Week 2 Flashcards
Opioid analgesics
MORPHINE
Sedation/analgesia dosing
adult & peds
- Adults: 2-20 mg q2-4h IV, IM, SC
- Peds: 0.02-0.1 mg/kg IV
MORPHINE
Adult Neuraxial dosing
Epidural
- Bolus 2-6 mg q8-24h
- Infusion 0.2-1 mg/hr
Intrathecal
- 0.1-0.5 mg
MORPHINE
Peds Neuraxial dosing
Epidural
- 0.03-0.05 mg/kg
- MAX = 0.1 mg/kg or 5 mg/24h
Intrathecal
- 0.01 mg/kg
HYDROMORPHONE
Analgesic dosing
adult & peds
- Adults: 0.4-2 mg IV
- Peds: 0.005-0.02 mg/kg
MEPERIDINE
Sedation/analgesia dosing
adult & peds
- Adult: 50-150 mg IV, IM q3-4h
- Peds: 0.5-2 mg/kg IV, IM
MEPERIDINE
Adult Postoperative Shivering dosing
- 12.5-25 mg IV
remember - this is NORMOTHERMIC shivering related to volatile agents
FENTANYL
Induction dosing
- 1-3 mcg/kg (Dr. C says 1 mcg/kg is the go to)
ok to round up - e.g. 80 kg patient coudl get a full 100 mcg
FENTANYL
Sedation/analgesia Bolus/Infusion dosing
- Bolus: 0.25-5 mcg/kg
- Infusion: 0.01-0.04 mcg/kg/hr
FENTANYL
General anesthesia adjunct dosing
- Bolus: 2-20 mcg/kg
- Infusion: 2-10 mcg/kg/hr
FENTANYL
Neuraxial dosing
- Intrathecal: 10-25 mcg (Dr. C says 20 is a sweet spot)
- Epidural: 10-100 mcg
REMIFENTANIL
Induction dosing
- 1-3 mcg/kg over 1 minute
Slow push to avoid profound bradycardia
more often used in specialty cases
REMIFENTANIL
General anesthesia adjunct dosing
General anesthesia
- Bolus: 0.5-1 mcg/kg
- Maintenance: 0.05-2 mcg/kg/min (Dr. C likes 0.1 mcg/kg/min)
Slow push to avoid profound bradycardia
more often used in specialty cases
REMIFENTANIL
Sedation dosing
Sedation:
- Load: 0.5-1 mcg/kg over 30-60 seconds
- Maintenance: 0.025-0.2 mcg/kg/min
Slow push to avoid profound bradycardia
more often used in specialty cases
SUFENTANIL
General anesthesia dosing (minor procedure)
Minor procedure:
- Load: 1-2 mcg/kg load
- PRN 10-50 mcg
SUFENTANIL
General anesthesia dosing (moderate procedure)
Moderate procedure:
- Load: 2-8 mcg/kg
- Infusion: 0.3-1.5 mcg/kg/hr
- PRN: 10-50 mcg
SUFENTANIL
General anesthesia dosing (major procedure)
Major Procedure:
- Load: 8-30 mcg/kg
- Infusion: 0.5-2.5 mcg/kg/hr
- PRN:10-50 mcg
METHADONE
PO, IV/IM/SC dosing
- PO: 2.5-10 mg
- IV/IM/SC: 2.5-5 mg q8-12h
titrate up q3-5 days
OXYCODONE
Immediate release, Controlled release dosing
- IR: 5-15 mg q4-6h PO
- CR: 10 mg q8-12h
titrate up 25-50% q1-2 days
HYDROCODONE
PO dosing
- 2.5-10 mg q4h
similar in potency to oral morphine (10mg = 5-10 mg Hydrocodone)
CODEINE
Adult Antitussive dosing
- 15-60 mg PO q4-6h
(max 120 mg/day)
15mg is often an effective dose
CODEINE
Peds Antitussive dosing
- Peds: 1-1.5 mg/kg/day divided q4-6h
2-6 years: 30 mg/day
6-12 years: 60 mg/day
BUPRENORPHINE
Adult IV/IM dosing
Adults:
- 0.3-0.4 mg q6-8h IV, IM
- May repeat inital dose in 30-60 min x 1
- doses > 0.3 mg should only be given IM
0.3-0.4 mg is equianalgesic to 10 mg IV morphine
BUPRENORPHINE
Peds IV/IM dosing
Peds:
- 2-12 years: 2-6 mcg/kg IV, IM q 4-6h
- ≥ 13 years: 0.3 mg IV, IM q6-8h (max 300 mcg/dose)
0.3-0.4 mg is equianalgesic to 10 mg IV morphine
BUPRENORPHINE
Neuraxial dosing
- Epidural: 0.3 mg
- Intrathecal: 0.15 mg
NALOXONE
Opiate overdose dosing
Opiate overdose:
- 0.2-4 mg IV q2-3 min PRN (max 10 mg)
- Infusion: 0.4 mg/hr and titrate to effect
CAREFUL TITRATION
NALOXONE
Opiate-induced respiratory depression dosing
Reversal of opiate-induced respiratory depression:
- 0.04-0.4 mg IV q2-3 min
- Load: 5 mcg/kg
- Infusion: 2.5-160 mcg/kg/hr
CAREFUL TITRATION
NALOXONE
Opiate-induced pruritis dosing
- 0.25 mcg/kg/hr
