Pain Meds Flashcards by Rich Saldibar

Acetaminophen (Ofirmev):

Action

inhibits the synthesis of prostaglandins, which transmit pain signals and induce fever
Reduces pain by blocking the signals produced by prostaglandins

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Fentanyl

Indications

Treatment of Pain as Needed:

Abdominal Pain
Burns
Envenomation Injury
Trauma

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Fentanyl

Class

Analgesic; Opioid Agonist

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Fentanyl

Contraindications

None

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Acetaminophen (Ofirmev):

Side effects

nausea, vomiting
headache, sleep problems
constipation
itching, agitation
partial or total lung collapse in pediatric patients

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Midazolam (Versed)

Indications

Seizures
PEDS seizures
Unstable Bradycardia (adult only)
- pain associated with PACING — after fentanyl if BP ≥ 100
Unstable (conscious) VT: precardioversion
Conscious SVT: precardioversion
Unstable, Conscious A-fib, A-flutter
- precardioversion
Overdose with excited delirium
Combative Patients

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Fentanyl

Onset/Duration

Onset: 1-2 minutes

Duration: 30-60 minutes

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Acetaminophen (Ofirmev):

Contraindications

< 2 years old

severe hepatic impairment
severe active liver disease
if known or suspected total dose exceeding 4000mg in 24 hours

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Morphine (MS, MS04)

Administration

Slow IVP

document vital signs and pain scale before and after each administration

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Morphine (MS, MS04)

Contraindications

None

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Midazolam (Versed)

Contraindications

None

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Ketamine (Ketalar)

Requirements

- ≥ 15 years old
AND with GCS of 15
AND not pregnant
AND no known/suspected DRUGS/ETOH
AND have NOT received opioid analgesic in past 6 hours (prior to medic arrival)

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Midazolam (Versed)

Side Effects

Respiratory depression / apnea

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Ketamine (Ketalar)

BHO required for:

BP < 100
Change in the analgesic type
change in administration route

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Fentanyl

Maximum dose for < 65 years old

100mcg

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Midazolam (Versed)

Action

CNS depressant
Produces anterograde amnesia, then sedation
Stops and prevents seizures

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Acetaminophen (Ofirmev):

Dosage/route — Adult

1000 mg IV x1 SO

Infuse over 15 minutes !!!!

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Morphine (MS, MS04)

Adult IV dosage

0.1 mg/kg IV — SO
MR in 5 minutes at half the initial IV dose - SO
MR in additional 5 minutes at half the initial dose - BHO
Maximum for ANY IV dose is 10mg

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Ketamine (Ketalar)

Contraindications

Pediatrics
Pregnancy
Severe hypertension
Alcohol intoxication

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Midazolam (Versed)

Onset/duration

Onset: IV/IO/IN = 2 minutes
IM = 15 minutes

Duration: 1-4 hours

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Fentanyl

IN dose if ≥ 65 yrs old

25mcg IN q15 minutes, x2. SO
3rd dose of 25mcg IN = BHO

Treatment of BP < 100. BHO

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Fentanyl

Packaging

50mcg/ml

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Morphine (MS, MS04)

Packaging

10mg / ml

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Fentanyl

IN dose for < 65 yrs

50mcg IN q15 min x2 SO

- 3rd IN dose of 50mcg is BHO…. (winds up 150mcg??)

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Fentanyl Action

Potent narcotic analgesic and sedative

Fentanyl PEDS

<10kg - IV/IN. PDC BHO - MR PDC BHO ≥ 10kg - IV/IN PDC SO - MR PDC BHO... max 75mcg

Morphine (MS, MS04) Indications

Treatment of Pain as needed: - Abdominal Pain - Burns - Envenomation Injuries - Trauma

Midazolam (Versed) Dose/route: conscious SVT, precardioversion

Adult: 1-5mg slow IV/IO (1mg/min) - BHO PEDS: PDC slow IV (1mg/min) - BHPO

Midazolam (Versed) Dosage for seizures (adult/PEDS)

Adult: IN, IM, IV, IO - to max 5mg D/C iv/IO dose if seizures stop MR x1 in 10 minutes. Max, 10mg total PEDS PDC - IV, IM, IN

Acetaminophen (Ofirmev): Indications

Treatment of Pain as Needed: - Abdominal Pain - Burns - Envenomation - Trauma

Midazolam (Versed) Dose/Route: unstable Brady

Adult Only: 1-5 mg slow IV/IO (1mg/min) - SO If age ≥60, consider lower dose with attention to age and hydration status

Ketamine (Ketalar) Packaging

50mg/ml | 10ml multi-dose vial containing 500mg total

Morphine (MS, MS04) BHPO if:

- Isolated head injury - Acute onset severe headache - Drug/ETOH intoxication - Multiple trauma with GCS < 15 - Suspected active labor

Ketamine (Ketalar) Class

Anesthetic/Analgesic

Fentanyl BP requirement

BP ≥ 100 = SO BP < 100. = BHO

Ketamine (Ketalar) Dosage (adult only), IN route

- 0.5mg/kg IN SO 50mg/kg concentration Maximum for any IN dose = 50mg - MR x1 in 15 minutes if pain remains moderate or severe, SO

Morphine (MS, MS04) If BP < 100

BHO

Acetaminophen (Ofirmev): Packaging

1000mg/100ml (10mg/1ml)

Morphine (MS, MS04) Class

- opioid | - narcotic analgesic

Acetaminophen (Ofirmev): Onset/Duration

Onset: 15 minutes Peak: 1 hour Duration: up to 4-6 hours

Morphine (MS, MS04) Onset/Duration

Onset: 1-2 minutes Duration: 2-7 hours

Midazolam (Versed) Dose/route: Excited Delirium or Combative Patients

Adult Only 5mg IN, IM, IV MR x1 in 10 minutes

Morphine (MS, MS04) Dose/route for suspected CARDIAC/pacing

Adult Only: .05mg/kg IV x1 - SO (... half of IV dose)

Acetaminophen (Ofirmev): PEDS Administration

- get dose PDC and draw it from vial - inject this dose into 100ml NS bag - administer as piggyback ... over 1 minutes

Morphine (MS, MS04) PEDS dose/route

With signs of adequate perfusion: - PDC, IV/IM - MR - BHO

Midazolam (Versed) Class

Benzodiazepine: Sedative / Anticonvulsant

Morphine (MS, MS04) Action

- CNS depressant acting on opiate receptors in the brain | - Potent analgesic and sedative

Acetaminophen (Ofirmev): Class

Analgesic/Antipyretic

Midazolam (Versed) Administration rate

1mg / minute (when IV/IO)

Ketamine (Ketalar) Side Effects

- increased heart rate - increased blood pressure - increased respiratory rate - nausea - With higher doses and rapid infusion (disassociative effects): - Euphoria - Dysphoria

Ketamine (Ketalar) Maximum IV dose

20mg

Morphine (MS, MS04) Adult IM dosage

- 0.1mg/kg IM — SO - MR in 15 minutes at half the initial IM dose - SO - MR in additional 15 min at HALF the initial IV dose - BHO - Max for ANY IM dose = 10mg

Fentanyl IV dose if > 65 yrs

- 25mcg IV x1 SO - MR 25mcg slow IVP x2 q5” Maximum SO dose = 75mcg

Fentanyl For Pain of suspected Cardiac Origin or External Pacing

ADULT ONLY: | - 25mcg IV x1 SO

Ketamine (Ketalar) Dosage/Route: Adult (only) IV route

- 0.2mg/kg in 100ml of NS, SO SLOW IV drip over 15 minutes Maximum for any IV dose is 20mg - MR x1 in 15 minutes if pain remains moderate or severe, SO

Morphine (MS, MS04) Side effects

- respiratory depression/apnea - decreased LOC - Transient hypotension - Nausea/vomiting - Pinpoint pupils

Midazolam (Versed) Packaging

5mg/1ml (or 10mg/2ml)

Ketamine (Ketalar) Action

- Low and Slow dosing: strong analgesic effects acting on the limbic system and cortex to BLOCK afferent impulses of PAIN PERCEPTION - HIGH and Rapid dosing: fast acting dissociative anesthesia

Ketamine (Ketalar) Maximum IN dose

50mg

Midazolam (Versed) Dose/route: unstable conscious A-fib, A-flutter

Adult Only: 1-5mg slow IV/IO (1mg/min) - BHPO

Morphine (MS, MS04) Maximum for ANY IV dose

10mg

Acetaminophen (Ofirmev): Dosage/Route — PECS

≥ 2 y/o PDC, SO x1 Infuse over 15 minutes

Fentanyl IV dose IF < 65 yrs

Titrate to pain and vital signs: - up to 50mcg IV x1 SO - MR 25mcg IV q5” x2 SO - Maximum SO dose = 100mcg

Ketamine (Ketalar) Indications

Moderate-Severe Pain (score ≥5) - Burns - Envenomation Injury - Trauma

Acetaminophen (Ofirmev): BHPO for:

- Isolated Head Injury - Acute onset severe headache - Drug/ETOH - Multiple Trauma with GCD < 15 - Suspected active labor

Morphine (MS, MS04) maximum for ANY IM dose

10mg

Acetaminophen (Ofirmev): Maximum Daily Dose

4000 mg

Pain Meds Flashcards

(67 cards)