4. Pain Meds

• Mechanism of action of Fentanyl Citrate


  Binds to opioid receptors producing Analgesia, euphoria
• Contraindications for Fentanyl Citrate

  • Known sensitivity to fentanyl citrate
  • Use with caution in traumatic brain injury
• Dose of Fentanyl Citrate

  1. Moderate pain: 1 mcg/kg IN / IM, max dose 200 mcg

  2. Severe pain: 1 mcg/kg IV, max dose 200 mcg
• Dose of Ketorolac

  1. Adult: Moderate pain: 30 mg IM

  2. Severe pain: 15 mg IV

  3. Pedi: Moderate pain: 1 mg/kg IM, max dose 30 mg

  4. Severe pain: 0.5 mg/kg IV, max dose 15 mg
• Contraindications for Midazolam

  • Known sensitivity to midazolam
  • Alcohol intoxication
  • Respiratory depression and other depressed vital signs
  • Not to be used with: Barbiturates, Alcohol, Narcotics, or other CNS depressants
• Mechanism of action of Midazolam

  Inhibits GABA receptors in the CNS, reducing neuron excitability, causing Anti-convulsive, Sedative-hypnotic, Amnesic, Anxiolytic effects
• Mechanism of action of Ketorolac

  1. Potent Analgesia

  2. Inhibits prostaglandin synthesis

  3. Has no sedative or anxiolytic properties
• Contraindications for Ketorolac

  • Known sensitivity to Ketorolac
  • Known sensitivity to NSAIDs and ASA
  • Significant renal disease/impairment
  • Previous or current GI bleeding
• Dose of Midazolam

  Adult: Seizure: 0.2 mg/kg IN or IM, max 10 mg, 0.1 mg/kg IV, max 4 mg, Procedural sedation: 0.5 – 2.5 mg IV may be repeated to max 0.1 mg/kg, Chemical restraint: 5 mg IV, IM, or IN, Pedi: Seizure: 0.2 mg/kg IN, 0.1 mg/kg IM or IV, max 4 mg, Procedural sedation: 0.1 – 0.2 mg IV, max 4 mg, Chemical restraint: 0.3 mg/kg IN, 0.1 – 0.15 mg/kg IM, 0.05 – 0.1 mg/kg IV
• Ketorolac (Toradol)


  • NSAID
  • Non-opioid analgesic
• Indications for Fentanyl Citrate

  • Pain management
  • Anesthesia adjunct
• Indications for Ketorolac

  • Acute management of moderate to severe pain
• Indications for Midazolam


  • Active seizures
  • Sedation for medical procedures (intubation, ventilator patients, cardioversion)
  • Medical restraint
• Midazolam Hydrochloride (Versed)

  • Benzodiazepine
  • Short/intermediate-acting
  • Schedule IV drug
• Side effects of Ketorolac

  • Edema – face and extremities
  • GI bleeding
• Fentanyl Citrate (Sublimase)


  • Opioid analgesic
  • Synthetic opioid
  • Schedule II drug
• Side effects of Fentanyl Citrate

  • Confusion
  • Delirium
  • CNS depression
  • Paradoxical excitation
  • Respiratory depression, apnea, dyspnea
  • Hypotension
  • Cardiac dysrhythmias
  • Nausea/vomiting
• Side effects of Midazolam

  • Respiratory depression or arrest
  • Somnolence
  • Hypotension
  • Nausea/vomiting
  • Cardiac arrest
• Route of administration for Midazolam

  • IN, IM, IV