Analgesics/Sedatives/Anticonvulsive Drugs Flashcards
Funtanyl Citrate (Sublimaze) Class
Opiod analgesic ; schedule II drug
Funtanyl Citrate (Sublimaze) Mechanism of Action
Binds to opiate receptors, producing analgesia and euphoria.
Funtanyl Citrate (Sublimaze) Indications
Pain management, anesthesia adjunct
Funtanyl Citrate (Sublimaze) Contraindications
Known hypersensitivity. Use with caution in traumatic brain injury.
Funtanyl Citrate (Sublimaze) Adverse Reactions/ Side effects
Confusion, paradoxical excitation, delirium, drowsiness, CNS depression, sedation, respiratory depression, apnea, dyspnea, dysrhythmias, bradycardia, tachycardia, hypotension, syncope, nausea, vomiting, abdominal pain, dehydration, fatigue
Funtanyl Citrate (Sublimaze) Drug Interactions
Increased respiratory effects when given with other CNS depressants.
Funtanyl Citrate (Sublimaze) Adult Dosage and administration
50 to 100 mcg(1mcg/kg) IM and IV slow push (over 1 to 2 minutes) to a maximum of 150mcg. IN is rapid push.
Funtanyl Citrate (Sublimaze) Pediatric Dosage and administration
1 to 2 mcg/kg IM, IV, or IN slow push(over 1 to 2 minutes) . The safety in children under 2 years has not been established.
Funtanyl Citrate (Sublimaze) Duration of action
onset: 1 to 3 minutes
peak: 3 to 5 minutes
duration: 30 to 60
Funtanyl Citrate (Sublimaze) pregnancy class
C
Funtanyl Citrate (Sublimaze) special considerations
Chest wall rigidity passible with a high dose rapid infusion. A dose of 100mcg of fentanyl citrate is equivalent to 10mg of morphine or 75mg of meperidine.
Ketorolac Tromethamine(Toradol) class
NSAID analgesic
Ketorolac Tromethamine(Toradol) Mechanism of action
Potent analgesic that does not possess any sedative or anxiolytic activities by inhibiting prostaglandin synthesis
Ketorolac Tromethamine(Toradol) Indications
Short term management of moderate to severe pain.
Ketorolac Tromethamine(Toradol) Contraindications
Allergy to salicylates or other NSAIDs. Patients with a history of asthma, bleeding disorders(especially GI related, such as peptic ulcer disease), renal failure.
Ketorolac Tromethamine(Toradol) Adverse reactions/ Side effects
Drowsiness, dizziness, headache, sedation, bronchospasm, dyspnea, edema, vasodilation, hypotension, hypertension, GI bleeding, diarrhea, dyspepsia, nausea.
Ketorolac Tromethamine(Toradol) Drug Interactions
May increase bleeding time in patients taking anticoagulants.
Ketorolac Tromethamine(Toradol) Adult Dosage and Administration
30 to 60 mg IM, 15 to 30mg IV
Ketorolac Tromethamine(Toradol) Pediatric Dosage and Administration
Not recommended
Ketorolac Tromethamine(Toradol) Duration of Action
onset: 10 min
peak: 1 to 2 hours
duration 2 to 6 hours.
Ketorolac Tromethamine(Toradol) pregnancy safety category
C
Ketorolac Tromethamine(Toradol) Special Considerations
Use with caution in older patients due to higher risk of renal and fatal GI adverse reactions. Because it is a salicylate derivative, it is important to use caution if pain is possibly from a traumatic source.
Morphine Sulfate (Roxanol, MS Contin) Class
Opiod analgesic; schedule II drug
Morphine Sulfate (Roxanol, MS Contin) Mechanism of Action
Alleviates pain through CNS action. Suppresses fear and anxiety centers in the brain. Suppresses fear and anxiety centers in the brain. Depresses brain stem respiratory centers. Increases peripheral venous capacitance and decreases preload and after load, which decreases mycardial oxygen demand.
Morphine Sulfate (Roxanol, MS Contin) Indications
Severe heart failure, acute cardiogenic pulmonary edema, chest pain associated with AMI, analgesia for moderate to severe acute and chronic pain.
Morphine Sulfate (Roxanol, MS Contin) Contraindications
Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased level of consciousness, suspected hypovolemia, patients who have taken MAOIs within 14 days.
Morphine Sulfate (Roxanol, MS Contin) Adverse reactions/ Side effects
Confusion, sedation, headache, CNS depression, respiratory depression, apnea, bronchospasm, dyspnea, hypotension, orthostatic hypotension, syncope, bradycardia, tachycardia, nausea, vomiting, dry mouth.
Morphine Sulfate (Roxanol, MS Contin) Drug Interactions
Potentiates sedative effects of phenothiazines. CNS depressants may potentiate effects of morphine. MAOIs may cause paradoxical excitation.
Morphine Sulfate (Roxanol, MS Contin) Adult Dosage and Administration
STEMI: Initial dose of 2 to 4 mg slow IV (over 1 to 5 mins). Repeat Dose: 2 to 8 mg at 5 to 15 min intervals.
NSTEMI/unstable angina: 1 to 5 mg IV push if symptoms not relieved by nitrates, use with caution.
Morphine Sulfate (Roxanol, MS Contin) Pediatric Dosage and administration
0.1 to 0.2 mg/kg per dose IV,IO,IM, subcutaneous. Max of 5mg
Morphine Sulfate (Roxanol, MS Contin) Duration of Action
onset: immediate
peak effect: 20min
duration: 2 to 7 hours
Morphine Sulfate (Roxanol, MS Contin) Pregnancy safety category
C
Morphine Sulfate (Roxanol, MS Contin) special considerations
Use caution weighing risks and benefits during pregnancy. Use cautiously in breastfeeding women. Morphine rapidly crosses the placenta. Safety in neonates has not been established. Use with caution in older patients, those with asthma, and in those susceptible to CNS depression. Vagotonic effect in patients with acute inferior MI (bradycardia, heart block). Naloxone hydrochloride(Narcan) should be readily available as an antidote.
Nitrous Oxide 50:50(Nitronox) Class
Gaseous analgesic and anesthetic
Nitrous Oxide 50:50(Nitronox) Mechanism of action
Exact mechanism unknown; affects CNS phospholipids
Nitrous Oxide 50:50(Nitronox) Indications
Moderate to severe pain, anxiety, apprehension.
Nitrous Oxide 50:50(Nitronox) Contraindications
Impaired level of consciousness, head injury, inability to follow or comply with instructions, decompression sickness (nitrogen narcosis, air embolism, and air transport), undiagnosed abdominal pain or marked distention, bowel obstruction, hypotension, shock, COPD, cyanosis, chest trauma with pneumothorax.
Nitrous Oxide 50:50(Nitronox) Adverse Reactions/Side Effects
Light - Headedness, drowsiness, respiratory depression, apnea, nausea, vomiting, malignant hyperthermia.
Nitrous Oxide 50:50(Nitronox) Drug interactions
None of significance
Nitrous Oxide 50:50(Nitronox) Adult Dosage and Administration
Instruct the patient to injale deply through demand valve and mask or mouthpiece.
Nitrous Oxide 50:50(Nitronox) Pediatric Dosage and Administration
Same as adult
Nitrous Oxide 50:50(Nitronox) Duration of action
onset: 2 to 5 min
peak: variable
duration: 2 to 5 min
Nitrous Oxide 50:50(Nitronox) Pregnancy Safety Category
C
Nitrous Oxide 50:50(Nitronox) Special Considerations
Nitrous oxide increases the incidence of spontaneous abortion. Ventilate patient care area during use. Nitrous oxide is nonflammable and nonexplosive. Nitrous oxide is ineffective in 20% of the population.
Tetracaine Class
Local anesthetic
Tetracaine Actions
causes a reversible blockade of nerve conduction by decreasing nerve membrane permeability to sodium
Tetracaine Indications
Used to numb the eye before surgery, certain tests, or procedures
Tetracaine Contraindications
Hypersensitivity
Tetracaine Side effects
Blurred vision, sensitivity to light, severe stinging in the eye, tearing, throbbing eye pain.
Tetracaine Dosage
1 to 2 drops in the eye every 5 to 10 minutes for 1 to 3 instillations
Tetracaine route
eye drops
Tetracaine how supplied
0.5% sterile eye drops in 15 ml dispensers
Tetracaine Pediatric dosage
1 to 2 drops in the eye every 5 to 10 minutes for 1 to 3 instillations
Tetracaine onset/ duration
30 secs, 10 - 15 mins
Diazepam(valium and others) Class
Benzodiazepine, long acting; sedative hypnotic; anticonvulsant; schedule IV drug
Diazepam(valium and others) Mechanism of action
Potentiates effects of inhibitory neurotransmitters. Raises the seizure threshhold. Induces amnesia and sedation.
Diazepam(valium and others) Indications
Acute anxiety states and agitation, acute alcohol withdrawal, muscle relaxant, seizure activity, sedation for medical procedures(intubation, ventilated patients, cardioversion), chemical restraint, may be helpful in acute symptomatic cocaine overdose.
Diazepam(valium and others) Contraindications
Hypersensitivity, narrow angle glaucoma, myasthenia gravis, respiratory depression, coma, head injury.
Diazepam(valium and others) Adverse reactions/side effects
Dizziness, drowsiness, confusion, headache, respiratory depression, hypotension, reflex tachycarida, nausea, vomiting, muscle weakness, tissue necrosis, ataxia, thrombosis, phlebitis.
Diazepam(valium and others) Adult Dosage and administration
Seizure activity: 5mg IV over 5 minutes or 10 mg IM.
Anxiety: 2 to 10 mg IM/IV. Premedication for cardioversion: 5 to 15mg IV over 5 to 10 min prior to cardioversion
Diazepam(valium and others) Pediatric Dosage and Administration
Seizure activity: 0.05 to 0.1 mg/kg slow IV or 0.1 to 2 mg/kg IM
Diazepam(valium and others) Duration of Action
onset: 2 to 5 minutes IV; 15 to 30 minutes IM.
peak: 15 to 30 minutes
duration: 20 to 50 mins
Diazepam(valium and others) Pregnancy safety category
D
Diazepam(valium and others) special considerations
Contraindicated in pregnancy especially during the first trimester. Rectal administration of anticonvulsants is no longer recommended.
Lorazepam(Ativan) Class
Benzodiazepine, short/intermediate acting; sedative, anticonvulsant; schedule IV drug
Lorazepam(Ativan) Mechanism of Action
Anxiolytic, anticonvulsant, and sedative effect; suppresses propagation of seizure activity produced by foci in cortex, thalamus, and limbic areas
Lorazepam(Ativan) Indications
Initial control of status epilepticus or severe recurrent seizures, severe anxiety, sedation, chemical restraint.
Lorazepam(Ativan) Contraindications
Acute narrow angle glaucoma, coma, shock, suspected drug abuse
Lorazepam(Ativan) Adverse reactions/side effects
Dizziness, drowsiness, CNS depression, headache, sedation, respiratory depression, apnea, hypotension, bradycardia.
Lorazepam(Ativan) Drug interactions
May precipitate CNS depressant medications
Lorazepam(Ativan) Adult Dosage and Administration
When given IV it must be diluted with an equal volume of sterile water or sterile saline. When given IM, Lorazepam is not diluted. Anxiety/sedation: 2mg IV; 4mg IM. Seizures: 0.1 mg/kg IV, max of 4mg.
Lorazepam(Ativan) Pediatric Dosage and Administration
0.05 mg/kg IV or IM
Lorazepam(Ativan) Duration of Action
onset: 2 to 5 min IV; 15 to 30 min IM
peak: Variable
duration: 6 to 8 hours
Lorazepam(Ativan) pregnancy safety category
D
Lorazepam(Ativan) special considerations
Monitor respiratory rate and BP during administration. Have advanced airway equipment readily available. Inadvertent arterial injection may result in vasospasm and gangrene. lorazepam expires in 6 weeks when not refrigerated.
