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Pain Management Flashcards

(39 cards)

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1
Q

What is the treatment for an adult in mild pain?

A
  • Paracetamol 1000mg oral
    OR
  • Paracetamol 500mg oral (frail or elderly)
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2
Q

What is the treatment for an adult in moderate pain?

A
  • Morphine up to 5mg IV
    – Repeat up to 5mg @ 5/60 (consult after 20mg)
    OR
  • Fentanyl up to 50mcg IV
    – Repeat up to 50mcg IV @ 5/60 (consult after 200mcg)
    OR
  • Fentanyl 200mcg IN
    – Repeat up to 50mcg IN @ 5/60 (consult after 400mcg)
    – Fentanyl 100mcg IN (frail or elderly)
    OR
  • Methoxyflurane 3mL inhaled
    – Repeat 3mL if required (max 6mL)
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3
Q

What is the treatment for an adult in severe pain?

A
  • Morphine/Fentanyl IV as per moderate pain
  • Fentanyl IN or methoxyflurane as per moderate pain
  • Consult for Ketamine IV in extreme traumatic pain (10-20mg @ 5-10min)
  • Morphine 10mg IM
    • Repeat morphine 5mg IM after 15mins
    • Morphine 0.1mg/kg IM (frail or elderly)
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4
Q

What is the preferred treatment for pain in a paediatric patient?

A
  • Fentanyl IN followed by ketamine +/- IV opioids rather than opioids alone
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5
Q

What is the treatment for a paediatric patient in mild pain?

A
  • Paracetamol 15mg/kg oral
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6
Q

What is the treatment for a paediatric patient in moderate pain?

A

Fentanyl IN

  • Small child (10-17kg) = 25mcg
  • Medium child (18-39kg) = 25-50mcg
    • Repeat initial dose @ 5-10/60 (consult after 3 doses)
- Consider paracetamol in combination
OR
If unable to administer Fentanyl IN 
- Methoxyflurane 3mL inhaled
-- Repeat 3mL if required (max 6mL)
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7
Q

What is the treatment for a paediatric patient in severe pain?

A
  • Fentanyl IN +/- Methoxyflurane as per moderate pain

- Consider Ketamine 0.25mg/kg IV @ 5-10/60 (max 0.5mg/kg) MICA ONLY

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8
Q

What is the presentation and route of administration of Paracetamol?

A 
Presentation 
= 500mg tablets
= 120mg in 5mL oral liquid (24mg/mL)
Route
= oral
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9
Q

What is the pharmacology of Paracetamol?

A
  • Analgesic and antipyretic agent
  • Thought to inhibit prostaglandin synthesis
  • Metabolised by the liver and excreted by the kidneys
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10
Q

What are the primary indications for Paracetamol?

A
  1. Mild pain

2. Headache

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11
Q

What are the contraindications for Paracetamol?

A
  1. Hypersensitivity
  2. Child age < 1month
  3. Already administred in the last 4hrs
  4. Greater than 4g in a 24hr period (adult) or 60mg/kg (child)
  5. Chest pain in suspected acute coronary syndrome
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12
Q

What are the precautions for Paracetamol?

A
  1. Impaired hepatic function or liver disease
  2. Elderly/frail
  3. Malnourished
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13
Q

What is the onset, peak and duration of Paracetamol?

A 
Onset = 30mins
Peak = n/a
Duration = 4hrs
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14
Q

What is the presentation and route of administration for Morphine?

A
  • 10mg in 1mL

- IV/IM/subcutaneous

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15
Q

What is the pharmacology of Morphine?

A

Opioid analgesic

CNS effects:

  • depression (leading to analgesia)
  • resp depression
  • depression of cough reflex
  • stimulation
  • dependence

Cardiovascular effects:

  • vasodilation
  • decreases conduction velocity through AV node

Metabolised by liver and excreted by kidneys

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16
Q

What are the primary indications for Morphine?

Study These Flashcards
A
  1. Pain relief
  2. Sedation to enable intubation
  3. Sedation to maintain intubation
  4. RSI
17
Q

What are the contraindications for Morphine?

Study These Flashcards
A
  1. Hypersensitivity
  2. Late second stage labour
  3. Renal impairment/failure
18
Q

What are the precautions for Morphine?

Study These Flashcards
A
  1. Elderly/frail patients
  2. Hypotension
  3. Respiratory depression
  4. Current asthma
  5. Respiratory tract burns
  6. Known addiction to opioids
  7. Acute alcoholism
  8. Patients on monoamine oxidase inhibitors
19
Q

What is the onset, peak and duration of IV Morphine?

Study These Flashcards
A 
Onset = 2-5mins
Peak = 10mins
Duration = 1-2hrs
20
Q

What is the onset, peak and duration of IM Morphine?

Study These Flashcards
A 
Onset = 10-30mins
Peak = 30-60mins
Duration = 1-2hrs
21
Q

What is the presentation and route of administration for Fentanyl?

Study These Flashcards
A 
Presentation
- 100mcg in 2mL
- 250mcg in 1mL (IN only)
Route
- IV/IN/IV infusion
22
Q

What is the pharmacology of Fentanyl?

Study These Flashcards
A

Synthetic opioid analgesic

CNS effects:

  • depression (leading to analgesia)
  • resp depression
  • dependence

Cardiovascular effects:
- decreases conduction velocity through AV node

Metabolised by the liver and excreted by the kidneys

23
Q

What are the primary indications for Fentanyl?

Study These Flashcards
A
  1. Sedation to facilitate intubation
  2. Sedation to maintain intubation
  3. Sedation to facilitate transthoracic pacing
  4. Sedation to facilitate synchronised cardioversion
  5. CPR interfering patient
  6. Analgesia - IV/IN
24
Q

What are the contraindications for Fentanyl?

Study These Flashcards
A
  1. Hypersensitivity

2. Late second stage labour

25
What are the precautions for Fentanyl?
1. Elderly/frail patients 2. Impaired hepatic function 3. Resp depression 4. Current asthma 5. Patients on monoamine oxidase inhibitors 6. Known addiction to opioids 7. Rhinitis, rhinorrhea or facial trauma (IN route)
26
What is the onset, peak and duration of IV Fentanyl?
``` Onset = immediate Peak = < 5mins Duration = 30-60mins ```
27
What is the onset, peak and duration of IN Fentanyl?
``` Onset = immediate Peak = 2mins Duration = 30-60mins ```
28
What is the presentation and route of administration for Methoxyflurane?
3mL | Self-administration under supervision using the hand held Penthrox inhaler
29
What is the pharmacology of Methoxyflurane?
Inhalational analgesic Metabolised by the liver and excreted by the lungs
30
What are the primary indications for Methoxyflurane?
1. Pain relief
31
What are the contraindications for Methoxyflurane?
1. Pre-existing renal disease 2. Exceeding 6mL in 24hrs 3. Concurrent use of tetracycline antibiotics 4. Family history of malignant hypothermia 5. Muscular dystrophy
32
What are the precautions for Methoxyflurane?
1. Penthrox inhaler must be hand-held by patients 2. Pre-eclampsia 3. Concurrent use with Oxytocin may cause hypotension
33
What is the presentation and route of administration for Ketamine?
200mg in 2mL | IV/IO/IM
34
What is the pharmacology of Ketamine?
Rapid acting dissociative anaesthetic agent (NMDA receptor antagonist) Produces a dissociative state characterised by: - trance like state with eyes open - nystagmus (eye twitching) - profound analgesia - normal pharyngeal and laryngeal reflexes - normal or slightly enhanced skeletal muscle tone - occasionally a transient and minimal resp depression Metabolised by the liver and excreted by kidneys
35
What are the primary indications for Ketamine?
1. RSI 2. Extreme traumatic pain refractory to opioid analgesia 3. Extreme agitation 4. CPR interfering patient
36
What are the contraindications for Ketamine?
1. Hypersensitivity | 2. Severe hypertension (SBP > 180)
37
What are the precautions for Ketamine?
1. Any condition where significant elevation of BP would be hazardous - Hypertension - CVA - Recent AMI - CCF 2. Inject slowly over 1min to minimise risk of resp depression and hypertension
38
What is the onset, peak and duration of IV Ketamine?
``` Onset = 30secs Peak = n/a Duration = 10mins ```
39
What is the onset, peak and duration of IM Ketamine?
``` Onset = 3-4mins Peak = n/a Duration = 12-25mins ```

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