Lecture

• Put these drugs strongest to weakest(heroin, fentanyl, morphine, hydrocodone, methadone, carfentanil, hydromorphone and oxycodone, morphine and oxymorphone): carfentanil, fentanyl, heroin, hydromorphone, oxymorphone, methadone, oxycodone, morphine and hydrocodone.
• PTs that take narcotics get constipation; remember this for abdo pain patients
• Opioids can cause vasodilation which results in hypotension
• Half life of most narcotics is 1 to 5 hours. The exception are carfentanil, methadone(24 hours) and propoxyphene(12-24 hours and used in hospitals)
• Methadone is used for recovery from addictions; often mixed in juices and other things to take the edge off. May cause accidental ODs for PEDs
• AEIOUTIPS is an acronym used to make potential Differential diagnoses for unconscious unknown PTs
• AEIOUTIPS stands for: Alcohol, Endocrine, Insulin, Oxygen/Obstruction, Uremia, Trauma, Infection, Poison/Psychiatric and Seizure/Stroke/Shock
• 5 signs of major toxicity for narcotics: coma, cardiac dysrhythmias, GI disturbances, respiratory depression and hypotension/hypertension
• Partially half closed eyes is horrendous looks
• Naloxone can induce vomiting when PTs wake up
• The half life of Naloxone is shorter than the half life of most opioids
• For suspected ODs, get a resp rate by counting 30 seconds to to a minute
• Dilated pupils may occur from sympathomimetics or anticholinergic drugs
• Cocaine, meth and other stimulants cause dilated pupils while opiates and sedatives cause constricted pupils
• Think about vomitting for ODs as this may just get rid of the naloxone you just pushed
• Make sure to bring drugs to the hospital with you
• Ask about previous antidotes given previously in ODs
• The only indication for Analgesia is Pain
• There are 3 meds we can give for pain: acetaminophen, ibuprofen and ketorolac
• For analgesia, Acetaminophen and ibuprofen are given PO while ketorolac is given IV/IM
• To give analgesia, PTs must be over the age of 12
• To give analgesia, all PTs must be unaltered and ketorolac requires normotension as a condition
• Ketorolac and Ibuprofen are NSAIDs and they are metabolized by the kidney. Acetaminophen is metabolized by the liver
• Contraindications for acetaminophen: no previous use of it within the last 4 hours, no Hx of liver disease, no active vomitting, no inability to take drugs PO, no suspected ischemic chest pain and no allergy to it
• Contraindications for Ibuprofen: no use of NSAIDs within the last 6 hours, pregnancy, PT on anticoagulative therapy, current active bleeding, active vomitting, CVA/TBI within the last 24 hours, Hx of peptic ulcers/GI bleeding, Hx of renal failure, asthmatic with no prior use of NSAIDs/ASA, inability to take drugs PO, suspected ischemic pain and allergy to it
• Contraindications for Ketorolac are the same as the ones for Ibuprofen except it doesn't include vomitting and inability to take drugs PO bcuz ketorolac is delivered IM/IV
• Acetaminophen is given at a dose of 500 to 650 mg once for Pts between 12-18 years old. It's give at a dose of 960 to 1000 for Pts older than 18
• Ibuprofen is has a max dose of 400 mg and can be give once
• Ketorolac has a dose of 10 to 15 mg and can only be given once IM/IV
• Acetaminophen comes in tablets of 500 mg while ibuprofen comes in tablets of 200 mg
• Whenever possible, both Ibuprofen and Acetaminophen should be given for analgesia
• Suspected renal cholic Pts should be routinely considered for NSAIDS; ibuprofen or ketorolac
• Ketorolac has a higher risk for GI bleeds and ulcers
• Conditions for naloxone: You must be older than 24 hours, have an altered LOA, have a resp rate below 10 and must have an inability to ventilate adequately or persistent need to assist ventilation
• Only contraindication of naloxone is an allergy to it
• Buprenorphine/Naloxone is known as Suboxone
• You must be over 16 to take suboxone, must have unaltered LOAs, have taken naloxone for opioid toxicity and PT is exhibiting withdrawal with a COWs score of equal to 8 or greater
• Contraindications to suboxone is an allergy to it and the consumption of methadone in the last 72 hours
• Naloxone given IV/IM is 0.4 mg per dose(also max) and can be given up to 3 times; the time between intervals is 5 minutes
• Naloxone given IN is 2 to 4 mg per dose(also max) while given SC is 0.8 mg per dose(also max)