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Flashcards in pain meds Deck (48):

Ketorolac/Toradol class



Ketorolac/Toradol MOA

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


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


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


Ketorolac/Toradol CI

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


Ketorolac/toradol dose

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


Acetaminophen/Tylenol class

antipyretic, analgesic, antiprostaglandin cenrally acting NSAID


Acetaminophen/Tylenol MOA

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


Acetaminophen/Tylenol PK

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


Acetaminophen/Tylenol SE

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


Acetaminophen/Tylenol CI

liver and renal disease, decrease dose for alcoholic cirrhosis,


Acetaminophen/Tylenol dose

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


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.


Hydromorphone/Dilaudid- class

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


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


Hydromorphone/Dilaudid CI

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


Hydromorphone/Dilaudid dose

1-4mg IV a4-6hr


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


Morphine class

natural opioid agonist


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.


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


Morphine ci

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


Morphine dose

1-5mg IV q2-5min


Meperidine/Demoral class

phenyl-piperidine synthetic opioid agonist


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


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


Meperidine/Demoral CI

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


Meperidine/Demoral dose

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


Fentanyl class

phenyl piperidine synthetic opioid agonist


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


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;


Fentanyl CI

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


Fentanyl dose

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


sufentanil class

phenyl-piperidine synthetic opioid agonist= most potent opoid


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


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


sufentanil CI

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


sufentanil dose

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


alfentanil class

tetrazole fentanyl derivative that is a synthetic opid agonist


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


alfentanil SE

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


alfentanil CI

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


alfentanil dose

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


Remifentanil class

phenyl-piperidine synthetic opioid agonist with ester link


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


Remifentanil SE

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


Remifentanil cI

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


Remifentanil dose

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