Opioids

Question 1

What controlled drugs can a midwife prescribe?

Answer 1

Fentanyl, morphine and pethidine

Question 2

When can midwives prescribe an opioid?

Answer 2

For intrapartum use only (active labour). Otherwise doctor prescribed

Question 3

What is the dosing regime of pethidine?

Answer 3

IM 100mg (max dose)
IV 12.5 - 25mg (increment doses)

Question 4

What are the fetal side effects of pethidine?

Answer 4

Reduced FHR variability, reduce neonatal respiratory depressed if within 4 - 5 hours of birth, increased BF depression on day 3 - 4

Question 5

Contraindications for pethidine use?

Answer 5

Within 4 hours of delivering, respiratory depression, PET, low platelet count, head injury

Question 6

What are the maternal side effects of pethidine?

Answer 6

Hypotension, respiratory changes, prolonged labour, reduced frequency of contractions

Question 7

Can pethidine and entonox be used together?

Answer 7

Cautiously

Question 8

What is the preferred opioid in labour and why?

Answer 8

Morphine due to reduced respiratory impact on foetus

Question 9

Contraindications to morphine?

Answer 9

Asthma or impaired ventilation, epidural to be site imminently

Question 10

What is the dosing regime of IM morphine?

Answer 10

10 mg (max dose). Repeated dose = consult with obstetrics

Question 11

What is the dosing regime of IV morphine?

Answer 11

2mg increments every 3 minutes to a max of 10mg. Dilute 10mg ampule in 10ml sodium chloride (20ml total)

Question 12

Side effects of morphine?

Answer 12

Reduced FHR variability, euphoria, nausea and vomiting, neonate respiratory depression, rash

Question 13

If using an opioid and antiemetic together, which should you draw up first?

Answer 13

The opioid to ensure exact dose

Question 14

Which opioid should not be used with entonox?

Answer 14

Fentanyl

Question 15

What is the dosing regime of fentanyl?

Answer 15

50 - 100mcg (max dose) Give in IV bolus doses

Question 16

Side effects of fentanyl?

Answer 16

Respiratory depression, apnoea, hypoxia, reduced FHR variability, neonatal respiratory depression

Question 17

How do you mix fentanyl for dosing?

Answer 17

Dilute 100mcg of fentanyl in up to 10ml of sodium chloride 0.9% water for injection creating dose strength of 10mcg per 1 ml

Question 18

With which opioid should you monitor maternal observations closely and how often?

Answer 18

With fentanyl. Maternal 02 sats during administration, and 1 hour post. All obs five minutely within the first 30 minutes

Question 19

What medication is used to reverse the effects of an opioid?

Answer 19

Naloxone

Question 20

How is the dose for naloxone calculated?

Answer 20

By weight

Question 21

What does NZCOM (2014) consensus statement on prescribing and administration of opioid analgesia in labour state?

Answer 21

Providing continuous support in the latent phase of labour at home helps to reduce requirements for analgesia and improves outcomes for mother and baby.

Question 22

Changes to which Act and Regulation enable the midwife to complete the required education and prescribe Pethidine, Morphine, and Fentanyl ?

Answer 22

Medicines Amendment Act 2013 and Misuse of Drug Amendment Regulations 2014.