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Flashcards in pain meds Deck (48):
1

Ketorolac/Toradol class

NSAID

2

Ketorolac/Toradol MOA

blocks cyclooxygenase 1&2 inhibiting prostaglandin synthesis causing anti-inflammatory effects and analgesia effects

3

Ketorolac/Toradol PK

99%PB, onset 10min, peak 2-3 hours, e1/2 5HR- prolonged 5-8hr with elderly.liver conduction and 60% renal excretion unchanged

4

Ketorolac/Toradol Se

no respiratory or CV depression, impaired bone healing, GI bleed, ulcers, bonchospasm (increased leukotrines), ARF, increased bleeding time, can inhibit platelet function, chronic use increases likely hood for MI and stroke

5

Ketorolac/Toradol CI

asthma, RF, ASA allergy, liver failure, GIB, coagulation problems, 3rd trimester, BLACK BOX- do not use post CABG

6

Ketorolac/toradol dose

30mg IV x1 or q6hr (daily max 120mg), don't give longer then 5 days, decrease dose for elderly to 15mg

7

Acetaminophen/Tylenol class

antipyretic, analgesic, antiprostaglandin cenrally acting NSAID

8

Acetaminophen/Tylenol MOA

NMDA receptor blocker in CNS, blocks substance P in SC; desensitizes TRPA channels which transmit CA2+ and NA. lacks peripheral effects

9

Acetaminophen/Tylenol PK

c-max 15min, PO peaks 30-60min, conjugated and hydroxylated in the liver with little excreted unchanged in the urine

10

Acetaminophen/Tylenol SE

renal toxicity bc metabolites can acculate; od= liver failure, ulcers, can impair platelet function

11

Acetaminophen/Tylenol CI

liver and renal disease, decrease dose for alcoholic cirrhosis,

12

Acetaminophen/Tylenol dose

ig IV over 15 min q 4-6hr, 325-650mg PO-
4G max per day

13

opioid MOA

activates g-coupled protein receptors on Mu1, Mu2, Kappa and Delta receptors located on the peripheral ends of primary afferent neurons to directly decrease transmission or inhibit the release of neurotransmitters increasing the pain threshold, altering pain perception and inhibiting ascending pain pathways. They mimic endogenous substances such as endorphins, enkephalins, and dynorphins at the opioid receptor resulting in presynaptic receptors to decrease neurotransmitter release such as ePI, NE, ACh, and substance p; postsynaptic effects include hyper polarization of the neuron because increase K conductance out of the cell and Ca2+ channel inactivation.

14

Hydromorphone/Dilaudid- class

opioid agonist that is derivative of morphine that is 5x more potent than morphine

15

Hydromorphone/Dilaudid SE

provides analgesia, euphoria, sedation, and no histamine release; can cause N/v/C, pruritus, dry mouth, respiratory depression, urinary retention, bradycardia, decrease sVr (dose dependent), tolerance with prolonged use

16

Hydromorphone/Dilaudid CI

allergy, severy respiratory depression- COPD, asthma, wooden chest syndrome, decrease dose in elderly and/or hypovolemia

17

Hydromorphone/Dilaudid dose

1-4mg IV a4-6hr

18

Hydromorphone/Dilaudid PK

8-19%PB, onset <30min IV, Peak 5-10min, DOA 4-5h, e1/2 1-3hr, significant 1st pass metabolism in liver with 95% metabolized to Hydromorophone-3-glucuronide (inactive) and excreted in the urine

19

Morphine class

natural opioid agonist

20

Morphine PK

pKa=7.9, 23% unionized, 30%PB, low lipid solubility; IV Peak 15-30min, redistributes in 3 min; DOA 3 hours, e1/2 3-4h, liver metabolism to morphine-3-glucoronide (less active) and morphine-6-glucoronide(active metabolite that is 650x's more potent than parent) and excreted in the urine 1-12%unchanged and excreted in bile.

21

Morphine SE

Histamine release, decreases HR, BP, SVR, CO (these 4 are dose dependent), CBF, ICP, CO2 response curve and shifts to the right. Miosis. inhibits SA/AV node can lead to bradycardia, delayed respiratory depression in epidurals and spinals bc hydrophilic and takes a longer time to diffuse to the respiratory center in the brain. urinary retention, pruritus, N/V/C; increased risk of dependence and tolerance- Class 2 drug. SOO

22

Morphine ci

respiratory depression, asthma/COPD, allergy, bronchospasm, decrease dose or give only 1 dose to RF pts bc the metabolites accumulate

23

Morphine dose

1-5mg IV q2-5min

24

Meperidine/Demoral class

phenyl-piperidine synthetic opioid agonist

25

Meperidine/Demoral Pk

60%PB, fast onset, nonionized 10%, DOA 3h, low lipid solubility, redistributes in 4-16min, e1/2 3-5h, liver metabolism to normeperdine (e1/2 15h and 1/2 potency of parent and can cause sz, confusion, hallucinations, myoclonus), and excreted in urine, 65% pulmonary 1st pass effect

26

Meperidine/Demoral Se

histamine release, decreases shivering; increases HR and direct cardiac depression, increases ICP, dry mouth, urinary retention, N/V/C, increased risk of tolerance and dependence

27

Meperidine/Demoral CI

fatal interaction with MAOi's, metabolite accumulates in renal disease; watch for CV disease, watch in neuro disease, allergy, sz history

28

Meperidine/Demoral dose

12-.5- 50mg IV
max dose 1gm/day

29

Fentanyl class

phenyl piperidine synthetic opioid agonist

30

Fentanyl PK

80%PB, nonionized <10%; highly lipid soluble- Vd=4L/kg, effect site 6.4min; redistributes in 13min, short DOA 1hr, e1/2 3-6h, liver metabolism that is dependent on HBF and excreted in the urine, 75%pulmonary 1st pass effect, long context sensitive 1/2 time

31

Fentanyl SE

respiratory depression, sz, wooden chest syndrome, delayed gastric emptying, ADH release, SOO spasm, N/V/C, pruritus, dose dependent decrease in HR, BP, CO, SVR;

32

Fentanyl CI

liver disease, watch in renal disease, head trauma, gallbladder disease, brady arrhythmias

33

Fentanyl dose

bolus 15-50mcg; initial 1-3mcg/kg; infusion 0.01-0.05 mcg/kg/min

34

sufentanil class

phenyl-piperidine synthetic opioid agonist= most potent opoid

35

sufentanil PK

93%PB, highest lipid solubility; 20%nonionized, effect site 6.2min, short DOA- 30min, redistributes in 17min, e1/2 2.5h, liver and SI metabolism, excreted in urine 1%unchanged, 75% pulmonary 1st pass effect

36

sufentanil SE

hypotension, brady, cardiac arrest, potent respiratory depression, bronchospasm, wooden chest syndrome, muscle ridgidity, SOO, N/V/C, good for cardiac surgery; urinary retention, pruritus, dose dependent decrease in HR, BP, SVR, and CO; can cause dependence and tolerance

37

sufentanil CI

asthma, allergy, airway obstruction, decrease dose in elderly and hypovolemia

38

sufentanil dose

initial 0.1mcg/kg; infusion- 0.001mcg/kg/mi

39

alfentanil class

tetrazole fentanyl derivative that is a synthetic opid agonist

40

alfentanil PK

90%PB, 90%unionized, onset 1-2min, effect site 1.4min, short DOA 30-60 min, e1/2 90min, high lipid solubility so little accumulates in the tissues; metabolized in the liver and SI and leaves the plasma in 30min

41

alfentanil SE

slows eeg, increases ICP, respiratory depression, no change to SVR, CO. SOO, pruritus, N/V/C, skeletal muscle rigidity

42

alfentanil CI

untreated parkinson's, increased ICP, respiratory depression, allergy

43

alfentanil dose

initial 10-20mcg/kg; infusion 0.25--.75mcg/kg/min

44

Remifentanil class

phenyl-piperidine synthetic opioid agonist with ester link

45

Remifentanil PK

80%PB, 67%non-ionized, high lipid solubility, onset 1-3min, very short DOA 10min, effect site 1.4min, metabolized by tissue plasma esterase's- not affected by cholinesterase deficiency

46

Remifentanil SE

N/V/C delayed gastric emptying, SOO, dose dependent decrease hr bp; respiratory depression, dizziness, pruritus

47

Remifentanil cI

do not use in epidural/spinals; need plan for post op pain control; allergy, respiratory depression

48

Remifentanil dose

initial 1-2mcg/kg; infusion 0.05-0.25mcg/kg/min