Analgesics

Question 1

Acetaminophen (Tylenol)

Answer 1

For: Pain, fever

Adult dose: 650-1000mg PO or IV, q 4 hours to a daily max of 3000mg

Ped dose: 15mg/kg PO or PR q 4 hours

Contraindications: Liver disease, hypersensitivity

Question 2

Hydromorphone (Dilaudid)

Answer 2

For: Pain

Adult dose: 1-2mg IM,SQ, or slow IV every 6hrs titrated to pain relief

Ped dose >50kg: 1mg SQ or slow IV every 4hrs, titrated to pain relief

Ped dose <50kg: 0.015-0.02mg/kg SQ or slow IV every 2-4hours, titrated to pain relief

Contraindications: Asthma, GI obstruction, respiratory depression

Question 3

Fentanyl (as analgesic)

Answer 3

For: Pain

Adult dose: 50-100mcg IM or slow IV/IO PRN (typically every 30-60min)

Ped dose: 1-2mcg/kg/dose to a maximum of 50mcg IM or slow IV/IO PRN (typically every 30-60min)

Contraindications: Known intolerance

Note: Shorter half-life compared to morphine but typically fewer side effects

Question 4

Ibuprofen

Answer 4

For: Pain, fever

Adult dose: 200-400mg IV/PO every 4-6hours PRN to a max of 3.2 g/day

Ped dose: 10mg/kg/dose to a max of 400mg

Question 5

Ketamine (as analgesic)

Answer 5

For: Pain, dissociation

Adult dose: 0.3-0.5mg/kg IV, repeated once in 10 min OR 1mg/kg IM/IN, repeated once in 20 min

Ped dose: Same

Contraindications: Dangerous HTN, pregnancy, hypersensitivity

Question 6

Ketorolac

Answer 6

For: Pain, inflammation

Adult dose <65 yo: 60mg IM or 30mg slow IV

Adult dose >65 yo: 30mg IM or 15mg slow IV

Ped dose: Not recommended

Contraindications: Hypersensitivity, including to other NSAIDs such as ASA. Bleeding disorders, renal failure.

Question 7

Tetracaine

Answer 7

For: Local anesthesia

Adult dose: 1-2 gtts ophthalmic solution

Ped dose: Safety not established

Contraindications: Less than 1 year old. Hypersensitivity to ester anesthetics

Question 8

Morphine (as analgesic)

Answer 8

For: Pain

Adult dose: 0.1 mg/kg IV,IM,SQ to a max of 10mg

Ped dose: 0.1-0.2mg/kg/dose IV,IO,IM,SQ every 5min titrated to a max of 5mg

Contraindications: Head injury, respiratory depression, hypotension/hypovolemia, decreased LOC, undiagnosed abd pain

Note: Longer half-life compared to fentanyl but typically more side effects

Question 9

Demerol

Answer 9

For: Pain

Adult dose: 50-100mg IM/SQ or 25-50mg slow IV

Ped dose: 1-2mg/kg/dose IV/IO/IM/SQ

Contraindications: Head injury, undiagnosed abd pain, concurrent MAOI use (eg. within last 14 days), during labor or delivery of a premature infant. Hypersensitivity to narcotic agents.

Question 10

Butorphanol

Answer 10

For: Pain

Adult dose: 1-4mg IM every 3-4hrs OR 0.5-2mg IV every 3-4hrs

Ped dose: Not recommended

Contraindications: Severe bronchial asthma, significant respiratory depression; GI obstruction. Hypersensitivity