IP/PP pain-pharm

Question 1

Difference between analgesia and anesthesia?

Answer 1

Analgesia-lessens pain

Anesthesia-blocks all sensation (usually c-section)

Question 2

T or F: epidural is analgesia, not anesthesia

Answer 2

F-it can be both

Question 3

Commonly used sedatives/hypnotic for pain management (may be used with opioids)

Answer 3

Promethazine (Phenergan)
Antihistamines-vistaril or benadryl
Anticholinergic/antiemetic
Compazine-dopamine receptor antagonist

Question 4

Dose, onset, and duration for Phenergan/promethazine?

Answer 4

25-75mg IV/IM
O: 10-20mins
D: 3-4 h

Question 5

Dose, route, onset and duration of Vistaril/hydroxzine (antihistamine)

Answer 5

25-50mg IM
O: 30mins
D: 4h

Question 6

Dose, route, onset and duration of Diphenhydramine (benedryl)-antihistamine

Answer 6

10-50mg IV
O: 5-10mins
D: 6-8h

Question 7

Dose, route, onset and duration of Prochlorperazine (Compazine) -dopamine receptor antagonist

Answer 7

5-10mg IV/IM
5-10min
3-4h

Question 8

Common opioids used in labor

Answer 8

Stadol/Butorphanol-IV/IM: 1-2mg q3-4h
Fentanyl/Sublimaze-IV/IM: 50-100mcg/h
Demerol/Meperidine: IV: 25-50mg q1-2h; IM: 50-100mg q2-4h
Morphine: IV: 2-5mg IM: 10mg q4h
Nubaine: IV/IM: 10mg q3h
Remifentanil: PCA admin

Question 9

How does labor pain travel?

Answer 9

T10-L1, via visceral afferent (sympathetic) nerves

Question 10

Primary MOA of opioids during labor

Answer 10

Sedation

Question 11

Most opioids have this significant side effect(s)

Answer 11

• prolonged gastric emptying

- N/V

Question 12

Meperidine (Demerol) dosage & route

Answer 12

25-50mg IV (better to have later in labor due to active metabolite)
Or PCA 15mg q15 mins

Question 13

Dose and route of Nalbuphine (Nubian)

Answer 13

5-10mg IV q3h

Question 14

Dose and route if Fentanyl

Answer 14

50-100mcg IV q1h (short duration of action)

Question 15

Which opioid(s) provide a ceiling effect on respiratory depression?

Answer 15

Nalbuphine (Nubian)

Question 16

Route and dose of Remifentanil

Answer 16

0.5mcg/kg q2-3 mins (very short 1/2 life)

Question 17

How to treat hypotension in labor?

Answer 17

Turn to side (uterine perfusion) 
IV bolus
Vaspressors
-phenylephrine (decreases poor cord gases and N/V)
-ephedrine

Question 18

Pain management options for mild-moderate pain in the PP period

Answer 18

Acetaminophen (Tylenol) q6h
Ibuprofen (Motril, Advil) q6h
Naproxen (Aleve) q4h
Keteroloac (Toradol) q 4-6h

Question 19

T or F: Tylenol has a ceiling effect

Answer 19

False, NSAIDs have a ceiling effect

Question 20

Dosing regimens for Acetaminophen (Tylenol)

Answer 20

325, 500, 650, 1000 mg Q6h (Max 4g/d)

Question 21

Dosing regimens for Ibuprofen

Answer 21

200, 400, 600 mg Q6h (Max=3200mg/d)

Question 22

Dosing regimens and route considerations for Ketorolac (Toradol)

Answer 22

First dose should be IV or IM
IV/IM: 15, 30, 60 mg q6h (Max=120 mg)
PO: 20 mg, followed by 10 mg q4-6hr (Max=40 mg)

Question 23

Pain management options for moderate to severe pain in the PP period.

Answer 23

Codeine, Morphine, or Tramadol (Ultram) options:

codeine No. 3, Norco, Vicodin, Vicodin ES, Morphine, Percocet, Dilaudid, Morphine

Question 24

Dosing regimens for Naproxen (Aleve)

Answer 24

250, 375, 500, 800 mg Q4h (max=1500 mg)

Question 25

Dosing regimens for Tramadol (Ultram)

Answer 25

50-100 mg Q4-6h

Question 26

Dosing regimens for codeine No. 2, 3, & 4

Answer 26

Codeine No. 2, 3, 4: 15, 30, 60mg (respectively) Codeine + 300mg Tylenol Q4-6h

Question 27

Dosing regimens for Norco, Vicodin, and Vicodin E.S.

Answer 27

Norco: Hydrocodone 5, 7.5, or 10 mg + 325 mg Tylenol
Vicodin: Hydrocodone 5 mg + 300 mg Tylenol
Vicodin E.S: Hydrocodone 7.5 mg + 300 mg Tyelnol

Question 28

What is in Percocet?

Answer 28

Oxycodone + Tylenol