Analgesia Medical Directive

Question 1

What are the indications?

Answer 1

Pain

Question 2

What are the 3 medications for pain directive?

Answer 2

• Acetaminophen, Ibuprofen, & ketorolac

Question 3

What are the conditions for acetaminophen?

Answer 3

• Age= >12 yrs
• LOA= unaltered
• HR= n/a
• RR= n/a
• SBP= n/a
• Other= n/a

Question 4

What are the conditions for Ibuprofen?

Answer 4

• Age= >12 yrs
• LOA= unaltered
• HR= n/a
• RR= n/a
• SBP= n/a
• Other= n/a

Question 5

What are the conditions for ketoroloac?

Answer 5

• Age= >12 yrs
• LOA= unaltered
• HR= n/a
• RR= n/a
• SBP= normotension
• Other= n/a

Question 6

What are the contraindications for acetaminophen?

Answer 6

• Acetaminophen use within previous 4 hrs
• Allergy or sensitivity to acetaminophen
• Hx of liver disease
• Active vomiting
• Unable to tolerate oral medication
• Suspected ischemic chest pain

Question 7

What are the contraindications for ibuprofen?

Answer 7

• NSAID use within previous 6 hrs
• Allergy or sensitivity to ASA or NSAIDS
• Pt on anticoagulation therapy
• Current active bleeding
• Hx of peptic ulcer disease or GI bleed
• Pregnant
• If asthmatic, no prior use of ASA or other NSAIDS
• CVA or TBI in previous 24 hrs
• Known renal impairment
• Active vomiting
• Unable to tolerate oral meds
• Suspected ischemic chest pain

Question 8

What are the contraindications for ketorolac?

Answer 8

• NSAID use within previous 6 hrs
• Allergy or sensitivity to ASA or NSAIDS
• Pt on anticoagulation therapy
• Current active bleeding
• Hx of peptic ulcer disease or GI bleed
• Pregnant
• If asthmatic, no prior use of ASA or other NSAIDS
• CVA or TBI in the previous 24 hrs
• Known renal impairment
• Suspected ischemic chest pain

Question 9

What is the treatment of acetaminophen? (Age: >12 yrs to <18 yrs)

Answer 9

• Route= PO
• Dose= 500-650mg
• Max. single dose= 650mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 10

What is the treatment of acetaminophen? (Age: >18 yrs)

Answer 10

• Route= PO
• Dose= 960-1000mg
• Max. single dose= 1000mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 11

What is the treatment for ibuprofen?

Answer 11

• Age= > 12 years
• Route= PO
• Dose= 400mg
• Max. single dose= 400mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 12

What is the treatment for ketorolac?

Answer 12

• Age= >12 yrs
• Route= IM/IV
• Dose=10-15mg
• Max. single dose= 15mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 13

What are the clinical considerations?

Answer 13

• Whenever possible co-administration of acetaminophen and ibuprofen
• Suspected renal colic pt’s should routinely be considered for NSAIDS, either ibuprofen or ketorolac
• IV administration of ketorolac applies only to PCPs authorized for PCP Autonomous IV