Managing pain and Behavior guidance (Chapter 12) Flashcards
Why are infants and children more sensitive to pain?
Ascending pathways intact allowing full transmission of pain. Descending pathways modulating pathways poorly developed and unable to attenuate pain and do not have cognitive skills to modulate pain.
Theory of pain
descending pathway modify pain gate-activation of large fiber sensory neurons can modify pain perception.
Wong-baker FACES pain scale
Self reported pain w/faces validated for 3+
Visual Analogue pain scale
0-10 pain scale for 6+ on a numerical line.
Observational pain scale (FLACC)
Provider observes face, legs, arms, crying, consolability scale (FLACC) with a 0-2 scale.
Why does sucrose work to help manage pain?
Sucrose has same pathway as opioids; efficacy wanes at 6 months.
Benzocaine as a topical anesthetic
Up to 20%
Ester
Not for age 2 and under
Lidocaine as topical
Amide
5-10%
as ointment, patch or spray
Compound local topical anesthetics
High doses Tetracaine lidocaine benzocaine prilocaine phenylephrine Must consider systemic absorption when calculating total amount of anesthetic dosage administered.
What is the preservative in local anesthetics with epinephrine?
Bisulphate.
Use anesthetic w/o epinephrine for allergies to bisulphate
Articaine is metabolized where?
Liver and plasma.
Lidocaine metabolized by P450 cytochrome enzymes.
Which anesthetic has no epinephrine?
Mepivacaine.
Rule of 25
Can use 1 cartridge of any marked local anesthetic for every 25 pounds of body weight
Where is IAN foramen in children compared to adults?
More inferior and posterior in young children
What is phentolamine mesylate used for and MOA?
Local anesthetic reversal agent. Causes vasodilation by reversible nonselective alpha-adrenergic antagonist moving local anesthetic away from site for metabolism
What are the biphasic clinical manifestation of local anesthetic toxicity.
Initial excitatory reaction: circumoral tingling, dizziness, tinnitus, increased HR and BP
Later depressive reaction: drowsiness, loss of consciousness, seizure, cardiovascular collapse.
Ibuprofen MOA and contraindications
NSAID
First line for pain
Inhibits cyclooxygenase thereby impairing transformation of arachidonic acid to prostaglandins, prostacyclin and thromboxanes
Acetaminophen MOA and contraindications
MOA unknown
Thought to inhibit cyclooxygenase enzyem
Antipyretic inhibits of hypothalamic heat regulating center
Asprin
Not recommended for children
Ibuprofen Doses
4-10mg/kg q 6-8 hours
40mg/kg/day
Acetaminophen doses
10-15mg/kg q 4-6hours
90mg/kg/day, no more than 5 doses per day
Naproxen Doses
5-7mg/kg q 8-12 hours
600mg/24 hours
Is codeine recommended for children
NO
Acetaminophen with hydrocodone doses
0.1-0.2mg/kg/dose of hydrocodone q 4-6 hours
Acetaminophen with oxycodone doses
0.05-0.2mg/kg/dose of oxycodone q 4-6 hours
Naproxen MOA and contraindications
Reversibly inhibits cyclooxygenase-1 and 2,
Not recommended for any under 12
Opioids MOA and contraindications
Hydrocodone, oxycodone
Binds to opioid receptors in CNS causing inhibition of ascending pain pathways
CNS depression
Metabolized by liver cytochrome P450, CYP3A4, CYP2D6
Cytochrome inhibitors increase longevity of drugs in system (macrolide, proton pump inhibitors, SSRI, St. Johns warts, echinacea.
What opioids can be given to patients that are poor/rapid metabolizers for pain management?
Morphine and hydromorphone-are not metabolized by CYP2D6 enzymes.
