Pain

Question 2

What is the dose of IV fentanyl given to pediatrics?
What is the dosage interval?
What concentration is given?
What is the total max dose?

Answer 2

Dose: 0.5 microg/kg to single max 25 microg
Interval: 5min
Concentration: 100microg / 10ml (100microg / 2ml mixed with 2ml saline)
Total max dose: 2 microg/kg

Question 3

When is consultation required for administering fentanyl?

Answer 3

Consultation required for
* IV fentanyl: pts < 6yrs
* IN fentanyl: for pts < 1yr

Question 4

In giving IN fentanyl, when should the 450microg/1.5ml formulation be used?
When should 100microg/2ml be used?

Answer 4

The 100microg/2ml formulation should be used where less than 30 microg of fentanyl is being given. i.e. patients less than 20kg (approx 5yrs).

Question 5

What is the dose of IN fentanyl given to pediatrics?
Dosage interval?
Max dose?

Answer 5

1.5microg/kg
Interval 5min
Max dose 4.5microg/kg

Question 6

What is the dose of of IN fentanyl given to adults?
What is the dosage interval?
What is the max dose?

Answer 6

180microg, repeat prn every 5min, max dose 400microg

Question 7

What are the indications for fentanyl?
What is the IV dose for adults?
What is the max dose?

Answer 7

Indications:
* Moderate to severe pain
* Chest pain

IV dose 25-50microg (slow push over 1min)

Max dose
* Moderate to severe pain: Max 300microg in 1st hour and 100microg every subsequent hour
* Chest pain: Total max dose not to exceed 300microg

Question 8

What are the indications for ibuprofin?
What are the contraindications?
What is the age restriction?

Answer 8

Indicated for pain management as part of a multimodal approach

Contraindications
* Chronic kidney disease
* Active peptic ulcer disease
* GI bleeding
* Congestive cardiac failure (CCF)
* Hx of MI
* Presenting with acute coronary syndrome (ACS)
* Pregnancy
* Hypoperfused state
* Ibuprofin use within 6hrs

Not to be used in infants < 3mo

Question 9

What are the precautions for ibuprofin?

Answer 9

Cardiovascular disease
Pre-existing renal disease including nephrectomy
Concurrent use of ACEi/ARB and diuretics
Dehydration
Age ≥ 65

Question 10

What are the common adverse effects of ibuprofin?

Answer 10

• Nausea
• Dyspepsia
• GI ulceration or bleeding
• Increased risk of bleeding

Bronchospasm and rash are less common adverse effects and may be associated with NSAID allergy

Question 11

What is the pediatric dose for ibuprofin?
What is the presentation / concentration of pediatric ibuprofin?

Answer 11

Pediatric dose is 10mg/kg
Presentation is 100mg/5ml -> 20mg/ml

Question 12

What are the indications and contraindications for ketorolac?

Answer 12

Used as part of multimodal approach in pain management
Contraindications
Chronic kidney disease
Active peptic ulcer disease
GI bleeding
Congestive cardiac failure (CCF)
Hx of MI
ACS
Pregnancy
Hypoperfused state
Age < 16 (not for use in pediatrics)

Question 13

What is presentation of ketorolac?
What are the administration routes?
What is the dose?
Repeat dose?

Answer 13

Presentation 10mg/1ml
Can be given IM or IV
IM: 10mg/1ml. IV 10mg/10ml (diluted with saline)
No repeat dose.

Question 14

What are the indications for morphine?

Answer 14

• Uncontrolled pain, and
• Chest pain
  if first line agents ineffective or unsuitable

Question 15

When is consultation required for morphine?

Answer 15

Consult required for all paediatrics

Consult required when exceeding daily limit of 30mg for adult palliative care patients

Question 16

Which patient groups are more likely to develop respiratory depression from morphine?

Answer 16

Elderly and/or patients with diminished renal function are more likely to develop respiratory depression

Question 17

Which patient groups are more sensitive to opioid induced CNS depression from morphine?

Answer 17

Elderly patients and children < 1 yr are significantly more sensitive to opioid-induced CNS depression

Question 18

What is the time of onset and duration of IV morphine?

Answer 18

Onset 5-15min
Duration 1-2hr

Question 19

What are the adverse effects of morphine?

Answer 19

Notable adverse effects include:
* dose-related respiratory depression
* euphoria / dysphoria
* delirium / hallucinations
* urticaria
* orthostatic hypotension

Question 20

What is the dose for morphine? Dosage interval?
Max dose?

Answer 20

Dose 2.5-5mg IV
Interval: repeat prn at 5min intervals (but consider that time to peak effect is approx 15min)
Max dose 30mg