Drug therapy Protocols QAS

Morphine DTP

Drug class:

narcotic analgesic

Pharmacology:

morphine is a narcotic analgesic that acts on the central nervous system by binding with opioid receptors. This alters processes affecting pain perception and emotional response to pain. it also combines to cause respiratory depression, vasodilation, decreases in the gag reflex and sloes AV node conduction

Metabolised by:

the liver, kidney and lungs

Indications:

· Significant pain

· Sedation autonomic dysreflexia (with a systolic BP of >160mmHg)

Precautions

· Hypotension

· Respiratory tract burns

· Respiratory depression and/or failure

· Known addiction to narcotics

· Concurrent MAOI therapy

· Cardiac chest pain

Contraindications:

· Allergy and/or adverse drug reaction

· Kidney disease (renal failure)

Side effects:

· Bradycardia

· Drowsiness

· Hypotension

· Nausea and/or vomiting

· Pinpoint pupils

· Respiratory depression

Presentation: ampoule, 10mg/1mL morphine sulphate pentahydrate

Onset

IM: 5-10 mins (peak 20-30min)

IV: 2-5 min (peak 20 min)

Duration: 1-2 hours

Half-life: 2 hours

Dosage:

>70 year old: 2.5-5mg every 10 min total maximum dose 10mg

<70 years old: 2.5-10mg repeated every 10 mins total max dose of 20mg

Paracetamol DTP

Drug class: analgesic antipyretic

Metabolised by: liver, excreted by kidneys

Pharmacology:

Paracetamol is a p-aminophenol derivative that exhibits analgesic and antipyretic activity. It does not possess significant anti-inflammatory activity

Indications:

· Mild to moderate pain

· Fever (causing distress)

Contraindications:

· Allergy and/or adverse drug reaction

· Patients less than 1 month of age

Precautions:

· Hepatic dysfunction

Side effects:

· nausea

presentation:

· tablet, 500mg paracetamol

· liquid, 24mg/mL paracetamol

Onset: (PO) 10-60 mins

Duration: (PO) 4 hours

Half-life: 2 hours

Dose:

· >16: 0.5-1g every 4 hours max 4g in 24 hours

Fentanyl DTP

Drug class: narcotic analgesic (synthetic)

Metabolised by: hepatic metabolism and renal excretion

Pharmacology: fentanyl is a synthetic narcotic analgesic that acts on the central nervous system by binding with the opioid receptors

Indications:

· Significant pain

· Sedation

· Autonomic dysreflexia (with a systolic BP >160 mmHg)

Contraindications:

Allergy and/or adverse drug reaction

Precautions:

· Hypotension

· Respiratory tract burns

· Respiratory depression and/or failure

· Known addiction to narcotics

· Current MAOI therapy

Side effects:

· Bradycardia

· Drowsiness

· Hypotension

· Nausea and/or vomiting

· Pinpoint pupils

· Respiratory depression

· Muscular rigidity (particularly muscles of respiration)

Presentation: Ampoule, 100 microg/2ml fentanyl

Onset: <3 mins

Duration: 30-60 mins

Half life: 2-3 hours

Dose

· >70yrs – 25 microg repeated at up to 25 microg every 5 mins, max dose 100microg

· <70yrs – 25-50 microg repeated at up to 50 microg every 5 mins total max dose 200microg

Methoxyflurane DTP

Drug class: analgesic (at low concentrations)

Metabolised by: extensive hepatic metabolism (50-70%) with urinary ~30% and exhalation ~20% excretion

Pharmacology: methoxyflurane is a fluorinated hydrocarbon anaesthetic that provides analgesia when inhaled at low concentrations. The precise mechanism of action is not established but may involve modulation of excitation and inhibitory ion channel activity in the brain and spinal cord.

Indications:

· Pain (with the ability to self-administer inhaled methoxyflurane

Contraindications:

· Allergy and/or adverse drug reactions

· Patients less than 1yr old

· Known liver or renal disease

· Malignant hyperthermia

Precautions:

· Altered level of consciousness

· Intoxicated or drug affected patients

· Cardiac instability

· Respiratory depression

Side effects:

· Altered level of consciousness

· Dizziness

· Cough

Presentation: Bottle, 3mL methoxyflurane/penthrox inhaler

Onset (INH): 1 min

Duration: 25 mins with continuous inhalation

Half-life: 3.2 hours

Dose:

3mL, repeated once after 20 mins, total max dose is 6mL in 24 hours or 15mL in 7 days

Ibuprofen DTP

Drug class: non-steroidal anti-inflammatory drug (NSAID)

Pharmacology: ibuprofen is a non-selective NSAID that inhibits the synthesis of prostaglandins resulting in analgesic, antipyretic and anti-inflammatory actions.

Metabolised by: ibuprofen is metabolised by the liver and excreted in the kidneys

Indications: moderate pain due to acute inflammation and tissue injury

Contraindications:

· Allergy and/or adverse drug reaction to and NSAID or aspirin

· Concurrent NSAID therapy

· Current GI bleeding or peptic ulcers

· Dehydration and/or hypovolaemia

· Renal impairment

· NSAID induced asthma

· Heart failure

· Pregnancy

· Angiotensin converting (ACE) inhibitor or angiotensin II receptor (ARB) therapy

· Patient less than 13 yrs or older than 65 yrs

· Patients taking anticoagulant medication

· Diuretic treatment

Precautions

· Asthma

· Hepatic dysfunction

· History of GI bleeding or peptic ulcers

Side effects:

· Nausea

· Dyspepsia

· GI bleeding

· Dizziness

Presentation: tablet, 200mg ibuprofen

Onset: ~15 mins

Duration: 4-6 hours

Half-life: 2 hours

Ondansetron DTP

Drug class: Anti-emetic (5 HT3 antagonist)

Metabolised by: majority of circulation ondansetron is metabolised by the liver and excreted by the kidneys

Pharmacology: ondansetron is a serotonin (5-HT3) receptor agent. It works by blocking the action of serotonin, a natural substance that can cause nausea and vomiting.

Indications:

· Significant nausea and/or vomiting

Contraindications:

Absolute contraindications:

· Allergy and/or adverse drug reaction

· Congenital long QT syndrome

· Current apomorphine therapy (used for severe Parkinson’s)

· Patient less than 2 years old

Relative contraindications:

· First trimester pregnancy

Precautions:

· Hepatic impairment

· Elderly patients

· Intestinal obstruction

· Patients with risk factors for QT interval prolongation or cardiac arrhythmias

Presentation:

· Ampoule 4mg/2ml ondansetron

· Orally disintegrating tablet (ODT), 4mg ondansetron

Onset (IV): 5 mins

Durations (IV): several hours

Half-life: 3-4 hours

Dose

Adult PO/IM: 4-8mg total max dose 8g

Must not be given within 8 hours of previous dose