pain management and sedation Flashcards
morphine sulfate ; morphine
Classification: opioid analgesic, opioid agonist
MOA: binds to opiate receptors in the CNS, altering perception to pain
Pharmacokinetics: Onset Immediate IV, 10-30 min IM, Duration 4-5 hrs
Indications: severe pain, pulmonary edema, pain associated with MI
AR/SE: respiratory depression, hypotension, confusion, sedations, N/V, constipation
Contraindications: known allergy, known hypersensitivity to tartazins, bisulfites, or alcohol
Dosage: Adult: 2-5 mg IV (5-10mg IM) q10 min for desired effect Peds( or adults under 50 kg): 0.01mg/kg IV, SQ, IM may repeat for desired effect, max dose 15 mg.
Special Considerations: (P Class C) Use caution in patients with head trauma, increased ICP.
hydromorphone ; dilaudid
Classification: Opioid analgesic, opioid agonist
MOA: binds to opiate receptors in the CNS, altering perception to pain
Pharmacokinetics: Well absorbed, Onset 10-15 min IV, Duration 2-3 hrs IV
Indications: moderate to severe pain, used alone and in combination with nonopioid analgesics.
AR/SE: respiratory depression, hypotension, confusion, sedation, constipation, physical dependence
Contraindications: Known allergy; should not be used during pregnancy or lactation
Dosage: 1mg IV (2mg IM) initially, may be repeated as needed for desired effect
Special Considerations: (P Class C)Added CNS depression may occur if used with other CNS depressant drugs; avoid use in patient who have received MAOI’s within 14 days.
meperidine ; demerol
Classification: opioid analgesic, opioid angonist
MOA: binds to opiate receptors in the CNS, altering perception to pain
Indications: moderate to severe pain, used as analgesic during labor
AR/SE: respiratory depression, hypotension, bradycardia, seizures, confusion, sedation, constipation, N/V, anaphylaxis
Contraindications: known allergy, pts with recent MAOI therapy
Dosage: 50-100 mg IV
Special Considerations: (P Class C)
fentanyl ; sublimaze
Classification: Opioid analgesic; opioid antagonist
MOA: binds to opiate receptors in the CNS, altering perception to pain
Pharmacokinetics: Absorbs Immediate, Onset 1-2 minutes IV, Duration ½-1 hour IV
Indications: severe pain, maintenance of analgesia
AR/SE: Apnea, Laryngospasm, respiratory depression, bronchospasm, hypotension, physical dependence
Contraindications: known allergy
Dosage: 0.5-1 mcg/kg (Adult over 12); 1-2 mcg/kg (peds under 12)
Special considerations: (P Class C) Added CNS depression may occur if used with other CNS depressant drugs; avoid use in patient who have received MAOI’s within 14 days.
nitrous oxide ; nitronox
Classification: medicinal gas, analgesic
MOA: exact MOA unknown, inhalation of 50% mixture of nitrous oxide and oxygen produces CNS depression and rapid pain relief.
Pharmacokinetics: rapid onset (2 minutes), duration 2-5 min
Indications: moderate to severe pain
AR/SE: lightheadedness, N/V, drowsiness, decreased respirations
Contraindications: known allergy, pts with decreased LOC, thoracic trauma, respiratory compromise, abdominal distention, pts who cannot follow simple instructions
Dosage: Self-administered
Special considerations: do not administer for abdominal pain if intestinal blockage is a possibility, nitrous oxide may collect in the obstructed space and aggravate the obstruction.
ketorolac ; toradol
Classification: NSAID, nonopioid analgesic
MOA: inhibits prostaglandin synthesis producing peripherally mediated analgesia; also has
antipyretic and anti-inflammatory properties
Pharmacokinetics: Rapid absorption, Onset 10 min IV, IM Duration 6+ hours IM, IM
Indications: short term (less than 5 days) management of moderate-severe pain
AR/SE: GI Bleeding, drowsiness, life threatening dermatitis, anaphylaxis
Contraindications: known allergy, cross-sensitivity may exist with other NSAIDS including
ASA; should not be given to patients with know alcohol intolerance; may inhibit labor and increase bleeding at delivery
Dosage: 30mg IV (60 mg IM) every 6 hours. May start with 15 mg IV (30mg IM) for patients over 65 yrs.
Special Considerations: (P Class C)increased risk of hypersensitivity in “aspirin triad patients”. Use with caution in cardiovascular disease, history of GI bleeding, and pts with renal impairment.
ibuprofen ; motrin
Classification: Nonopioid analgesic, NSAID
MOA: Inhibits prostaglandin synthesis, decreasing pain and inflammation
Pharmacokinetics: Well absorbed, Onset within 2 hours, Duration 6 hours
Indications: mild to moderate pain and fever
AR/SE: Rash, GI Bleeding, Hepatitis, Anaphylaxis, constipation, dyspepsia, N/V, headache
Contraindications: Known allergy, active GI bleeding or ulcer disease, risk of anaphylaxis in “aspirin triad patients” (asthma, nasal polyps, ASA intolerance); cross-sensitivity may exist with other NSAIDS including ASA.
Dosage: (Adult) 400-800 mg every 6 hours prn. Do not exceed 3200 mg/day
Special considerations: (P Class C till 30 then D) may limit cardioprotective effects of ASA. May increase the hypoglycemic effects of insulin or oral hypoglycemic agents. Discontinue at first site of rash as it may be life threatening.
acetaminophen ; tylenol
Class: Nonopoid analgesic; antipyretic
MOA: Inhibits synthesis of protstaglandins to reduce pain and fever, does not have significant anti-inflammatory properties
Pharmacokinetics: Well absorbed orally, onset ½-1 hour, duration 3-8 hours
Indications: Mild pain, Fever
AR/SE: Liver Failure and Hepatotoxicity with overdose; renal failure with chronic use
Contraindications: Known hypersensitivity
Dosage: Adult- 325-650 mg PO every 4-6 hours Peds- age and weight based.
Special Considerations: (P Class B)
midazolam ; versed
Classification: benzodiazepine, antianxiety, sedative/hypnotic
MOA: Acts on CNS to produce generalized CNS depression via GABA
Pharmacokinetics: Onset IN 5 min, IM 15 min, IV 1.5-5 min, Duration IN ½-1 hr, IM/IV 2-6 hrs
Indications: seizure activity, anxiety, premedication before painful procedures
AR/SE: Apnea, laryngospasm, respiratory depression, cardiac arrest, phlebitis, hiccups
Contraindications: known allergy, preexisting CNS depression, uncontrolled severe pain or angle-closure glaucoma.
Dosage: 1-2.5mg IV, 5mg IN (for sedation/induction, initial dose of 2-4 mg IV/IO followed by 3-5 mg q 15 min to maintain sedation)
Special considerations: (P Class C) monitor vital signs continuously.
lorazepam ; ativan
Classification: anticonvulsant, antianxiety
MOA: Depresses CNS by potentiating GABA
Pharmacokinetics: Absorbed rapidly, onset 15-30 minutes IV, duration 8-12 hours
Indications: decrease anxiety and seizure activity
AR/SE: Apnea and cardiac arrest (rapid IV), dizziness, drowsiness, lethargy, slurred speech
Contraindications: known allergy, pre-existing CNS depression, uncontrolled severe pain, severe hypotension, angle-closure glaucoma.
Dosage: 1-2 mg IV/IO/IM/IN, may be repeated if necessary but not to exceed 8 mg in 12 hrs.
Special considerations: (P Class D) Flush line before administration if other drugs have been given. Use caution in pts with severe liver, renal, or pulmonary impairment.
ketamine ; ketalar
Classification: Anesthetic; analgesic agent
MOA: blocks afferent transmission of impulses associated with pain perception; causes short-acting amnesia without muscular relaxation
Pharmacokinetics: Well absorbed, onset 30 seconds, duration 10-15 minutes
Indications: sedation, pain control, induction agent for RSI
AR/SE: Apnea, Severe Respiratory depression, hallucinations, explicit dreams
Contraindications: known allergy, hypertensive patients or patients with increased ICP
Dosage: Adult- 1mg/kg over 1 min IV (2-4 mg/kg IM) Peds- 1-2 mg over 1 min IV (3-5 mg/kg IM)
Special considerations: (P Class C) prolonged recover time if used with other opioids or barbituates, monitor vital signs frequently.
etomidate ; amidate
Classification: Sedative/hypnotic
MOA: exact MOA is unknown; believed to enhance GABA neurotransmission.
GABA is an inhibitory neurotransmitter in the CNS.
Pharmacokinetics: Well absorbed IV, Onset 1 minute, Duration 4-15 minutes
Indications: induction of anesthesia; premedication before tracheal intubation or cardioversion
AR/SE: Apnea, N/V, involuntary muscle movement
Contraindications: Known allergy, pts in labor
Dosage: 0.3 mg/kg over 30-60seconds IV
Special considerations: (P Class C) increased risk of apnea if administered with verapamil; monitor vitals constantly
propofol ; diprivan
Class: General Anesthetic
MOA: unknown but produces amnesia, has no analgesic properties
Pharmacokinetics: complete absorption; onset 45 sec; duration 3-5 min
Indications: sedation of intubated & ventilated patients
AR/SE: apnea, bradycardia, hypotension, burning, pain, stinging, long term use can lead to refractory bradycardia then asystole.
Contraindications: known allergy including to soybean oil, egg lecithin, and glycerol
Dosage: 40 mg every 10 seconds until induction achieved, then 100-200 mcg/kg/min for maintenance.
Special Considerations: (P class B)
succinycholine ; anectine
Class: Depolarizing neuromuscular blocker
MOA: prevents muscle from contracting by prolonging time during which the receptors at the neuromuscular junction cannot respond to acetylcholine
Pharmacokinetics: rapid absorption; onset 30-60 sec; duration 2-3 min
Indications: facilitate ET intubation
AR/SE: bradycardia/asystole in pediatric patients, apnea, bradycardia, therapeutic
hyperthermia, hyperkalemia
Contraindications: known allergy, therapeutic hyperthermia pts, acute narrow angle glaucoma or penetrating eye injury.
Dosage: 1.0 mg/kg IV/IO max dose 150 mg
Special Considerations: (P class C) fractures can occur from severe muscle spasms in pediatric pts.
pancuronium ; pavulon
Class: Neuromuscular blocker
MOA: competes with acetylcholine for the receptor sites in the muscle cells, causing paralysis.
Pharmacokinetics: rapid absorption; onset 30-45 sec; duration 30-60 min
Indications: produce muscle relaxation and facilitate ET intubation
AR/SE: bronchospasm, apnea, tachycardia, hypotension
Contraindications: known allergy including to bromides
Dosage: 0.1 mg/kg IV
Special Considerations: (P class C) note that it does not effect consciousness!
