Pain Management in the Context of an Opioid Epidemic: Considerations and Tool...VITAS Healthcare
This presentation details how to conduct a comprehensive pain assessment, considerations when prescribing analgesics, and when opioids may be appropriate.
a detailed description of pain and therpaeutic options available and clinical assessment of pain, approach to the patient with pain, assessment of intensity of pain, nsaids and opioids, tca. WHO pain ladder, chronic opioid therapy
Pain Management in the Context of an Opioid Epidemic: Considerations and Tool...VITAS Healthcare
This presentation details how to conduct a comprehensive pain assessment, considerations when prescribing analgesics, and when opioids may be appropriate.
a detailed description of pain and therpaeutic options available and clinical assessment of pain, approach to the patient with pain, assessment of intensity of pain, nsaids and opioids, tca. WHO pain ladder, chronic opioid therapy
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
4. Background
Chronic Pain
• Lasts longer than 3-6 months
• Serves no purpose
• Cannot identify a cause
• Can lead to pain behaviors
• Very difficult to treat
5. Pain Conduction
•Injury triggers release of bio-chemicals
•Inflammation takes place
•Stimulation of nerve fibers
•Bio-chemicals causes pain impulses to
begin
6. Pain Perception
•Impulse is sent to the brain via ascending
tracts in spinal cord
•Neurotransmitters released by C fibers
(substance P)
•Message to the brain (Thalamus)
•Sends message down descending
pathway= pain response
7. Why Pain Control
•Persistent acute postoperative pain:
•Decreases the body’s physiologic
reserves
•May exacerbate co-morbid conditions
(e.g.) increase risk of MI in patients with
CAD
•Contributes to pulmonary complications.
8. •Impairs rehabilitation and functional
outcome
• May lead to development of chronic pain
syndromes and long-term disability.
• Increases hospital stay and the cost of
patient care
• Decreases patient satisfaction.
9. Metabolic Stress Response
•Surgical insult results in post op pain
•Increased circulating catecholamines
•Resulting in tachycardia and hypertension
•Leading to increased cardiac work
•Resulting in increased myocardial oxygen
consumption
13. Pre Op Assessment
•Indication for surgical procedure
•Allergies and intolerances to medications,
anesthesia, or other agents
•Known medical problems
•Surgical history
•Trauma (major)
•Current medications (incl.OTC herbal &
dietary supplements,and illicit drugs)
Gayatri,P (2005). Post-op pain services. Indian J. Anaesth. 49 (1) : 17-19
14. •Discuss History of Acute or Chronic Pain
•Identify history of pain control methods
•What has worked
•How long on pain meds
•Do they work
•True allergies, ask what happens
15. •Differentiate between tolerance and
physical dependence
•Discuss pain management problems
(ie) anxiolytic therapy with pain meds
Identify if there is a need to wean from any
pain medications prior to surgery
•Do not stop suddenly
16. •Consider Patients with:
•Multiple back operations
•Abdominal pain patients (ie) Crohn’s
disease
•Recurrent cancer
•Chronic joint pain, (ie) RA or DJD
17. •If with a history of chronic opioid use for
pain management may require higher
doses for pain control
•This will include using PCA and/or meds
for break through pain
•May not get adequate relief with
“standard” doses of “standard” post op
pain orders
18. • Do a directed pain history
• Type of pain
• Location, description, duration,
exacerbation and relieving factors
• Directed pain examination
• Discussion of post-op pain control plan
19. •Evaluate each patient individually
•Do not assume that aging is the same in
all patients
•Evaluate for side effects of narcotics
•Need complete list of meds to check for
interactions
What about the Elderly
20. •Dispel myths
• Concerns about opioids
• Concerns about addiction
• Fear of tolerance
• Age related expectation of pain
21. Pre Op Teaching
Educate patient/family/staff
• Pain plan
• How & when to evaluate
•Use of alternative methods of pain control
•Patient and/or Family education on use of
PCA
22. •Explain blocks !!!!!!
•Provide pre-anesthetic evaluation,
brochures, and videotapes to educate
patients about therapeutic options (music
and/or guided imagery, other)
23. Preoperative Preparation of the Patient
Instruct on bedside postoperative
evaluation
Include instruction in behavioral
modalities to control anxiety
Distraction, deep breathing,
visualization (etc)
24. Preoperative Preparation of the Patient
Instruct on pain ranking tools prior to
surgery
Use age appropriate tools, why, when
and how to be used.
Instruct S.O., parents if needed.
May want to use personalized tool
(i.e.Randall)
25. •Generally there is decreased cardiac and
pulmonary reserve with increased age
•Opioids may produce confusion or cause
some delirium postoperatively in some
patients
•An elderly patient taking six medications
is likely to have adverse reactions 14 times
more than a younger person taking the
same number of medications.
26. •Consider additive respiratory depressant
effect of both opiates and anxiolytics
•Most elderly patients metabolize drugs at
a slower rate and may require less-
frequent dosing or a reduction in dosage
•Certain medications should be avoided in
elderly patients, based on their adverse
effects
•(Beers list)
27. •Sedative effects with an increased risk of
falls
•Constipation related to opiates & NSAIDS
• May have reduced gastrointestinal
motility
•Stool softener with stimulant
•Start pain meds at a lower dose and
increase to pain relief if opioid naive
28. Special Populations
Pediatrics
• Use pain scales specific to age
• FLACC (pre-op instruction)
• Observe frequently
• Medication dose wt specific
• Guided Imagery
• Distraction
• Music/video
30. Special Populations
Special needs:
• Identify what works for this patient
• Ask the family or caregiver
• Comfort frequently
• If non verbal anticipate painful
procedures result in pain
• Again be an advocate
31. Cultural Considerations
• Be aware of specific needs and
beliefs
• Respect the patient/family tradition
• Internalize (how would I feel if)
• Do not pre judge
• Explain need for pain control
32. Intra Op Consideration
•Therapy selected should reflect the
individual needs of the patient.
•Ability to recognize and treat adverse
effects during surgery
•Special caution during continuous
infusion modalities
•Drug accumulation may contribute to
adverse events
33. •Patients who are pretreated with pain
meds, anxiolytics or NSAIDS prior to
surgery
•Have a greater decrease in postoperative
pain
•Decrease in postoperative anxiety
•Olorunto,W & Galandiuk, S. 2006. Managing the Spectrum of Surgical Pain:
•Acute Management of the Chronic Pain Patient. American College of Surgeons
34. •Surgeries to upper abdominal and
thoracic areas associated with severe pain
can lead to:
• Restrictive lung defect
• Depressed diaphragmatic activity
Gayatri,P (2005). Post-op pain services. Indian J. Anaesth. 49 (1) : 17-19
35. Study:
•Early and aggressive use of pain
medications after surgery results in
shorter hospital stays, fewer chronic pain
problems later, and use less pain
medication overall than people who avoid
pain medication.
Taylor, M. (2001).Managing postoperative pain. Hosp Med; 62: 560-563.
36. Intra Op Consideration
•Patient Advocate
•Continue to assess for anxiety/pain
•Provide comfort
Positioning
Guided imagery
Music
38. •The risk of addiction to pain medication is
low for patients using such medications for
post-surgical pain
•Addictive personality leads to addiction
•Dependency is another issue
39. Effective Pain Control
Listen to the patient
• Believe the patient’s pain ranking
Support the patient/family
• Answer questions
• Provide information
Instruct re: need for pain control
40. •Acute nociceptive pain from incision.
• Musculoskeletal pain from abnormal
body positioning and immobility during and
after surgery
• Neuropathic pain from excessive
stretching or direct trauma to peripheral
nerves
Sources of postoperative pain
41. Post Operative Pain Control
Decreases risk of
• Myocardial ischemia
• Tachycardia and dysrhythmia
• Impaired wound healing
• Atelectasis
• Thromboembolic events
• Peripheral vasoconstriction
42. Post Operative Pain
Near the surgical site.
•Acute exacerbation of pain may be added
to the basal pain
•Increases with activities such as
coughing, turning, dressing changes
•Generally self limiting
•Progressive improvement over a relatively
short period
43. With Special Populations
• Geriatric
• Be aware of renal/hepatic function
• Sensitivities/allergies
• Be pro-active with medication
• Opioids
• Combination meds
• Be aware of drugs to be avoided in the
elderly
44. ASSESS & RE-ASSESS
• Before and after pain medications
• Put it in the patient’s own words
• Assess for non verbal cues
• Be aware of special needs of the
cognitively impaired patient
• Use appropriate pain scale
• Document, Document, Document,
46. Post Op of Special Populations
Geriatric
• If with Cognitive Impairment
• PAINAD scale
• Observe & re-assess frequently
• Guard/observe for delirium
• superimposed on dementia
• Know drug side effects
• Know method of elimination
47. Medication Use
• Review information gathered during pre
op assessment
• If something has not worked in the past
don’t use it.
• Explain what you are doing and what
you are giving
• When in doubt, follow the WHO
guidelines
48. World Health Organization (WHO)
3- Step Ladder approach to pain
management
• Step 1- Mild Pain (1-3/10)
• Nonopioid
• Add adjuvant analgesic agent
(i.e.) Ice, heat
49. WHO cont’d
• Step 2 Mild to moderate pain (4-7/10)
• This step builds on step 1
• Treat with opioid combination drug
• (hydrocodone/acetaminophen)
• Watch ceiling effect of adjuvant drug
• Peds are dosed by weight
• Watch special needs patients/elderly
50. WHO cont’d
• Step 3- Severe pain (8-10/10)
• Use opioids
• Add adjuvant (i.e.)anti-anxiety,anti-
emetics, muscle relaxants
• Start with short acting opioids to
determine pain relief, breakthrough
needs and frequency.
• Switch to long acting use equianalgesic
dosing chart for conversion
51. POINTS TO REMEMBER
• The pain intensity determines the step
at which to begin.
• Opioids are the only group of analgesics
with no ceiling on dose with careful
titration.
• Most opioid side effects resolve within a
few days.
• Exception>>>>Constipation-- need to
write for this immediately
52. Commonly used first line opioids
• Codeine
• Morphine
• Hydromorphone
• Oxycodone
53. Share the following characteristics
• Half-life of immediate release
preparations is 2 to 4 hours
• Duration of analgesic effect between 4
to 5 hours when given at effective
doses.
• Sustained release formulations have
duration of analgesic effect of 8 to 12
hours
54. • Equianalgesic doses need to be
calculated when switching from one
drug to another
• when changing routes of administration
or both.
• An equianalgesic table should be used
as a guide in dose calculation
• Due to incomplete cross-tolerance
clinicians should consider reducing the
dose by 20 to 25% when ordering.
55. Morphine
Onset: 15 to 60 minutes
Peak Effect: 30 minutes to 1 hr
Half Life: 1.5 to 2 hr
IV: 0.05 to 0.1 mg/kg
5 minutes prior to procedure; max: 15
mg/dose
56. Morphine
Sedation, somnolence, respiratory distress
or depression, pruritis
Reversal:
Naloxone: 5 to 10 mcg/kg/dose; Single
dose should not exceed max
recommended adult dose of 0.2 mg
57. Fentanyl
• Fentanyl is 80 to 100 times more potent
than morphine.
• Studies report less constipation and
somnolence in patients using
transdermal fentanyl compared to those
using SR morphine.
58. Fentanyl
• Fentanyl’s high lipophilic properties
provide a sufficient sublingual
bioavailability of 90%, thus making it a
suitable opioid for use sublingually.
• Conditions that may effect absorption, bl
levels & clinical effects if the drug
• Morbid obesity
• Ascites
• opioid-naïve patients
59. Fentanyl
Onset: 1 to 5 minutes
• Peak Effect: (no data available)
• Half Life: 1.5 to 6 hr
• IV: 0.5 to 3 mcg/kg/dose; may repeat
after 30 to 60 minutes; max: 50
mcg/dose
• Use lower doses (0.5 to 1 mcg/kg/dose)
when used in combination with other
agents, such as midazolam
60. Fentanyl
• Respiratory distress or depression,
apnea, seizures, shock, chest wall
rigidity (most likely to occur with rapid
infusion or high doses)
• Reversal:
• Naloxone: 5 to 10 mcg/kg/dose; Single
dose should not exceed max
recommended adult dose of 0.2 mg
61. Sufentanil
• 5 to 10 times more potent than fentanyl.
• Injectable sufentanil (like fentanyl) is
readily absorbed through the mucous
membranes
• Early onset of action of about 5 to 10
minutes, when used sublingually
62. Sufentanil
• Good for incident pain control.
• Peak analgesic effect of 15 to 30
minutes
• Duration of the analgesic effect is 30 to
40 minutes.
• Use for incident pain control, dosing 10
to 15 minutes prior to the painful event.
63. Methadone
• Long half life of methadone prevent it
being a first-line opioid.
• When converting to methadone dose
reduction of 75 to 90% should be
considered
• Initiation for pain management is 5mg
bid or tid depending on age
64. Dilaudid
10mg IV morphine is equivalent to 1.3-
2mg Hydromorphone
IV Dilaudid has a half life of 2.5 hours,
duration of effect varies
Administering 1 mg or more of IV Dilaudid
every 1 - 2 hours leads to a build up of
the drug (stacking) and can increase
adverse effects like respiratory
depression. Know elimination
65. Stacking from delayed peak effect
Occurs when additional doses are given
prior to peak effect leads to multiple
doses, resulting in over dosage.
Caution:
Administration of a benzodiazepine with
narcotic analgesics increases the risk of
respiratory depression. (ie: Xanax,
Lorazepam, Versed, Valium)
66. Onset: 1 to 5 minutes (short acting)
• Peak Effect: 3 to 5 minutes (IV)
• Half Life: 1.5 to 12 hr
• Oral: 0.2 to 1 mg/kg; 30 to 45 minutes
before procedure; max: 20 mg
• IV: 0.05 mg/kg 3 minutes before
procedure (may repeat dose X 2); max:
2 mg/dose
Midazolam: CNS Depressant
68. POINTS TO REMEMBER
• Dosing intervals are determined by the
duration of action as well as the half-life
of the drug
• Know the route of elimination
• Adjust dose and frequency for special
populations.
• Be aware of prior surgeries involving
bowel, stomach, liver, kidneys
69. Opioid-induced Neurotoxicity (OIN)
• Hyperalgesia (heightened sensitivity to
the existing pain)
• Allodynia (a normally non-noxious
stimuli resulting in a painful sensation),
• Agitation/delirium with hallucinations
and possibly seizures.
• Due to the accumulation of toxic
metabolites and impaired renal
70. Post Op Documentation
• Document response to medication
• Pain relief
• Increased agitation
• Be pro-active if patient unable to
verbalize
• Painful procedures result in pain
(Treat as you would a family member)
71. GOAL
• Promote optimal pain management
• Reduce anxiety
• Support the patient
• Improve post op outcomes
• Promote patient satisfaction