Analgesic Agents

Question 1

Two categories:

Answer 1

opioid and nonopioid

Question 2

Opioids include:

Answer 2

naturally occuring agents (opium alkaloids); synthetic opiod agonists that elicit morphine-like activity (Codeine, Ocycodone, methadone, morphine, hydromorphone, meperidine, fentanyl)

Question 3

Mechanism of Action

Answer 3

Activation of receptors withing the CNS; decreased neurotransmitter release from nociceptive neurons, altering perception and response to pain

Question 4

Opioid receptors also exsist outside CNS in dorsal root ganglia and peripheral terminal of primary afferent neurons

Answer 4

Analgesia is obtained by spinal or supraspinal which leads to activation of opioid receptors; decrease NT release from neurons altering perception and response to pain

Question 5

WHO Analgesic Ladder-developed originally for the treatment of cancer pain

Answer 5

Mild pain-non-opioid, severe pain (weaker opiods or combos); severe pain (stronger; Usually reserve opiods for moderate to severe pain in out population with fentanyl and morphine being most common agents in NICU; Other: pain stress r/t mechanical ventilation, surgical procedures or pain

Question 6

adverse effects/side effects are minimized by appropriate drug selection and dosing

Answer 6

resp depression, hypotension; glottic and chest wall rigidity; constipation (long-term use), urinary retention; seizures, sedation, bradycardia; should have continious monitoring and continious VS with opioid intervention

Question 7

Naloxone: reverses resp depression by competing for narcotic receptor sites

Answer 7

Competitive opiod receptor agonist that reverses many side effects; also antagonizes endorphin effects;

Question 8

Which patient population should NOT receive Naloxone?

Answer 8

infants with chronic or long-term exposure should not be given Naloxone-even if in DOUBT

Question 9

What happens if give Narcan/Naloxone to exposed infant?

Answer 9

seizures secondary to acute opiod withdraw after the administration of naloxone born to an opiod abuser; long-term safety has not been studied

Question 10

Naloxone is a Narcotic antagonist

Answer 10

udjunct therapy to customary resusitative efforts for narcotic induced resp depression; it i NOT recommended for initial therapy for resp depression in delivery room; if Naloxone is needed; a normal heart rate and ventilatory efforts prior to administration

Question 11

Morphine

Answer 11

most common opioid, soluable in water, lipid soluability poor, metabolites cleared by the kidneys and partly by biliary excretion; there is no difference in analgesic effect was found between continious and intermittent dosing

Question 12

Morphine used IV-IM very painful and large variability noted with rectal administration

Answer 12

infants with impaired renal function may lead to accumulation

Question 13

Morphine clearance improves with postconceptual age (approaches adult levels by 6-12 months of age)

Answer 13

hypotension, bradycardia and flushing are part of the histamine responses to morphine and are associated with rapid adminstration; may have effects on blood pressure, but probably dependent on actual dosing and gestational age

Question 14

Morphine Peaks 45-90 minutes

Answer 14

Duration is 4-5 hours

Question 15

Methadone: Synthetic opioid with an analgesic potency similar to morphine; widely used in the treatment of opiod withdrawals

Answer 15

rapid distribution and slower elemination than morphine

Question 16

Fentanyl: Synthetic Opioid with 50-100 x potency than morphine with a wide margin of safety; rapid onsset (3-4 minutes) whorter duration (30 minutes); metabolized by the liver; decreased hepatic fx=decreased cleanance

Answer 16

Increased lipid soluability and molecular confirmation enabling effecient penetration of blood-brain barrier; preferred with patients with hemodynamic instability; patients sens to histamine release after morhine or morphine tolerance; good for procedural relief

Question 17

Synthetic opioids show a more rapid tolerance

Answer 17

3-5 days for morphine; 2 weeeks ir more for heroin

Question 18

Versed (Midazolam)

Answer 18

Benzodiazapine that offers sedation, anxiolysis, and amnesia but NOT ANALGESIA; penetrates the BBB rapidly (rapid onset of action)

Question 19

Versed

Answer 19

can cause respirtory depression -especially if administered rapidly, may cause hypotension, seizure-like myoclonus has been reported in premature infants receiving continious gtts

Question 20

Acetominophen: widely used in pain and fever, but lacks antinflammatory effects

Answer 20

used for mild discomfort (immunizations)

Question 21

NSAIDS have an antipyretic, analgesic and anti-inflammatory effects

Answer 21

can interfere with platelet aggregation, but this is reversible

Question 22

Non-pharmacological interventions

Answer 22

sucrose, sucking, kangaroo care, sucrose/sucking. facilitated tucking, music therapy, breast milk/BF, multisensorial stimulation