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pain pharmacotherapy, by catherine dowling. hi. my name is catherine dowling. i'm a nurseat children's hospital boston in the cardiac icu. the objectives of this presentation are tounderstand the pharmacology of analgesia and to recognize the complications of pain medication.

how to use laxatives for weight loss, non-narcotic analgesics. there are many options for pain control thatdo not involve narcotics. paracetamol is indicated for pain and/or fever. it should be used withcaution in patients with actual or potential liver dysfunction since it is metabolizedin the liver.

ibuprofen is an oral non-steroidal anti-inflammatoryagent indicated for pain, fever, and/or inflammation. it should be used with caution in patientswith actual or potential bleeding abnormalities and renal dysfunction. it is metabolized inthe liver and excreted in the urine. toradol is a non-steroidal anti-inflammatoryadministered intravenously. it is ideal for post-operative pain management in the patientwithout bleeding or renal dysfunction. it is indicated for pain, fever, and/or inflammation.it should be used with caution in patients with actual or potential liver dysfunction. narcotic analgesics. morphine is a common opioid analgesic usedin the cardiac intensive care unit. it is

metabolized in the liver and excreted in theurine. adverse effects include nausea, constipation, and respiratory depression. it may cause ahistamine release and local skin reaction during administration. fentanyl is a synthetic opioid analgesic indicatedfor pain management. infants may tolerate fentanyl better than morphine because thereis no histamine release with administration. it is 100 times more potent than morphine. fentanyl is metabolized in the liver and excretedin the urine. rapidly-infused bolus doses may cause chest-wall rigidity. as a precaution,have intubation equipment ready and administer muscle relaxants to reverse chest-wall rigidity.

methadone is indicated for opioid withdrawal.it works as a substitute for opioid drugs such as morphine and fentanyl by producingsimilar effects and preventing withdrawal symptoms. dosing and weaning should be monitoredclosely while watching for signs of withdrawal. weaning usually takes place in 10% increments. codeine is indicated for pain control in oraldosing. it is metabolized in the liver and excreted in the urine. adverse effects mayinclude nausea, constipation, dizziness, and drowsiness. point of clarification. please note that becauseof its pharmacology, the pain relief from codeine may be extremely variable from patientto patient.

sedatives. anxiety and pain are strongly related.individuals who experience high levels of anxiety also tend to have higher incidenceof pain. unrelieved pain has the potential to increase anxiety levels. when a patient's stress level is high, itmakes it more difficult to control the patient's pain. sedatives relieve anxiety. chloral hydrateis used for medical procedures. the onset of action is 15 to 30 minutes. adverseeffects include excitability and uncooperativeness. excessive sedation may lead to respiratorydepression. benzodiazepines are used as a hypnotic andanti-convulsant. negative effects include dose dependency, respiratory depression, hypotension,tolerance, and withdrawal. benzodiazepines

are a sedative used to treat anxiety and maybe used in conjunction with analgesics to treat pain. diazepam is used as a sedative, as well asan anti-convulsant. it is an anti-anxiety agent and a hypnotic. midazolam can be used continuously or as aninfusion with a short onset of action. lorazepam is indicated for long-term sedationand withdrawal management. anesthetic agents. ketamine is indicated for short term anesthesiaand analgesia, and for intensive care unit procedures. it is a rapid onset with a shortduration of action. adverse reactions include

hypertension, tachycardia, and hallucinations. propofol is indicated for intensive care unitprocedures and peri-extubation. adverse reactions are pain at the injection site, hypotension,bradycardia, acidosis, respiratory depression, and liver failure. propofol has a negativeinotropic effect, therefore it should not be used with single ventricle physiology orpoor ventricular function. dexmedetomidine is used for sedating intubatedand non-intubated patients. it can be used prior to and during surgical procedures inintubated and mechanically ventilated patients during treatments in the intensive care setting.it should be administered by continuous infusion. side effects include hypotension and bradycardia.it should be used wtih cautions in patients

with ventricular dysfunction. side effects. constipation, which can be severe, is a commonproblem for patients taking opioid pain medications. this may be problematic even for patientstaking the drugs over a short term. bowl regimens can be put in place to avoid the uncomfortablecondition of constipation. there are many options to help alleviate constipation,such as a stool softener. a bowel stimulant will help alleviate the discomfort of constipation.nausea and vomiting are common side effects following opioid analgesia. an anti-emeticcan be used for patients who experience this discomfort.

physiological dependency after prolonged administration. prolonged administration of benzodiazepinesand/or opioids to children may induce physiological dependence. sudden discontinuation of thesemedications may lead to withdrawal. symptoms of withdrawal include agitation,anxiety, muscle tension, sleeping for less than one hour, diarrhea, fever, sweating,tachypnea, and poor feeding. as mentioned earlier, methadone and lorazepam administrationcan be given to treat withdrawal symptoms. please help us improve the content by providingus with some feedback.