para drug study 128

Fentanyl drug class

Narcotic analgesic

Fentanyl pharmacology

Acts on CNS by binding with opioid receptors

Fentanyl Metabolism

Hepatic metabolism and renal excretion

Fentanyl schedule

S8 (controlled drugs)

Fentanyl indications

Significant pain, Sedation, Autonomic dysreflexia (SYS BP > 160 mmHg), Induction for Rapid Sequence Intubation (RSI)

Fentanyl contraindications

Allergy/ADR

Fentanyl precautions

Hypotension, Respiratory depression/failure, Respiratory tract burns, Concurrent MAOI therapy, Known addiction to narcotics

Fentanyl side effects

Bradycardia, Drowsiness, Hypotension, Nausea and/or vomiting, Pin point pupils, Respiratory depression, Muscle rigidity

Fentanyl presentation

Ampoule, 100microg/2mL

Fentanyl onset

< 3 minutes

Fentanyl duration

30 - 60 minutes

Fentanyl half-life

2 - 3 hours

Fentanyl ≥ 70 years/cachectic/frail IM administration

25 - 50 microg

Repeated at up to 50 microg every 10 minutes

Total max dose 100 microg (or MME)

Fentanyl < 70 years IM administration

50 - 100 microg

Repeated at up to 100 microg every 10 minutes

Total max dose 200 microg (or MME)

Fentanyl ≥ 70 years/cachectic/frail NAS administration

25 - 50 microg

Repeated at up to 50 microg every 10 minutes

Total max dose 100 microg (or MME)

Fentanyl < 70 years NAS administration

50 - 100 microg

Repeated at up to 100 microg every 10 minutes

Total max dose 200 microg (or MME)

Fentanyl ≥ 70 years/cachectic/frail IV administration

25 microg

Repeated at up to 25 microg every 5 minutes

Total max dose 100 microg (or MME)

Fentanyl < 70 years IV administration

25 - 50 microg

Repeated at up to 50 microg every 5 minutes

Total max dose 200 microg (or MME)

Methoxyflurane drug class

Analgesic (at low doses)

Methoxyflurane pharmacology

Inhalation analgesic indicated for short-term pain relief

Methoxyflurane metabolism

Liver metabolism and lung excretion

Methoxyflurane schedule

S4 (restricted drugs)

Methoxyflurane indications

Pain

Methoxyflurane contraindications

Allergy/ADR, Patients under 1 year of age, History of renal/liver disease, history of malignant hyperthermia

Methoxyflurane precautions

ALOC, Intoxicated or drug affected patients, cardiovascular instability, respiratory depression

Methoxyflurane side effects

ALOC, Cough, Renal/hepatic failure

Methoxyflurane presentation

Bottle, 3mL

Methoxyflurane onset

1 - 3 minutes

Methoxyflurane duration

5 - 10 minutes

Methoxyflurane half-life

N/A

Methoxyflurane INH administration

3mL

Repeated once after 20 minutes

Total max dose 6mL

Paracetamol drug class

Analgesic, antipyretic

Paracetamol pharmacology

p-aminophenol derivative that exhibits analgesic and antipyretic activity

Paracetamol metabolism

Liver metabolism and kidney excretion

Paracetamol schedule

S2 (therapeutic poisons)

Paracetamol indications

Mild to moderate pain, fever (causing distress)

Paracetamol contraindications

Allergy/ADR, patients under 1 month of age

Paracetamol precautions

Hepatic dysfunction, soluble tablets (patients with sodium restriction - heart failure, chronic kidney disease and phenylketonuria)

Paracetamol side effects

Nausea

Paracetamol presentation

Tablet, 500 mg

Elixir, 120mg/5mL

Paracetamol onset

10 - 60 minutes

Paracetamol duration

4 hours

Paracetamol half-life

~2 hours

Paracetamol PO administration

0.5 - 1 g

Must not be given within 4 hours of previous paracetamol administration

Repeated every 4 hours

Total max dose 4 g in 24 hours

Morphine drug class

Narcotic analgesic

Morphine pharmacology

Acts on CNS by binding with opioid receptors

Morphine metabolism

Metabolised by liver, kidneys and lungs

Morphine schedule

S8 (controlled drugs)

Morphine indications

Significant pain, sedation, autonomic dysreflexia (SYS BP > 160 mmHg)

Morphine contraindications

Allergy/ADR, kidney disease (renal failure)

Morphine precautions

Hypotension, Respiratory depression/failure, Respiratory tract burns, Known addiction to narcotics, Concurrent MAOI therapy, Cardiac chest pain

Morphine side effects

Bradycardia, Drowsiness, Hypotension, Nausea and/or vomiting, Pin point pupils, Respiratory depression

Morphine presentation

Ampoule, 10mg/1mL

Morphine onset

IM 5 - 10 minutes (peak 20 - 30 minutes)

IV 2 - 5 minutes (peak 20 minutes)

Morphine duration

1 - 2 hours

Morphine half-life

2 hours

Morphine ≥ 70 years/cachectic/frail IM administration

2.5 - 5 mg

Repeated at up to 5 mg every 10 minutes

Total max dose 10 mg (or MME)

Morphine < 70 years IM administration

2.5 - 10 mg

Repeated at up to 5 mg every 10 minutes

Total max dose 20 mg (or MME)

Morphine ≥ 70 years/cachectic/frail IV administration

2.5 mg

Repeated at up to 2.5 mg every 5 minutes

Total max dose 10 mg (or MME)

Morphine < 70 years IV administration

2.5 - 5 mg

Repeated at up to 5 mg every 5 minutes

Total max dose 20 mg (or MME)

Ondansetron drug class

Anti-emetic - 5-HT antagonist

Ondansetron pharmacology

A serotonin 5-HT3 receptor antagonist that block the action of serotonin

Ondansetron metabolism

Metabolised in liver and excreted by kidneys

Ondansetron schedule

S4 (restricted drugs)

Ondansetron indications

Significant nausea and/or vomiting

Ondansetron contraindications

Absolute: Allergy/ADR, Congenital long QT syndrome, Current apomorphine therapy, Patients under 2 years

Relative: First trimester pregnancy (unless extreme and uncontrolled hyperemesis)

Ondansetron precautions

Hepatic impairment, Elderly patients, Intestinal obstruction, Patients with risk factors for QT interval prolongation or cardiac arrythmias

Ondansetron adverse effects

Common (>1%): Headache, constipation

Rare (<0.1%): Hypersensitivity reactions (including anaphylaxis), ECG changes

Ondansetron presentation

Ampoule, 4 mg/2 mL

Orally Disintegrating Tablet, 4 mg

Ondansetron onset

5 minutes (IV)

Ondansetron duration

Several hours

Ondansetron half-life

3 - 4 hours

Ondansetron PO/IM administration

4 - 8 mg

Total max dose 8 mg

Must not be given within 8 hours of previous ondansetron administration

Ondansetron IV administration

4 - 8 mg

Total max dose 8 mg

Slow push over 2 - 3 minutes

Must not be given within 8 hours of previous ondansetron administration

Ibuprofen drug class

Non-steroidal anti-inflammatory drug (NSAID)

Ibuprofen pharmacology

Non-selective NSAID that inhibits the synthesis of prostaglandins

Ibuprofen metabolism

Liver metabolism and kidney excretion

Ibuprofen indications

Moderate pain due to acute inflammation and tissue injury

Ibuprofen contraindications

Allergy/ADR to any NSAID or aspirin, Concurrent NSAID therapy, Current GI bleeding or peptic ulcers, dehydration and/or hypovolaemia, Renal impairment, NSAID induced asthma, Heart failure, Pregnancy, ACE inhibitor or ARB therapy, Patients less than 13 or older than 65 years, Patients taking anticoagulant medications, Diuretic treatment

Ibuprofen precautions

Asthma, Hepatic function, History of GI bleeding or peptic ulcers

Ibuprofen side effects

Nausea, dyspepsia, GI bleeding, Dizziness

Ibuprofen presentation

Tablet, 200 mg

Ibuprofen onset

~ 15 minutes

Ibuprofen duration

4 - 6 hours

Ibuprofen half-life

2 hours

Ibuprofen schedule

S2 (therapeutic poisons)

Ibuprofen PO administration

200 - 400 mg

Must not be administered within 6 hours of previous ibuprofen administration