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Neonatal Pharmacology > Analgesics > Flashcards

Flashcards in Analgesics Deck (63):
1

T/F: They used to think Neonates could not feel pain

True :-(

2

Name the 2 categories of Analgesics

Opioid
Non-Opioid

3

There are 2 types of Opioids. What are they?

Naturally Occurring Agents (Opium Alkaloids)
Synthetic Opioid Agonists

4

What do Synthetic Opioid Agonists do?

Elicit Morphine-like activity

5

Name the 7 Synthetic Opioid Agonists mentioned in lecture

1. Codeine
2. Oxycodone
3. Methadone
4. Morphine
5. Hydromorphone
6. Meperidine
7. Fentanyl

6

What is the Mechanism of Action of Analgesics?

Activation of receptors within the CNS.

7

How is Analgesia Obtained?

By spinal or Supraspinal activation of Opioid Receptors--->Decreased Neurotransmitter release from Nociceptive/Sensory Neurons (Altering perception and response to pain).

8

Do Opioid Receptors exist outside the CNS?

Yes

9

Where are Opioid Receptors outside of the CNS?

The Dorsal Root Ganglia and in the terminals of Primary Afferent Neurons

10

What was the WHO Analgesic Ladder developed for originally?

Developed for the Tx of CA pain

11

How do you treat Mild Pain?

W/non-Opioid Analgesics

12

Name some non-Opioid Analgesics

Acetaminophen
NSAIDS

13

How do you treat Moderate Pain?
(According to WHO Analgesic Ladder)

W/Weaker Opioids or Combination Products

14

How do you treat Severe Pain?
(According to WHO Analgesic Ladder)

What are the 2 most common agents used
in the NICU to tx severe pain?

Stronger Agents


1. Morphine
2. Fentanyl

15

In Neonates, Opioids are reserved to treat _____ to _____ pain

Moderate to Severe

16

What are the Side effects of Opioids (8)?

1. Respiratory Depression
2. Hypotension
3. Glottic and Chest wall rigidity
4. Constipation
5. Urinary Retention
6. Seizures
7. Sedation
8. Bradycardia

17

How can Side effects be minimized when prescribing Opioids?

Appropriate Drug Selection
Appropriate Drug Dosing

18

What should be monitored during Opioid Administration?

Conitnuous Cardiac Monitoring &
Frequent VS

19

What is Naloxone?

What does it do?

(Narcan)
Competitive Opioid Receptor agonist
Reverses many side-effects of Opioids

20

In addition to reversal of side effects, what else does Naloxone do?

Antagonizes the Endorphin Effects (Increases pain perception)

21

Which patients should Not receive Naloxone?

Why?

Infants with Long-term, Chronic exposure of Opioids in Utero

Seizures

22

What are the long-term side-effects of Naloxone?

We don't know.
They are not studied.

23

What is the T 1/2 of Naloxone in a NB?

Why could this be a problem?

~70 minutes

It could be shorter than the T 1/2 of the Opioid

24

What is the onset of action of Naloxone?

Variable,
IV administration-within minutes
IM administration-within 30 minutes

25

What might Naloxone be used for?

What is Naloxone NOT used for?
If necessary in the DR, what must be restored 1st?

Narcotic induced Respiratory Depression

In the DR for initial Respiratory Depression
Restore Proper HR and Ventilation

26

What is the most common Opioid used in NICU?

Morphine

27

Morphine is soluble in _____ but has poor ______ solubility

Water
Lipid

28

Morphine metabolites are cleared by the ________ and partly by _____ ________

Kidneys
Biliary Excretion

29

Is there a difference in Analgestic effect between continuous and intermittent Morphine dosing?

No

30

What can happen in infants with impaired Renal function receiving Morphine?

Accumulation of Morphine

31

How is Morphine mainly administered for Analgesia?

IV
Can be used IM (but is painful)
Rectal-exists but wide variability

32

Morphine clearance improves with?

Postconceptual Age

33

What 3 signs are A/W the Histamine response from Morphine administration?

Hypotension, Bradycardia, & Flushing

34

The Histamine response from Morphine is a/w?

Rapid Administration

35

Morphine may have effects on b/p but are probably dependent on ______ & _______ ___.

Dosing
Gestational Age

36

What is the Peak of Morphine?

45-90 minutes

37

What is the Duration of Morphine

4-5 hours

38

Methadone is a synthetic Opioid with an analgesic potency similar to ______.

Morphine

39

What medication is Widely used for the tx of Opioid withdrawal in Neonates?

Methadone

40

Methadone has a Slower/more Rapid distrubution and a more Rapid/Slower elimination than Morphine.

More rapid Distribution
Slower elimination

41

What medication is used in addicted adults to avoid withdrawl?

Methadone

42

What medication has a propensity toward muscle rigidity?

Fentanyl

43

Fentanyl has ___ - ____ fold potency of Morphine

50-100 fold

44

There is a Narrow/Wide margin of safety with Fentanyl

Wide

45

What is the onset of Fentanyl?

3-4 minutes

46

What is the Duration of action of Fentanyl?

30 minutes

47

Fentanyl is metabolized by _______

Liver

48

What makes Fentanyl a good choice for precedural pain?

It has a shorter duration (30 minutes)-probably due to increased lipid solubility & molecular confirmation enabling efficient penetration of the BBB

49

Is the tolerance of a synthetic opioid like Fentanyl faster or slower?

Faster (3-5 days) vs. MsO4 (2 wks) or Heroin (2 wks)

50

Clearance of Fentanyl may be impaired with what?

Decreased Liver blood flow or function

51

What agent may be the preferred agent for:
Critically ill pt w/hemodynamic instability;
Symptoms of Histamine release w/Morphine administration; or pts with Morphine tolerance?

Fentanyl

52

Name the Benzodiazepine most often used in NICU

Midazolam (Versed)

53

Is a Benzodiazepine an Analgesic?

No

54

What does a Benzodiazepine do?

Sedation, Anxiolysis, Hypnosis, and Amnesia

55

Do Benzodiazepines cross the BBB rapidly?

Yes, accounting for rapid onset of action

56

Can Benzodiazepines cause respiratory depression?

Yes, especially when administered rapidly

57

Besides respiratory depression, what else can Benzodiazepines cause?

Hypotension
Seizure-like myoclonus (in premature infants w/continuous infusions)

58

What medication is widely used for management of pain and fever, but lacks anti-inflammatory effects?

Acetaminophen

59

When is Acetaminophen used?

Mild discomfort
1st immunizations & 24 hours past

60

NSAID's have what effects?

Antipyretic, Analgesic, Anti-inflammatory

61

What side effect do NSAID's have?

Is it reversible?

Interfere w/Platelet aggregation

Yes, it's reversible

62

When can non-pharmacologic interventions be used?

Any time appropriate

63

What are the non-pharmacologic interventions for pain?

Sucrose
NNS
Sucrose + NNS
KC
Facilitated tucking
Music Therapy
Breastmilk
Breastfeeding
Multi-sensorial stimulation