PCA and Pain Meds

Question 1

Who cannot get continuous basal infusion?

Answer 1

#opioid naive
#elderly
#prescribed other sedatives
#morbidly obese or OSA

Question 2

Use of continuous nighttime infusion?

Answer 2

None

Question 3

How to calculate continuous infusion rate?

Answer 3

Add up all analgesics in 24 hours

Divide by 24

Give 50% if pain will improve over time (ie postop patient) or 100% if not (cancer patient)

Question 4

Pros and cons of fentanyl?

Answer 4

patient must constantly activate PCA

#quick onset and short duration
#good if concerned of accumulating effects

Question 5

Pros and cons of hydromorphone?

Answer 5

good pharmacology

Question 6

Pros and cons of moorphine?

Answer 6

#delay in onset
#avoid in elderly patients, CKD

Question 7

Doses?

Answer 7

Demand
Lockout (6-10 minutes)
Basal/continuous infusion (continuous hourly dose)
Rescue

Question 8

How to wean opioids?

Answer 8

#half dose for each of the first two days
#decrease dose by 25% every two days until at morphine equivalent of 30 mg/day
#discontinue opioids after 2 days at 30mg/day of morphine equivalents

Question 9

Analgesic effects of benzodiazepines?

Answer 9

NONE - anxiolytics

Question 10

Bolus dose for IV opioids?

Answer 10

Up to 3x lowest available dose of the drug