Medications for Pain Management

Question 1

fentanyl citrate (Sublimaze)

Answer 1

A NARCOTIC ANALGESIC, schedule II, that binds to opiate receptors producing analgesia and euphoria.

Question 2

fentanyl citrate (Sublimaze) Indications

Answer 2

Treatment of hemodynamically STABLE patients with moderate to severe pain due to traumatic or medical conditions.

Question 3

fentanyl citrate (Sublimaze) Contraindications

Answer 3

Hemodynamic instability
Shock
Respiratory Depression

Question 4

fentanyl citrate (Sublimaze) Dosage and Administration

Answer 4

1-2 mcg/kg. May be repeated after 5 minutes and titrated to clinical effect to a max dose of 300 mcg.

Intranasal: 1-2 mcg/kg. May be repeated after 5 minutes for a max dose of 300 mcg.
IV route is preferred for repeat dosing.
Additional analgesia requires base contact.

Question 5

fentanyl citrate (Sublimaze) Pediatric Dosage and Administration

Answer 5

1-2 mcg/kg. May be repeated after 5 minutes and titrated to clinical effect. Max dose of 3 mcg/kg.
Additional dosing : Contact Base.

Intranasal: 2 mcg/kg. May be repeated after 10 minutes to a max dose of 4 mcg/kg.

Question 6

fentanyl citrate (Sublimaze) Special Considerations

Answer 6

Do not administer more than 1 mL per nostril.
100 times more potent than morphine and is less likely to cause a histamine response.
The goal is to make the pain tolerable enough to allow for adequate assessment, treatment, and transportation.
Respiratory depression, including apnea, may occur suddenly without warning. Start with half the traditional dose in children or the elderly.
Chest wall rigidity has been reported with rapid administration of fentanyl.

Pregnancy Class C.

Question 7

ketamine (Ketalar)

Answer 7

A general anesthetic, ANALGESIC, and sedative that is a non-competitive NMDA receptor antagonist and dissociative.

Onset - 1-5 minutes after IM administration.
Duration - 10-15 minutes

Question 8

ketamine (Ketalar) Indications

Answer 8

If fentanyl is contraindicated
Opiate dependence in acute pain

NOT TO BE USED FOR SEDATION.

Question 9

ketamine (Ketalar) Contraindications

Answer 9

Known allergy
Relative contraindication in patients with known cardiovascular disease because it can cause tachycardia.
Altered mental status
Kids less than 18 and adults over 65.
Known history of severe behavioral disorder.

Question 10

ketamine (Ketalar) Dosage and Administration

Answer 10

0.3 mg/kg IV in 50 mL of D5W or NS over 5 minutes - typically 20-30 mg

0.5 mg/kg IM/IN - typically 30-50 mg

The typical duration of action is 20 minutes. May repeat after 20 minutes for a total of 2 doses.
Contact base for additional analgesia.

Question 11

ketamine (Ketalar) Special Considerations

Answer 11

May provoke hyper-salivation, typically controlled by suctioning (not usually seen at the analgesic dose).
May cause hallucinations, euphoria, and dysphoria.
Potential increase in heart rate and blood pressure.

Question 12

Topical Ophthalmic Anestehetics

Answer 12

proparacaine and tetracaine are local anesthetics approved for ocular administration for relief of eye pain caused by corneal abrasion or chemical injury.

Indications: Pain secondary to eye injuries and corneal abrasions.
Topical anesthetic to facilitate eye irrigation.

Contraindications: Known allergies to local anesthetics and globe lacerations or rupture.

Precautions: Transient burning/stinging when initially applied.

Dosage and administration: 2 drops into the affected eye. Contact base for repeat dosing.

Special considerations:
Transient burning/ stinging when initially applied.
Single patient use. Unused portions should be discarded, only new bottles may be used.
Do not administer until patient consents to transport and transport has begun - TRANSPORT IS REQUIRED.
Topical ophthalmic anesthetics should never be given to a patient for self-administration.

Question 13

ketorolac (Toradol)

Answer 13

An NSAID that inhibits the production of prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors.

Question 14

ketorolac (Toradol) Indications

Answer 14

Moderately severe acute pain.

Question 15

ketorolac (Toradol) Adverse Effects

Answer 15

Headache
Drowsiness
Dizziness
Abdominal Pain
Dyspepsia
Nausea/vomiting
Diarrhea

Question 16

ketorolac (Toradol) Contraindications

Answer 16

Pregnancy or breast feeding
History of GI bleeding or active stomach ulcer.
History of chronic kidney disease or transplant.
Anticoagulation/Antiplatelet (blood thinners) or history of a blood clotting disorder.
Multisystem Trauma.
Acute head trauma or suspected intracranial bleed.
Patients less than 12 years old and over 65 years old.
Severe dehydration.

Pregnancy class C; class D during thrid trimester.

Question 17

ketorolac (Toradol) Dosage and Administration

Answer 17

15 mg IV or IM

Not indicated for pediatrics.

Question 18

morphine sulfate

Answer 18

An OPIATE AGONIST, schedule C-II, that binds with opioid receptors. Reduces simulation of the sympathetic nervous system caused by pain and anxiety.

Question 19

morphine sulfate Indications

Answer 19

Treatment of hemodynamically STABLE patients with moderate to severe pain due to traumatic or medical conditions.

Question 20

morphine sulfate Contraindications

Answer 20

Hypotension
Hemodynamic instability
Shock

Question 21

morphine sulfate Dosage and Administration

Answer 21

Adult: 5-10 mg IV/IM. Dose may be repeated after 10 minutes and titrated to clinical effect. Max dose of 10 mg. Additional dosing requires base contact.

Pediatric: 0.1 mg/kg. Max single dose of 6 mg. The dose may be repeated after 10 minutes and titrated to clinical effect up to max cumulative dose of 0.2 mg/kg or 10 mg.
Less than 1 year = Contact base.

Question 22

morphine sulfate Special Considerations

Answer 22

Should not be given IN, as it is poorly absorbed.
Should only be given to hemodynamically stable patients and titrated slowly to effect.
The goal is to make the patient’s pain tolerable enough to allow for adequate assessment, treatment, and transport.
Respiratory depression, including apnea, may occur suddenly without warning and is more common in children and the elderly. Start with half the traditional dose in children and the elderly.
Coadministration of opioids and benzodiazepines is discouraged and may only be done with a direct physician verbal order.

Pregnancy Class C.