Pain Pharm Flashcards
What are the immediate negative effects of untreated pain in early life?
Physiological stability, pain processing, and neurodevelopment.
Long-term outcomes can also include altered cognition and behavior.
What is commonly reported regarding inadequate pain management during procedures?
Inadequate pain management is commonly reported for infants born preterm.
This includes exposure to repeated pain and related distress.
What long-term issues are associated with repeated pain exposure in preterm infants?
Altered pain processing, cognition and behavior including executive function and visual abilities, altered HPA axis development, cortisol regulation, reduced cerebellar size.
These effects can impact overall development.
What methods can be used to reduce pain in infants during procedures?
Limit unneeded tests, bloodwork, and use pain scales like NPASS and PIP.
Interventions include direct breastfeeding, skin-to-skin contact, non-nutritive sucking with sucrose, and facilitated tucking.
What is the effectiveness of sucrose in pain management for infants?
Sucrose given in frequent small volumes throughout the procedure is more effective than large doses at once.
It is particularly effective when combined with other non-pharmacological interventions.
What are the pharmacological interventions for managing acute pain in infants?
Topical lidocaine, acetaminophen, opioids, NSAIDs.
Each has varying levels of effectiveness and specific use cases.
What are the limitations of using acetaminophen for procedural pain?
Acetaminophen is not effective for procedural pain but is effective for mild to moderate pain post-operatively.
It has an antipyretic effect but no anti-inflammatory effect.
What are the effects of opioids on pain management in infants?
Opioids are used for moderate to severe pain and work by activating μ, κ, and/or δ receptors in the CNS.
Commonly used opioids include morphine and fentanyl.
What are the adverse effects of opioids?
Respiratory depression, hypotension, sedation, constipation, urinary retention, bradycardia.
These effects can complicate pain management in infants, especially preterm infants.
What is the clinical consideration for using mechanical ventilation in pain management?
Effective analgesics must be given prior to all non-emergent intubations to reduce physiological instability and intracranial pressure.
This is crucial to avoid harm during procedures.
What are the characteristics of midazolam as a sedative?
Short acting with rapid onset, has sedative and anticonvulsant effects, and is metabolized by the liver.
Clearance increases with postnatal age.
What are the effects of benzodiazepines in premature infants?
Benzodiazepines should generally be avoided in premature infants due to potential adverse effects.
They can produce physiological stability but have no analgesic effect.
What is nociception?
The effects of a noxious stimulus independent of any judgement of higher consciousness, memory, or emotional effects.
It is measured in studies of neonatal pain.
What physiological responses occur in infants due to nociceptive stimuli?
Lower limb withdrawal, flexor muscle activity, hormonal, metabolic, and cardiovascular responses.
Routine handling can result in hypoxemia, which analgesia can help reduce.
What is the impact of heel pricks on infants?
Heel pricks cause large increases in heart rate and blood pressure, which can be prevented by local analgesia.
This highlights the necessity of pain management in neonatal care.
What are the long-term effects associated with greater exposure to procedural stress and pain?
Adverse effects on brain growth and development, cognitive and motor functions.
This emphasizes the importance of effective pain management.
What is the difference between muscle relaxants, sedatives, and analgesics?
Muscle relaxants produce physiological stability but no sedative or analgesic effect; sedatives may produce physiological stability but have no analgesic effect; analgesics provide both effects.
Understanding these distinctions is critical for proper medication use.
What are the potential side effects of opioid use in infants?
Respiratory depression, sedation, dysphoria, seizures, nausea/vomiting, urinary retention.
These side effects necessitate careful monitoring during treatment.
What is tolerance in the context of opioid use?
Physiologic tolerance develops, requiring increased doses to achieve desired effects after 7-10 days of use.
Withdrawal may manifest as neonatal abstinence syndrome (NAS).
What is the significance of morphine’s half-life in neonates?
Morphine has a longer elimination half-life (6-12 hours) in neonates due to immature hepatic metabolism.
This affects dosing and potential side effects.
Why is fentanyl often preferred in critically ill patients?
Fentanyl has a rapid onset of action, short half-life, and lesser histaminic effects, making it suitable for procedural pain.
Its potency and lipid solubility contribute to its effectiveness.
What are the concerns associated with prolonged opioid use in infants?
Increased risk of dependence, tolerance, and potential long-term effects on development.
Continuous evaluation of pain management strategies is essential.
What is a major con of using opioids during ECMO?
Wide individual variation, with late rebounds in plasma levels
This variability can affect dosing and patient response.
What is the primary concern with the use of opioids for longer than 3-7 days?
Transition to a different drug class due to tolerance
This is important to prevent the development of tachyphylaxis and hyperalgesia.
