Medications for Pain Management Flashcards
fentanyl citrate (Sublimaze)
A NARCOTIC ANALGESIC, schedule II, that binds to opiate receptors producing analgesia and euphoria.
fentanyl citrate (Sublimaze) Indications
Treatment of hemodynamically STABLE patients with moderate to severe pain due to traumatic or medical conditions.
fentanyl citrate (Sublimaze) Contraindications
Hemodynamic instability
Shock
Respiratory Depression
fentanyl citrate (Sublimaze) Dosage and Administration
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.
fentanyl citrate (Sublimaze) Pediatric Dosage and Administration
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.
fentanyl citrate (Sublimaze) Special Considerations
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.
ketamine (Ketalar)
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
ketamine (Ketalar) Indications
If fentanyl is contraindicated
Opiate dependence in acute pain
NOT TO BE USED FOR SEDATION.
ketamine (Ketalar) Contraindications
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.
ketamine (Ketalar) Dosage and Administration
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.
ketamine (Ketalar) Special Considerations
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.
Topical Ophthalmic Anestehetics
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.
ketorolac (Toradol)
An NSAID that inhibits the production of prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors.
ketorolac (Toradol) Indications
Moderately severe acute pain.
ketorolac (Toradol) Adverse Effects
Headache
Drowsiness
Dizziness
Abdominal Pain
Dyspepsia
Nausea/vomiting
Diarrhea
ketorolac (Toradol) Contraindications
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.
ketorolac (Toradol) Dosage and Administration
15 mg IV or IM
Not indicated for pediatrics.
morphine sulfate
An OPIATE AGONIST, schedule C-II, that binds with opioid receptors. Reduces simulation of the sympathetic nervous system caused by pain and anxiety.
morphine sulfate Indications
Treatment of hemodynamically STABLE patients with moderate to severe pain due to traumatic or medical conditions.
morphine sulfate Contraindications
Hypotension
Hemodynamic instability
Shock
morphine sulfate Dosage and Administration
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.
morphine sulfate Special Considerations
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.
