Opioids Flashcards
What controlled drugs can a midwife prescribe?
Fentanyl, morphine and pethidine
When can midwives prescribe an opioid?
For intrapartum use only (active labour). Otherwise doctor prescribed
What is the dosing regime of pethidine?
IM 100mg (max dose)
IV 12.5 - 25mg (increment doses)
What are the fetal side effects of pethidine?
Reduced FHR variability, reduce neonatal respiratory depressed if within 4 - 5 hours of birth, increased BF depression on day 3 - 4
Contraindications for pethidine use?
Within 4 hours of delivering, respiratory depression, PET, low platelet count, head injury
What are the maternal side effects of pethidine?
Hypotension, respiratory changes, prolonged labour, reduced frequency of contractions
Can pethidine and entonox be used together?
Cautiously
What is the preferred opioid in labour and why?
Morphine due to reduced respiratory impact on foetus
Contraindications to morphine?
Asthma or impaired ventilation, epidural to be site imminently
What is the dosing regime of IM morphine?
10 mg (max dose). Repeated dose = consult with obstetrics
What is the dosing regime of IV morphine?
2mg increments every 3 minutes to a max of 10mg. Dilute 10mg ampule in 10ml sodium chloride (20ml total)
Side effects of morphine?
Reduced FHR variability, euphoria, nausea and vomiting, neonate respiratory depression, rash
If using an opioid and antiemetic together, which should you draw up first?
The opioid to ensure exact dose
Which opioid should not be used with entonox?
Fentanyl
What is the dosing regime of fentanyl?
50 - 100mcg (max dose) Give in IV bolus doses
Side effects of fentanyl?
Respiratory depression, apnoea, hypoxia, reduced FHR variability, neonatal respiratory depression
How do you mix fentanyl for dosing?
Dilute 100mcg of fentanyl in up to 10ml of sodium chloride 0.9% water for injection creating dose strength of 10mcg per 1 ml
With which opioid should you monitor maternal observations closely and how often?
With fentanyl. Maternal 02 sats during administration, and 1 hour post. All obs five minutely within the first 30 minutes
What medication is used to reverse the effects of an opioid?
Naloxone
How is the dose for naloxone calculated?
By weight
What does NZCOM (2014) consensus statement on prescribing and administration of opioid analgesia in labour state?
Providing continuous support in the latent phase of labour at home helps to reduce requirements for analgesia and improves outcomes for mother and baby.
Changes to which Act and Regulation enable the midwife to complete the required education and prescribe Pethidine, Morphine, and Fentanyl ?
Medicines Amendment Act 2013 and Misuse of Drug Amendment Regulations 2014.
