Pharm Flashcards

1
Q

Central Regional Opioid Analagesia:

  • what are the two types? describe each.
  • when is this administered?
  • which medications are commonly used?
  • adverse SE of medication used?
A

Two types of central regional opioid analgesia:

  • epidural: injection outside the dura.
  • intrathecal: aka spinal anesthesia; injection through the dura directly into the CSF.

Administered preincisional

Medication commonly used is morphine or fentanyl

Adverse SE of morphine:
-pruritis, urinary retention,

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2
Q

Central Regional Opioid Analagesia:

  • single dose of Morphine (intrathecal opioid) can provide pain relief for up to how many hours?
  • onset of action for Morphine (intrathecal opioid)?
  • single dose of fentanyl (intrathecal opioid) can provide pain relief for up to how many hours?
  • onset of action for fentanyl (intrathecal opioid)?
A

MORPHINE:
Pain relief for up to 18-24hrs post op

Intrathecal opioid onset of action 45minutes

FENTANYL:
pain relief for up to 1-2hrs

onset of action 5-10minutes

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3
Q

Patient Controlled Analgesia:

-which medications are given in a PCA pump?

A

-Morphine, hydromorphone, and fentanyl can be given PCA, fentanyl is less desirable d/t short acting DOA.

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4
Q

T/F, using 2 or more drugs that act by different mechanism for providing analgesia offer better pain control?

A

True, e.g. opioids (IV morphine) + NSAIDS (Ketorolac). Central regional analgesia (epidural) + regional meds (nerve block)

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5
Q

Peripheral Regional Techniques:

  • what are these?
  • T/F preoperative nerve blocks are effective at reducing post op pain and decrease the need for opioid use?
  • T/F, preoperative infiltration of the incision with local anesthetic (bupivicaine) decreases post op pain scores.
A

What: peripheral nerve blocks, intraarticular blocks, and infiltration of incisions

True.

True.

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6
Q

Which patients are at risk for inadequate pain control?

A

Peds

Geriatrics

Critically ill

Congnitively impaired

others who may have difficulty communicating

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7
Q
Opioids: 
-what are these?
-administration 
-metabolism? 
-
A

What:

  • morphine*
  • Dilaudid* (hydromorphone)
  • Fentanyl*
  • Meperidine (Demerol)
  • = MC used for post op IV pain management

Administration:
-bolus injections(MC), continuous infusion (Can be dangerous), PCA.

Hepatically metabolized

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8
Q

Morphine:

  • peak effects
  • elimination half life
  • duration of action
  • onset
  • SE of morphine toxicity?
A

-peak effects: 1-2hrs

Elimination half life: 2-3hrs

Duration of action: 4-5hrs

Onset: rapid

Morphine toxicity:
-myoclonus, confusion, coma, death

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9
Q

Dilaudid:

  • onset
  • half life
  • potency compared to morphine
A

Onset: peak 30minutes

Half life: 2.4hrs

Potency: 4-6x more potent than morphine

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10
Q

Fentanyl:

  • potency compared to morphine
  • compared to morphine:
  • -onset
  • -half life
  • -elimination
  • -penetration
  • routes of administration
A

100x more potent than morphine

Onset: more rapid than morphine

Half life: shorter half life than morphine

elimination half life is 2-4hrs

Penetration: improved penetration of the blood brain barrier.

Administration: IV and Transdermal.

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11
Q

Meperidine:

  • indications
  • CI in which patients?
A

indications: short term management of acute pain

CI in pts on MAOI

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12
Q

Opiod SE

A

Somnolence

depression of brainstem control of resp drive

hypotension

urinary retention

N/V

slowed GI transit

Histamine release (MC with morphine)

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13
Q

WHen do we transition from IV to oral opioids?

How long to effect in PO analgesics?

Which PO opioids are MC used when transitioning from IV to PO pain control?

A

Switch from IV to oral once pt can tolerate PO.

PO analgesics effects take 30-60minutes

Meds:

  • oxycodone (oxycontin)
  • hydrocodone
  • hydromorphone (dilaudid)
  • morphine
  • Percocet (oxycodone/acetaminophen)
  • Vicodin (Hydrocodone/acetaminophen)
  • = MC used in PO pain meds post surgery
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14
Q

Opioids:

-which are short acting, moderate acting, and long acting?

A

Short: fentanyl

Moderate: Morphine, codeine, hydromorphone, oxycodone

Long acting: methadone

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15
Q

For patients with impaired renal function which opioids are safest? why?

A

Hydromorphone and oxycodone have inactive metabolites and are safer than morphaine.

Fentanyl: safer than morphine in pts with renal impairment

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16
Q

WHat is the opioid reversal agent? Administration?

A

Naloxone (Narcan)

Reversal of resp depression

Administration: IV, IM, SubQ, endotracheally.
0.04-0.4mg

17
Q

Non-opioid adjunctive medications?

A

NSAIDS, Ketamine, Lidocaine, magnesium, IV acetaminophen

18
Q

What are the nonselective NSAIDS? Selective NSAIDS?

A

Nonselective: Ketorolac, diclofenac and ibuprofen

Selective: celecoxib (Celebrex)

19
Q

Ketamine:

  • MOA
  • use limited d/t?

Lidocaine:

  • drug class
  • most effective for what type of surgery?
  • administration route?

Magnesium sulfate:

  • MOA
  • use
A

Ketamine:
MOA: NMDA receptor inhibitor
-limited use d/t hallucinations

Lidocaine:

  • drug class: class 1 antiarrhythmic
  • most effective following major abdominal surgery
  • adminstration: IV infusion for pain control

Magnesium sulfate:

  • MOA: NMDA receptor antagonist
  • Use: not routinely used at this time.