Opioid Free ED Flashcards
Why would we have an opioid free ED
To evaluate the feasibility of controlling acute painful conditions without oral and IV opioid narcotics for pain the can otherwise be controlled with non-opioid pain relievers.
Explain the current opioid epidemic and what pharmacists can do to help
Opioid are overprescribed and used more frequently than what is necessary. We can provide education on the safe uses of opioids and recommend other ways for our patients to manage pain without opioid use.
Identify the side effect profile of ketamine, lidocaine, dicyclomine and haloperidol
Ketamine: Dizziness, disorientation, mood changes, nausea
Lidocaine: Periorbital numbness, dizziness, vertigo and dysarthria (inability to control muscles in face, mouth and respiratory system), bradycardia and arrhythmias
Dicyclomine: Dizziness, blurred vision, nausea, dry mouth
Haloperidol: agranulocytosis (ANC < 100)
Identify non-opioid treatments for musculoskeletal pain
IV/IN ketamine, PO APAP, PO ibuprofen, IV/IM ketorolac, IV/PO dexamethasone, lidocaine patch, gabapentin PO, SQ lidocaine
For muscle relaxation: PO cyclobenzaprine or PO/IV diazepam
Identify non-opioid treatments for HA/migraine
PO APAP, PO ibuprofen, IV/IM ketorolac, NS bolus, IV metoclopramide, IV promethazine, IV prochlorperazine, SQ sumatriptan, IM lidocaine, IV DHE, IV magnesium, IV VPA, IV LTM, IV lidocaine, IV dexamethasone, IV haloperidol
If tension type: cyclobenzaprine or diazepam
Identify non-opioid treatments for abdominal pain
IV metoclopramide, IV Benadryl, IV prochloperazine, PO/IM dicyclomine, IV lidocaine, SQ sumatriptan, IV Haldol, IVP ketamine
Identify non-opioid treatments for renal colic (pain caused by kidney stones)
IV ketorolac, IV lidocain, PO APAP, 1 L NS
Explain the mechanism of action for ketamine and lidocaine
Ketamine: A noncompetive antagonist at NMDA receptors. (Blocks glutamate) Low doses produce analgesia and CNS sensitization, hyperalgesia and opioid tolerance. Basically, distracts the patients so they are dissociated from the surrounding environment by direct actions on the cortex and limbic systems.
Lidocaine: Class 1B anti arrhythmic that suppresses automatic conduction in various tissues. It blocks both initiation and conduction of nerve impulses by decreasing neuronal membrane’s permeability to Na ions which inhibits depolarization.
Identify non-opioid treatments for extremity fracture or joint dislocation
Ketamine, APAP, lidocaine
Describe the CERTA based multimodal pharmacologic approach to pain management
Multimodal therapy is using a combination of pharmacologic agents to target multiple receptors known to mediate pain transmission as a means of treating the cut pain episode without using narcs.
Explain how to administer IN/IM naloxone
Intranasal:
Give a few rescue breaths
Pull/pry off the yellow caps
Pry off the red cap
Grip clear plastic wings
Gently screw capsule of naloxone into barrel of syringe
Insert white cone into one nostril. Give a short, vigorous push on end of capsule to spray naloxone into the nose. ½ capsule into each nostril.
If no reaction in 2-5 mins, give the second dose.
Intramuscular:
Few rescue breaths to see if they are breathing
Use 1-1½ inch needle
Pop off orange top of vial
Draw up 1 mL (100 units) into the syringe
Inject straight into a muscle (thigh, butt or deltoid)
Continue rescue breathing for 2-3 minutes and administer another dose if no response in 2-3 minutes
Identify the duration of action of naloxone and when to give another dose if the patient doesn’t respond to initial dose
Naloxone lasts between 30-90 minutes
If no response to nasal in 2-5 mins, give another dose
If no response to IM, give another dose in 2-3 mins
