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ACTAS Pharmacology > Analgesia > Flashcards

Analgesia Flashcards

(51 cards)

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1
Q

Methoxyflurane: Type

A

Volatile inhalation anaesthetic and analgesic agent

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2
Q

Methoxyflurane: Action

A

Central nervous system depressant

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3
Q

Methoxyflurane: Onset/Offset

A

Onset: 3-5min. Offset 3-5min

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4
Q

Methoxyflurane: Adverse Effects (4)

A
  1. Altered consciousness
  2. Renal dysfuction (rare with once only ambulance use)
  3. Jaundice (rare with once only ambulance use)
  4. Uterine atonia
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5
Q

Methoxyflurane: Contraindications (4)

A
  1. Depressed level of consciousness
  2. Known hypersensitivity
  3. Malignant hyperthermia
  4. Concurrent doxycycline use
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6
Q

Methoxyflurane: Precautions (4)

A
  1. Renal disease
  2. Diabetes
  3. Caution if the patient is unable to self-administer
  4. Use in the post-delivery phase of labour, and with post-partum haemorrhage (may induce uterine atonia)
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7
Q

Methoxyflurane dose (adult and paediatric)

A

Up to 3ml - self administered via Penthrox inhaler
Repeat once if required
Dose should not exceed 6ml/day or 15ml/week
(if used during labour, discontinue post-delivery, and if PPH is suspected)

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8
Q

Morphine: Type

A

Narcotic analgesic

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9
Q

Morphine: Action

A
  1. Decreases pain perception and anxiety

2. Vasodilation

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10
Q

Morphine: Onset/Duration

A

IV onset 2-5 min, IV duration 1-2 hours

IM onset 5+ minutes, IM duration 2-3 hours

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11
Q

Morphine: Adverse Effects (6)

A
  1. Nausea & Vomiting
  2. Altered level of consciousness
  3. Respiratory depression
  4. Hypotension
  5. Bradycardia
  6. Dependence
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12
Q

Morphine: Contraindications (3)

A
  1. Respiratory depression
  2. BP < 70mmHg systolic
  3. Acute asthma attacks
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13
Q

Morphine: Precautions (9)

A
  1. Depressed level of consciousness (GCS less than or equal to 13)
  2. Known hypersensitivity
  3. Elderly patients (may be sensitive)
  4. Patients with CAL
  5. Hypovolaemic patients (hypovolaemia should be corrected before morphine administration)
  6. Patients with systolic BP 70-90mmHg
  7. Children under 1 year
  8. Pain management in labour
  9. Previous opiates
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14
Q

Morphine: IV dose normotensive

A

Up to 0.05mg/kg IV, over 2 minutes. May be repeated at 5 minute intervals until pain is managed
(AP max dose 20mg)
Use with caution under 1 yr of age

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15
Q

Morphine: IV dose BP 70-90 systolic

A

IV use only
Hypovolaemic patients must be receiving fluid
Up to half of a calculated 0.05mg/kg dose, given slowly
May be repeated as required, with great care, and with an appropriate time interval between doses, titrated to response
No further doses to be given if systolic BP drops 10mmHg or more with the half dose, even if it remains about 70mmHg (e.g. initial BP 85mmHg - following morphine dose, BP is now 75mmHg)

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16
Q

Morphine: IM

A

Pain relief only
Not for chest pain if cardiac ischaemia suspected
No IV available
No hypotension
Patient contact estimated 20 minutes or greater
0.1mg/kg. Repeat once, after 30-45 minutes, if required
(AP not to exceed 20mg)

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17
Q

Fentanyl: Type

A

A fast acting synthetic narcotic analgesic

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18
Q

Fentanyl: Action

A

Acts on the central nervous system by binding with the opioid receptors

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19
Q

Fentanyl: Adverse effects (5)

A
  1. Central nervous system depression
  2. Respiratory depression
  3. Nausea/vomiting
  4. Occasionally bradycardia
  5. Rigidity of the diaphragm, intercostals and jaw (rare)
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20
Q

Fentanyl: Contraindications (4)

A
  1. Known allergy or previous reaction to fentanyl
  2. Bleeding or bilateral occluded nostrils
  3. Altered level of consciousness
  4. Children under 1 yr of age
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21
Q

Fentanyl: Precaution

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A

Active labour

22
Q

Fentanyl: Dose 250mcg in 1ml

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A

1-5yr/<20kg: 25mcg. Rpt: up to 25mcg every 10 min PRN
5-12yr/20-40kg: 50mcg. Rpt: up to 50mcg every 10 min PRN
Small adult or adolescent/elderly/frail - 40-70kg: 100mcg. Rpt: up to 50mcg every 5 min PRN
12+ yrs - adult/ >70kg: 200mcg. Rpt: up to 50mcg every 5 min PRN

23
Q

Fentanyl: Dose 450mcg in 1.5ml

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A

1-5yr/<20kg: 30mcg (0.1ml). Rpt: up to 30mcg every 10 min PRN
5-12yr/20-40kg: 60mcg (0.2ml). Rpt: up to 60mcg every 10 min PRN
Small adult or adolescent/elderly/frail - 40-70kg: 150mcg (0.5ml). Rpt: up to 60mcg every 5 min PRN
12+ yrs - adult/ >70kg: 210mcg (0.7ml). Rpt: up to 60mcg every 5 min PRN

24
Q

Analgesia polypharmacy dose modifications

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A

Doses of morphine following fentanyl - half dose
Doses of ketamine following fentanyl or morphine - half dose
AP - no fentanyl after maximum morphine dose

25
Ketamine: Type
Anaesthetic agent
26
Ketamine: Actions (5)
Complex, multiple actions 1. Analgesic, sedative agent 2. Amnesic properties 3. Bronchodilating properties 4. Does not tend to cause respiratory depression 5. Does not tend to cause hypotension (via sympathetic stimulation), unless catecholamine depleted (e.g. shock)
27
Ketamine: Onset
Onset of action is rapid: IV 1-2 min, IM 3-5 min
28
Ketamine: Adverse effects (6)
1. Laryngospasm 2. Hypersalivation 3. Emergence reactions 4. Muscle twitching and purposeless movements 5. Respiratory depression - apnoea 6. Hypotension if given too rapidly to a hypovolaemic patient
29
Ketamine: Contraindications (3)
1. Known hypersensivity 2. Active cardiac disease (myocardial ischaemia, LVF, uncontrolled hypertension). (Not applicable when used for RSI or to maintain sedation for ETT) 3. Children < 1 yr old
30
Ketamine: Precaution
SHOCKED PATIENT. When using ketamine for any indication (e.g. RSI, sedations, pain etc) in a shocked, catecholamine-depleted patient, consider a smaller dose than the full weight-based dose, and be mindful that onset of actions will be prolonged (i.e. consider delaying subsequent dose/s to give the first dose/s a chance to work)
31
Ketamine: Special notes
Patients who receive ketamine may still have significant awareness despite an appearance of unconsciousness. They may be able to hear and have some recall. Pts should be advised that they will experience strange/unusual sensations. Pts who become agitated may be managed with small repeat doses of midazolam
32
Ketamine: Dose: Pain management
Adult: IV: up to 1mg/kg in increments up to 20mg at 30-60 second intervals, rpt 5-10min. Adult IM: 1mg/kg, rpt 5-10 min Adult previous opiates: IV up to 10mg increments; IM 0.5mg/kg Elderly (>65yrs)/Paediatric (>20kg) IV: up to 1mg/kg in increments up to 10mg at 30-60 second intervals, rpt 5-10min Elderly (>65yrs)/Paediatric (>20kg) IM: 0.5mg/kg, rpt after 5-10min Elderly (>65yrs)/Paediatric (>20kg) previous opiates: IV up to 5mg increments, IM 0.25mg/kg Paediatric <20kg IV: up to 1mg/kg in increments up to 5mg at 30-60 second intervals, rpt 5-10min Paediatric <20kg IM: 0.5mg/kg, rpt after 5-10 min Paediatric < 20kg previous opiates: IV up to 2.5mg increments, IM 0.25mg/kg
33
Ketamine: Dose: Combative/Agitated Patients
ICP: when used as first line agent: up to 4mg/kg IM When used as second line agent: up to 2mg/kg IM/IV/IO For all regimes, repeat as required IV doses to be given slowly, over 30 seconds Reduce dose by half following droperidol use AP: Initial treatment of combative/agitated patients who are an immediate danger to themselves or others: 200mg IM injection (reduce dose to 100mg IM injection with age >65 yrs or with general debility). Rpt: 1mg/kg IM after 5 min PRN
34
Ketamine: Dose: Intubation
``` With suxamethonium (adult): 1mg/kg fast push IV or IO) If suxamethonium contraindicated: 2mg/kg fast push IV or IO To maintain sedation post intubation (paed and adult): 1mg/kg IV or IO at 1-5 minute intervals titrated to effect ```
35
Paracetamol: Type
Simple analgesic/antipyretic
36
Paracetamol: Actions (2)
1. Antipyretic | 2. Mild-moderate analgesic
37
Paracetamol: Use (2)
1. Pyrexia in children who have had or may have a febrile convulsion (generally >38 degrees) 2. Mild to moderate pain
38
Paracetamol: Adverse effects (6)
Rare - none of these side effects have been confirmed or refuted as being linked to the casual use of paracetamol. 1. Dyspepsia 2. Nausea 3. Allergic reactions 4. Haematological reactions 5. Dizziness 6. Pain at injection site
39
Paracetamol: Contraindications (6)
1. Known or suspected allergy 2. Previous paracetamol dose in last 4 hours (oral dose) 3. Previous paracetamol dose in last 6 hours (IV dose) 4. Children who do not have sufficient gag reflex to swallow the measured dose 5. Not to be given to children < 1 month old 6. Diagnosed liver failure
40
Paracetamol: Precautions (2)
1. Impaired hepatic function | 2. Impaired renal function
41
Paracetamol: Dose: Pyrexia in children
15 mg/kg oral liquid via a syringe | Do not exceed 60mg/kg/24hrs
42
Paracetamol: Pain
Adult: PO: 2 tablets (1g) swallowed Adult: IV: 50kg or greater: 1g over 15 minutes Adult: IV: Under 50kg: 15mg/kg over 15 minutes (via burette) Paediatric: PO 1mth-12yr: 15mg/kg (10-12 may take 500mg tablet if preferred) Paediatric: IV: 15mg/kg over 15 min (via burette) Do not exceed 60mg/kg/24hrs
43
Topical Anaesthetic Cream (LMX4): Type
Topical anaesthetic
44
Topical Anaesthetic Cream (LMX4): Presentation
5g tube of cream containing lignocaine 40mg/g
45
Topical Anaesthetic Cream (LMX4): Action/onset
Local topical anaesthesia | Onset: 30 minutes
46
Topical Anaesthetic Cream (LMX4): Use
Topical anaesthesia prior to anticipated IV cannulation in paediatric patients
47
Topical Anaesthetic Cream (LMX4): Adverse Effects (6)
1. Irritation 2. Redness 3. Itching 4. Rash 5. Anaphylaxis (rare) 6. Corneal irritation (accidental eye exposure)
48
Topical Anaesthetic Cream (LMX4): Contraindications (3)
1. Amide local anaesthetic hypersensitivity 2. Broken skin (atopic dermatitis, wounds, mucous membranes) 3. Infants < 3 months old
49
Topical Anaesthetic Cream (LMX4): Precautions (4)
1. Eye contact 2. Excessive dosing (large area and prolonged application time) 3. Severe hepatic, renal or cardiac impairment 4. Anticipated need for IV access within 30 minutes
50
Topical Anaesthetic Cream (LMX4): Doses
``` Paediatric only 1g cream = 5cm cream 3-12 months: up to 1g per site (3 sites only - 2 x ACF, 1 x dorsum of hand) Greater than 12 months: 1g-2.5g per site Do not exceed 10g total application ```
51
Topical Anaesthetic Cream (LMX4): Notes (2)
Pain, anxiety, distress and subsequent needle phobia is associated with IV access attempts. Preparation of potential IV cannulation sites with topical anaesthetic cream can reduce pain and minimise distress to patients. If skin irritation occurs, remove the cream immediately.

ACTAS Pharmacology (2 decks)

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