Pain Medication

Question 1

Entonox Trade Names

Answer 1

Nitrous oxide (Laughing gas)

Question 2

Entonox classification

Answer 2

Gaseous analgesic

Question 3

Entonox Mechanism of Action

Answer 3

Rapid reversible CNS depression and analgesia - 50% nitrous oxide, 50% oxygen

Question 4

Entonox Indications

Answer 4

Musculoskeletal, burns, active labour, kidney stones

Question 5

Entonox contraindications

Answer 5

-Pt cannot follow commands
-ALOC and/or any depressant drug/alcohol
-Head injury
-Sustained Thoracic injury (pneumothorax)
-Respiratory compromise where 100% O2 is needed
-Abdominal trauma
-Distension suspicious of bowel obstruction
-Pregnant (not active labour)

Question 6

Entonox Dosage

Answer 6

To be determined by patient, record PSI at start and at the end of administration

Question 7

Entonox Side Effects

Answer 7

-Dizziness / lightheaded
-Drowsiness
-Headache
-Nausea / vomiting

Question 8

Entonox Pharmacokinetics

Answer 8

Onset - immediate
Duration - <5 minutes

Question 9

Entonox EMS Considerations

Answer 9

-Can be administered while IV is being established in ALS environment
-Invert green cylinder 3 times before use
-Mouthpiece used by patient
-Patient should be instructed to use or remove mask as they see fit
-You may notice a deeper tone of the patients voice with use

Question 10

Ibuprofen Trade Names

Answer 10

Advil, Motrin

Question 11

Ibuprofen Classification

Answer 11

-Non-steroidal anti-inflammatory drug (NSAID)
-Non-opioid analgesic

Question 12

Ibuprofen Mechanism of Action

Answer 12

Inhibits prostaglandin synthesis, decreasing pain and inflammation through nonselective reversible inhibition of cyclooxygenase enzymes COX-1 and COX-2

Question 13

Ibuprofen Indications

Answer 13

-Treatment of mild pain associated with arthritis or muscle, joint or bone pain
-Reduction of fever
-Dysmenorrhea or headaches

Question 14

Ibuprofen Contraindications

Answer 14

-Hypersensitivity to NSAID’s / salicylates
-Suspected intracranial bleeding
-Sub-arachnoid hemorrhage (sudden onset / most severe ever headache)
-Ibuprofen induced asthma
-Renal disease, except renal colic
-Diagnoses of crohns / ulcerative colitis / IBD
-Patient currently taking oral anticoagulants
-Patient currently undergoing chemotherapy
-Pregnancy

Question 15

Ibuprofen Dosage

Answer 15

400mg PO, No repeat dose

Question 16

Ibuprofen Side Effects

Answer 16

-Mild hypertension
-GI Irritation
-Nausea / vomiting
-Constipation
-Tinnitus
-Increased risk of bleeding

Question 17

Ibuprofen Pharmacokinetics

Answer 17

Onset - 30 minutes
Duration - 4-6 hours

Question 18

Ibuprofen EMS Considerations

Answer 18

-Do not administer if the patient has taken the maximum dose within 6 hours
-if patient has received less than maximum dose of 400mg within 6 hours, administer remaining medication up to the maximum dose of 400mg
-Works well for pain associated with renal colic, dental or musculoskeletal
-Cautious use with patients who have PMHx of; recent trauma / suspected subarachnoid hemorrhage, renal impairment, GI bleed, CHF, elderly over 65yrs, chronic alcoholics

Question 19

Acetaminophen Trade Names

Answer 19

Tylenol, Tempra

Question 20

Acetaminophen Classification

Answer 20

Non-opioid analgesic, antipyretic

Question 21

Acetaminophen Mechanism of Action

Answer 21

-Inhibits synthesis of prostaglandins that may serve as mediators of pain and fever; does not have anti-inflammatory properties
-Inhibits prostaglandin synthesis in the central nervous system by blocking pain impulses
-Acts on the hypothalamic heat regulating center to produce peripheral vasodilation resulting in increased blood flow through the skin, sweating and heat loss

Question 22

Acetaminophen Indications

Answer 22

-Treatment of mild pain
-Reduction of fever

Question 23

Acetaminophen Contraindications

Answer 23

-Hypersensitivity to alcohol, sugars, saccharin, FDC yellow dye #5
-Active liver disease / hepatic impairment