What class is fentanyl?
Narcotic analgesic (schedule 2)
What is fentanyl also called?
Sublimase
What is the MOA for fentanyl?
Agonist actions at the body’s opioid (eg, morphine) receptor. Increases tone and decreases smooth muscles of the GI tract
What are the indications for fentanyl?
This drug is used to treat severe pain, used as an anesthetic or for procedural sedation.
What are the contraindications for fentanyl?
Myasthenia gravis, children under 2 years old.
Adverse reactions for fentanyl?
Skeletal and thoracic muscular rigidity, bradycardia, seizures and diaphoresis
Drug interactions for fentanyl?
May interact with alcohol or any CNS depressants.
How fentanyl supplied?
50 ug/mL ampules
Dosage and administration for fentanyl
Adult dose is 25-100 ug (.5-2 ug/kg) IM, IO, IVP or atomized intranasal. (Varies considerably by protocols).
Pediatric 2-12 years: 1.7-3.3 ug/kg IM, IO, IVP
Duration of action for fentanyl
Onset: immediate IV 7-15 minutes IM Peak effect: 3-5 minutes IV, 30 minutes IM Duration m: 30-60 minutes IV 1-2 hours IM
Special considerations for fentanyl
Pregnancy safety: category C. May cause life threatening hypoventilation, naloxone hydrochloride [narcan] should be readily available.
What is morphine sulfate also called?
Astramorph/PF and others
What class is morphine?
Opioid analgesic (schedule 2 narcotic)
MOA for morphine
Alleviates pain through CNS action, suppresses fear and anxiety centers in the brain; depresses brain stem respiratory centers, increases peripheral venous capacitance and decreases venous return, decreases preload and after load, which decreases myocardial oxygen demand.
Indications for morphine
Severe CHF, pulmonary edema, chest pain associated with acute MI, analgesia for moderate to severe acute and chronic pain (use with caution)
Contraindication for morphine
Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased level of consciousness, suspected hypovolemia, patients who have taken MAOIs within the past 14 days.
Adverse reactions for morphine
Respiratory depression, hypotension, decreased level of consciousness, nausea, vomiting, bradycardia, tachycardia, syncope, facial flushing, euphoria, bronchospasm, dry mouth.
Drug interactions for morphine
Potentiates sedative effects of phenothiazine. CNS depressant may potentiate effects of morphine. MAOIs may cause paradoxical excitation.
How is morphine supplied?
10mg in 1ml of solution, ampules and tubex syringes.
Dosage and administration for morphine
Adult: initial dose: 2-4mg IV (over 1-5 minutes) every 5-30 minutes.
Repeat dose: 2-8mg at 5- to 15- minute intervals.
Pediatric: .1-.2mg/kg per dose via IV, IO, IM or SC; maximum dose of 5mg.
Duration of action for morphine
Onset: immediate
Peak effect: 20 minutes
Duration: 2-7 hours
Special considerations for morphine
Pregnancy safety: category C. Morphing rapidly crosses the placenta. Safety in neonate not established. Use with caution in geriatric population and those with COPD, asthma. Vagotonic effect in patient with acute inferior MI (bradycardia, heart block). Naloxone hydrochloride (narcan) should be readily available as an antidote.
What is nitrous oxide also known as?
Oxygen (50:50) nitronox
What class is nitrous oxide?
Gaseous analgesic and anesthetic
MOA for nitrous oxide
Exact mechanism unknown; affects central nervous system phospholipids
Indications for nitrous oxide
Moderate to severe pain, anxiety, apprehension
Contraindications for nitrous oxide
Impaired level of consciousness, head injury, inability to comply with instructions; decompression sickness (nitrogen narcosis, air embolism, air transport); undiagnosed abdominal pain or marked distention, bowel obstruction; hypotension, shock, COPD (with history/suspicion of carbon dioxide retention); cyanosis; chest trauma with pneumothorax
Adverse reactions to nitrous oxide
Dizziness, apnea, expansion of gas filled pockets, cyanosis, nausea, vomiting, malignant hyperthermia, drowsiness, euphoria
Drug interactions for nitrous oxide
None of significance
How is nitrous oxide supplied?
D and E cylinders (blue and Green) of 50% nitrous oxide and 50% oxygen compressed gas
Dosage and administration for nitrous oxide
Adult: (note: invert cylinder several times before use) instruct the patient to inhale deeply through demand valve and mask or mouthpiece. Pediatric: same as adult
Duration of action for nitrous oxide
Onset: 2-5 minutes.
Peak effect: variable
Duration: 2-5 minutes.
Special considerations for nitrous oxide
Pregnancy safety: nitrous oxide increases the incidence of spontaneous abortion. Ventilate patient area during use. Nitrous oxide is a nonflammable and nonexpolsive gas. Nitrous oxide is ineffective in 20% of the population.
What class is oxygen?
Naturally occurring atmospheric gas
MOA for oxygen
Reverses hypoxemia
Indications for oxygen
Confirmed or expected hypoxemia, ischemic chest pain, respiratory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased level of consciousness
Contraindications for oxygen
Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation. Oxygen should never be withheld from a patient who needs it. Be prepared to assist with ventilations in a patient with COPD who requires high concentration, as apnea may result.
Adverse reactions for oxygen
Decreased level of consciousness and respiratory depression in patients with chronic carbon dioxide retention. Retrolental fibroplasia if giving high concentrations to premature infants (maintain 30-40% oxygen)
Drug interactions for oxygen
None
How is oxygen supplied?
Oxygen cylinders (usually green and white) of 100% compressed oxygen gas
Dosage and administration for oxygen
Adult: cardiac arrest and carbon monoxide poisoning: 100%.
Hypoxemia 10-15 l/min via NRB. COPD 1-6 l/min via nasal cannula or 28-35% Venturi mask. Be prepared to provide ventilatory support if higher concentrations of oxygen needed. Pediatric: same as for adult with exception of premature infant
Duration of action for oxygen
Onset: immediate
Peak effect: not applicable
Duration: less than 2 minutes
Special considerations for oxygen
Be familiar with liter flow and each type of delivery device used. Supports possibility of combustion.
What is diphenhydramine also called?
Benadryl
What class is diphenhydramine
Antihistamine; anticholinergic
MOA for diphenhydramine
Blocks cellular histamine receptors; decreases vasodilation; decreases motion sickness. Reverses extrapyramidal reactions.
Indications for diphenhydramine
Symptomatic relief allergies, allergic reactions, anaphylaxis, acute dystonic reactions (phenothiazines). Blood administration reactions; used for motion sickness, hay fever.
Contraindications for diphenhydramine
Asthma, glaucoma, pregnancy, hypertension, narrow-angle glaucoma, infants, patients taking monoamine oxidase inhibitors (MAOIs)
Adverse reactions for diphenhydramine
Sedation, hypotension, seizures, visual disturbances, vomiting, urinary retention, palpitations, arrhythmias, dry mouth, and throat and paradoxical CNS excitation in children.
Drug interactions for diphenhydramine
Potentiates effects of alcohol and other anticholinergic may inhibit corticosteroid activity; MAOIs prolong anticholinergic effects of diphenhydramine
How is diphenhydramine supplied?
Tablets: 25,50mg
Capsules: 25,50mg
Prefilled syringes: 50- or 100 mg vials(IV or IM)
Elixir, 12.5 mg/5ml.
Dosage and administration for diphenhydramine
Adult: 25-50 mg IM or IV or PO.
Pediatric: 1-2ng/kg IV, IO slowly or IM. If given PO: 5mg/kg/24 hours.
Duration of action for diphenhydramine
Onset: 15-30 minutes
Peak effect: 1 hour
Duration: 3-12 hours
Special considerations for diphenhydramine
Not used in infants or in pregnancy. Category B. If used in anaphylaxis, will be in conjunction with epinephrine, corticosteroids