitated tucking
Music Therapy
Breastmilk
Breastfeeding
Multi-sensorial stimulation

Neonatal Pharmacology (17 decks)

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