Analgesia and Nausea Vomiting Flashcards
Analgesia Medical Directive
What are the INDICATIONS?
How can we interpret pain? Types of pain
Pain
Nociceptive Pain - Typically the result of tissue injury
Inflammatory Pain - An abnormal inflammation caused by an inappropriate response by the body’s immune system
Neuropathic Pain - Pain caused by nerve irritation
Functional Pain - Pain without obvious origin, but can cause pain
Analgesia Medical Directive
What is Acetaminophen? + Generic Name
What is Ibuprofen? + Generic Name
Drug to treat mild to moderate pain, commonly known for its analgesic and antipyretic effects - acetaminophen does not disrupt or inhibit platelet aggregation.
Tylenol
NSAID – non-steroidal anti-inflammatory drug, shown to
have properties for management of pain (analgesia), fever (antipyretic), and inflammation (anti-inflammatory)
Advil
Analgesia Medical Directive
What is Ketorolac? + Generic Name
An non-selective blocker of prostaglandin synthesis NSAID that’s used to treat moderate pain
Toradol
Analgesia Medical Directive
What are the CONDITIONS for Acetaminophen?
Why is liver disease important?
What are the CONTRAINDICATIONS?
≥ 12 years
Unaltered
it’s metabolized in the liver i.e. disease implies poor metbolization
Allergy or sensitivity to acetaminophen
Acetaminophen use within previous 4 hours
Hx of liver disease
Active vomiting
Unable to tolerate oral medication
Suspected ischemic chest pain
Analgesia Medical Directive
Why is 4h important as a contraindication for acetaminophen?
Because it’s dosing interval is 4-6 hours - all of the receptors are occupied
Analgesia Medical Directive
What are the CONDITIONS for Ibuprofen?
What are the CONTRAINDICATIONS?
≥ 12 years
Unaltered
Allergy or sensitivity to ASA or NSAIDs
NSAID use within previous 6 hours
Patient 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 hours
Known renal impairment
Active vomiting
Unable to tolerate oral medication
Suspected ischemic chest pain
Analgesia Medical Directive
What would happen if the patient were on anticoagulation medication/therapy and you were thinking of giving ibuprofen?
Why is 6h important as a contraindication for ibuprofen?
Why is pregnancy relevant?
Don’t give it because it’s known to slow down blood clotting which would cause further complications.
Because it’s dosing interval is 6-8hours
Ibuprofen can pass the placental barrier and is excreted in breast milk which can be toxic for the fetus
Analgesia Medical Directive
Why is renal impairment important as a contraindication for ibuprofen?
Ibuprofen is removed by the kidneys i.e. impairment would result in a buildup of the medication in the body
Analgesia Medical Directive
What are the CONDITIONS for Ketorolac?
What are the CONTRAINDICATIONS?
≥ 12 years
Unaltered
Normotension
Allergy or sensitivity to ASA or NSAIDs
NSAID use within previous 6 hours
Patient 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 hours
Known renal impairment
Suspected ischemic chest pain
Analgesia Medical Directive
Why is normotension a condition for ketorolac?
How should you administer it?
Why is hx of peptic ulcer disease or GI bleed a contraindication?
becasue administration can cause severe reboud bradycardia - BUT hypertension is more common
You should push slowly
because the medication can be hard on the tissue that lines the stomach (already not good if theres a hx of peptic ulcer disease or GI bleed)
Analgesia Medical Directive
What is the ROUTE, and TREATMENT PLAN for Acetaminophen for a pt who is ≥12 years to < 18 years?
What is the ROUTE, and TREATMENT PLAN for Acetaminophen for a pt who is ≥ 18 years?
ROUTE - PO
Dose - 500-650mg
Max. Single Dose - 650mg
Dosing Interval - N/A
Max # of Doses - 1
ROUTE - PO
Dose - 960 - 1,000mg
Max. Single Dose - 1,000mg
Dosing Interval - N/A
Max # of Doses - 1
Analgesia Medical Directive
What is the ROUTE, and TREATMENT PLAN for Ibuprofen?
ROUTE - PO
Dose - 400mg
Max. Single Dose - 400mg
Dosing Interval - N/A
Max # of Doses - 1
Analgesia Medical Directive
What is the ROUTE(s), and TREATMENT PLAN for Ketorolac?
The vial is supplied in 30mg/1mL
How much volume will you need to draw up if you’re looking to give 10mg? AND 15mg?
ROUTE - IM/IV
Dose - 10 – 15 mg
Max. Single Dose - 15 mg
Dosing Interval - N/A
Max # of Doses - 1
.333mL AND .5mL
Analgesia Medical Directive - clinical considerations
Can you administer more than one pain medication at the same time?
IV in this directive means what?
What should suspected renal colic patients be considered for?
Yes, try to co-administer acetaminophen and ibuprofen (but not ibuprofen and ketorolac)
only to PCPs authorized for PCP Autonomous IV can administer ketorolac
Ibuprofen and ketorolac
Analgesia Medical Directive
When would you go IV over IM?
Can ketorolac and ibuprofen be taken together?
In preperation for more the potential for more meds or fluid therapy
NO - they have similar effects and targeted receptors therefore toxic buildup and/or increased adverse effects will occur