Pharm Flashcards
Central Regional Opioid Analagesia:
- what are the two types? describe each.
- when is this administered?
- which medications are commonly used?
- adverse SE of medication used?
Two types of central regional opioid analgesia:
- epidural: injection outside the dura.
- intrathecal: aka spinal anesthesia; injection through the dura directly into the CSF.
Administered preincisional
Medication commonly used is morphine or fentanyl
Adverse SE of morphine:
-pruritis, urinary retention,
Central Regional Opioid Analagesia:
- single dose of Morphine (intrathecal opioid) can provide pain relief for up to how many hours?
- onset of action for Morphine (intrathecal opioid)?
- single dose of fentanyl (intrathecal opioid) can provide pain relief for up to how many hours?
- onset of action for fentanyl (intrathecal opioid)?
MORPHINE:
Pain relief for up to 18-24hrs post op
Intrathecal opioid onset of action 45minutes
FENTANYL:
pain relief for up to 1-2hrs
onset of action 5-10minutes
Patient Controlled Analgesia:
-which medications are given in a PCA pump?
-Morphine, hydromorphone, and fentanyl can be given PCA, fentanyl is less desirable d/t short acting DOA.
T/F, using 2 or more drugs that act by different mechanism for providing analgesia offer better pain control?
True, e.g. opioids (IV morphine) + NSAIDS (Ketorolac). Central regional analgesia (epidural) + regional meds (nerve block)
Peripheral Regional Techniques:
- what are these?
- T/F preoperative nerve blocks are effective at reducing post op pain and decrease the need for opioid use?
- T/F, preoperative infiltration of the incision with local anesthetic (bupivicaine) decreases post op pain scores.
What: peripheral nerve blocks, intraarticular blocks, and infiltration of incisions
True.
True.
Which patients are at risk for inadequate pain control?
Peds
Geriatrics
Critically ill
Congnitively impaired
others who may have difficulty communicating
Opioids: -what are these? -administration -metabolism? -
What:
- morphine*
- Dilaudid* (hydromorphone)
- Fentanyl*
- Meperidine (Demerol)
- = MC used for post op IV pain management
Administration:
-bolus injections(MC), continuous infusion (Can be dangerous), PCA.
Hepatically metabolized
Morphine:
- peak effects
- elimination half life
- duration of action
- onset
- SE of morphine toxicity?
-peak effects: 1-2hrs
Elimination half life: 2-3hrs
Duration of action: 4-5hrs
Onset: rapid
Morphine toxicity:
-myoclonus, confusion, coma, death
Dilaudid:
- onset
- half life
- potency compared to morphine
Onset: peak 30minutes
Half life: 2.4hrs
Potency: 4-6x more potent than morphine
Fentanyl:
- potency compared to morphine
- compared to morphine:
- -onset
- -half life
- -elimination
- -penetration
- routes of administration
100x more potent than morphine
Onset: more rapid than morphine
Half life: shorter half life than morphine
elimination half life is 2-4hrs
Penetration: improved penetration of the blood brain barrier.
Administration: IV and Transdermal.
Meperidine:
- indications
- CI in which patients?
indications: short term management of acute pain
CI in pts on MAOI
Opiod SE
Somnolence
depression of brainstem control of resp drive
hypotension
urinary retention
N/V
slowed GI transit
Histamine release (MC with morphine)
WHen do we transition from IV to oral opioids?
How long to effect in PO analgesics?
Which PO opioids are MC used when transitioning from IV to PO pain control?
Switch from IV to oral once pt can tolerate PO.
PO analgesics effects take 30-60minutes
Meds:
- oxycodone (oxycontin)
- hydrocodone
- hydromorphone (dilaudid)
- morphine
- Percocet (oxycodone/acetaminophen)
- Vicodin (Hydrocodone/acetaminophen)
- = MC used in PO pain meds post surgery
Opioids:
-which are short acting, moderate acting, and long acting?
Short: fentanyl
Moderate: Morphine, codeine, hydromorphone, oxycodone
Long acting: methadone
For patients with impaired renal function which opioids are safest? why?
Hydromorphone and oxycodone have inactive metabolites and are safer than morphaine.
Fentanyl: safer than morphine in pts with renal impairment
