Pedia Pain Mgt Nelson Flashcards by Furqaan Lim

Give examples of nonopioid meds (common ones)

Para/acetaminophen
Asa
Nsaids (ibup, ketorolac)
Coxibs (celecoxib)
Gabapentin

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Examples of nonopioid pain meds (quite uncommon to you)

Antipsychotics (quetiapine, risperidone, chlorpromazine, haloperidol)
Ssri (fluoxetine)
Sucrose soln via pacifier or gloved finger

Naprosyn
Choline magnesium salicylate
Nortriptyline, amitriptyline, desipramine

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Para has no ___ and ___ effects

Antiplt

Adverse gastric effects

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Aspirin

Associated with ___ syndrome

Reye Syndrome

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Dose of para

10-15 mg/kg PO/IV q4-q6

20-30 mg/kg PR q4

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Ibup dose

8-10 mg/kg PO q6

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For neuropathic pain (2)

Gabapentin

TCA (Nortriptyline, amitriptyline, desipramine)

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Adr

Aspirin

Gastritis

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Adr

Nsaids

Antiplt effects

Gastritis

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Risk of ___ in prolonged Qtc syndrome if given TCA

Can also enhance ___

Dysrhythmia

Suicidal ideation

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Adr

Gabapentin (5)

Sedation, dizziness, ataxia, headache, behavioral changes

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Check for ___ before initiating antipsychotics

Normal Qtc

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Antipsychotics useful when ___

Arousal is amplifying pain

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Adr

Antipsychotics

And how to treat

Extrapyramidal reactions

Diphenhydramine

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For children with anxiety disorders in which arousal amplifies pain

Clue: SSRI

Fluoxetine

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Cox-1:
Cox-2:

Cox enzymes produce___ causing pain

Gastric mucosa, platelets

Inflammation, cortical renal blood flow regulation

Prostaglandins

Avoid NSAIDS in (3)

*coxibs can substitute

Bleeding diathesis
When surgical hemostasis is concern (tonsillectomy)
Bone healing

Increased risk of ___ and ___ in coxibs and nsaids

Heart attack

Stroke

Opiods

Natural:
Synthetic:

Opium poppy (opiates)
Opioids

Opioid

Indications (4)

Mod to severe pain
Acute post op pain
Sickle cells crisis pain
Cancer pain

Opioids

Common SE

Constipation - most common
n and v
Urinary retention
Pruritus

Opioids

Mgt of consti

Acute (1)
Chronic (2)

Stool softeners and laxatives
Methylnaltrexone
Lubiprostone

Opioids

Mgt of vomiting

Anti emetics:

Phenothiazine
Butyrophenones
Antihistamines
Serotonin receptor antagonist (ondansetron, granisetron)

Opioids

Mgt of pruritus and complix

Low dose iv naloxoneq

Give some opioids

``` Morphine Fentanyl Hydromorphone Oxycodone Hydrocordone Meperidine Methadone ```

More potent than morphine (2)

Fentanyl | Hydromorphone

Common ADR opioids

``` Resp dep Constipation N and v Pruritus Excessive sedation Urinary retention ```

Opioid Mgt of resp dep

Naloxone

Opioid Mgt of excessive sedation

Methylphenidate | Dextroamphetamine (not for young kids)

Opioid Mgt of nausea and vomiting (5)

``` Metoclopramide Trimethobenzamide Prochlorperazine Ondansetron Granisetron ```

Opioid Mgt of pruritus (5)

``` Hydroxyzine Naloxone Ondansetron Nalbuphine Cyproheptadine ```

Opioid Mgt of constipation General types (8-9)

Water, fiber, vegetable ``` Bulk laxatives Lubricants Surfactants Stimulants Enema Electrolytic/osmotic ```

Opioid Bulk laxatives (2)

Metamucil | Maltsupex

Opioid Lubricant

Mineral oil

Opioid Surfactant

Sodium docusate

Opioid Stimulants (2)

Bisacodyl (dulcolax) | Senna

Opioid Electrolytic/osmolytic (2)

Milk of magnesia | Polyethylene glycol

Opioid Mgt of urinary retention

Straight cath | Indwelling cath