Pharm Pain Management

Question 1

Patient Controlled Analgesic (PCA) to use in hepatic or renal insufficiency

Answer 1

Fentanyl

Question 2

Opioids

Answer 2

Morphine
Hydromorphone (Dilaudid)
Fentanyl
Meperidine

Question 3

Morphine

Answer 3

Onset of analgesia is rapid
Peak in 1-2 hours
Analgesic duration of action is 4-5 hours
adverse effects like sedation, hypotension, respiratory depression and hypoxemia
Active metabolites eliminated renally
Relatively contraindicated in severe renal disease
Erratic absorption from the GI tract

Question 4

Hydromorphone (Dilaudid)

Answer 4

More rapid onset of analgesia reaching peak within 30 min

Approximately 4-6 times more potent than morphine

Question 5

Fentanyl

Answer 5

Synthetic derivative of morphine
Approximately 100 times more potent than morphine
More rapid onset of action
Improved penetration of the blood-brain barrier
Shorter half life
Does not release histamine and may be preferred in the presence of hemodynamic instability or bronchospasm
IV infusion for pain control in mechanically ventilated patients > 5 days

Question 6

Opioid Reversal agent

Answer 6

Naloxone (Narcan)
Reversal of respiratory depression with therapeutic opioid doses:
IV, IM, SubQ. endotracheally

Question 7

Ketamine

Answer 7

NMDA receptor inhibitor
Use limited due to hallucinations
Reduces hyperalgesia and opioid tolerance