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What is the functional class of Fentanyl Citrate?
Narcotic agonist, analgesic
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What is the trade name for Fentanyl Citrate?
Sublimaze
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What is the mechanism of action for Fentanyl?
- Potent,short acting, synthetic narcotic agonist analgesic
- Principle actions are analgesia and sedation
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Inhibits ascending pain pathways in CNS
- Increases pain threshold
- Alters pain perception by binding to opiate receptors
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What are the indications to use Fentanyl? 1
Pain Management
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What are the contraindications for use of fentanyl? 3
- Myasthenia gravis
- Hypersensitivity to opiates
- MAOI use
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What are the precautions for Fentanyl? 4
- Increased ICP
- Severe respiratory disorders
- Hypotension
- Bradydysthymias
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What are the side effects that come with using Fentanyl? 11
- May result in severe respiratory depression
- BronchoConstriction
- Chest Wall Rigidity
- Sedation
- Bradycardia
- Diaphoresis
- N/V
- Miosis
- Blurred Vision
- Hypotension
- Cardiac Arrest
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What are the interactions with Fentanyl? 2
- Effects may be increased with CNS depressants such as alcohol, narcotics, and sedative/hypnotics
- MAOI use may cause hypotension
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What is the dosage and route for adults for fentanyl?
D: 25-50 mcg slow IVP or IM q 5 up to 150 mcg
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What is the dosage and route for pediatrics for fentanyl?
D: 0.5mcg mcg/kg slow IVP q 5 min up to 1.5 mcg/kg
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What are the pharmacokinetics of Fentanyl?
- Absorption= immediate
- Duration= 30-60 minutes
- Half-Life= 1.5-6 hours
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What is the trade name for ketorolac?
Toradol
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What is the functional class of ketorolac?
Analgesic NSAID
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What is the mechanism of action of Toradol
Reversibly blocks the action of cyclooxygenase which in turn prevents the formation of prostaglandins. Ketorolac causes analgesia equivalent to that of morphine sulfate
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What are the indications for use of Ketorolac?
Acute moderate to severe pain
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What are the contraindications of Ketorolac?
- NSAID allergy
- ASA sensitive asthma
- Known peptic ulcer disease
- Recent GI bleed
- Renal failure
- Confirmed cerebrovascular bleeding
- Recent CABG
- Pregnancy
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What are the precautions of Ketorolac ?
Use cautiously with CHF and cirrhosis patients due to renal failure
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What are the side effects of ketorolac?
- GI bleeding
- Inhibition of platelet aggregation
- Acute renal failure
- N/V
- Diarrhea
- Upset Stomach
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What are the interactions of Ketorolac?
Potentiates medications that inhibit platelet aggregation
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What is the dosage and route of Ketorolac?
Adult: 15-30 mg IVP or 30-60mg IM (single dose only)
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What is the functional class of morphine sulfate?
Narcotic analgesic
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What is the mechanism of action of morphine sulfate ?
A naturally occurring opiate which acts on opiate receptors in the brain, providing sedation and analgesia.
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Additionally, its vasodilatory properties (which are caused by mast cell degranulation and histamine release) increase peripheral venous capacity and decrease venous return to the heart.
This reduces cardiac workload, decreases myocardial oxygen demand, and decreases pulmonary venous congestion
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What are the indications for Morphine sulfate?
- Chest pain associated with ACS
- Pulmonary edema, CHF
- Pain Management
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What are the contraindications of morphine?
- Hypersensitivity
- Undiagnosed head injury
- Hypovolemia or severe hypotension
- Acute Asthma
- COPD
- Respiratory Depression
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What are the precautions with Morphine ?
- Administer slowly and titrate
- Undiagnosed abdominal injury
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What are the side effects of morphine?
- Dizziness
- N/V
- Cramps
- Blurred Vision
- AMS
- Miosis
- Headache
- Seizures
- Drowsiness
- Bradycardia
- Respiratory Depression
- Syncope
- Palpitations
- Hypotension
- Dry Mouth
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What are the interactions of morphine?
- Enhanced CNS depression when administered with antihistamines sedatives barbiturates and alcohol.
- Tricyclic antidepressants and MAOIs may precipitate hypotensive crisis
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What are is the Adult dosage and route of morphine?
- Adult: 1-5 mg slow IVP/IM q 5 min up to 15mg
- Titrate to pain level and systolic BP > 100mm/Hg
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What is the pedi dosage and route for Morphine ?
P: 0.1mg/kg IV may repeat once after 10 min
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What the pharmacokinetics of morphine?
- Onset= immediate IV
- Duration= 2-7 hours IV
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What drug can be used to reverse Morphine?
Naloxone
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What is the trade name of nitrous oxide?
Nitronox
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What is the functional class of Nitrous Oxide
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What is the mechanism of action of nitrous oxide?
- CNS depressant with analgesic properties
- 50/50 mixture of nitrous oxide and oxygen
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What are the indications of nitrous oxide
- Chest pain and anxiety associated with AMI or ischemia
- Pain secondary to trauma/ burns
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What are the contraindications of nitrous oxide?
- Head injury with AMS
- Thoracic trauma suspicious of pneumothorax
- Patients who cannot comprehend verbal instructions
- Patients with recent alcohol or drugs use
- COPD
- Severe abdominal pain and distention suggestive of bowel obstruction
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What are the precautions while using Nitrous oxide ?
- Use in a well ventilated area
- Patient self administration only
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What are the side effects of using nitrous oxide ?
- N/V
- Cramps
- AMS
- Dizziness
- Light headedness
- Headache
- Hallucinations
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What are the interactions of nitrous oxide?
Enhanced CNS depression when administered with narcotics, sedatives barbiturates and alcohol
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What is the dosage and route of nitrous oxide
Self administered Via inhalation and titrated to effect
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What is the trade name Proparacaine?
Alcaine
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What is the functional class of Proparacaine
Local anesthetic
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What is the mechanism of action of Proparacaine
Provides topical anesthesia to eye by preventing the transmission of nerve impulses by inhibiting the sodium channels along a nerve pathway this
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