Opioid Analgesics  Derived from opium plant – specific purpose to relieve pain: STRONGEST PAIN MEDICATIONS  May be used

in combinations with other meds to relieve pain, and can result in addiction Management: o Moderate to Severe Pain o Acute Pain (ex. PostOP pain) o Long-term chronic pain (ex. cancer pain) Most EFFECTIVE: when administered in small, frequent doses. Titration- technique delivering small doses of med until desired effect (pain relief) is observed. May be necessary to dose up or down dose to obtain adequate analgesia with minimal side effects. IN SEVERE PAIN SITUATIONS: titrate opioids to extremely high doses if needed to achieve adequate analgesia with minimal side effects. Ceiling dose- opioids have no ceiling dose: unique property: there is no point after which they are no longer effective Dosages: Dosed by weight for children, appropriate dosing is important aspect of pain management: appropriately individualize the dose to promote adequate analgesia/ minimize side effects. Most IV opioids can be converted to oral doses Classifications of Doses:  Neonatal doses: reduced by 1/3 to 1/4 to account for immature liver function/ differences in metabolism.  50KG or more Children = can receive ADULT doses  Should be dosed at REGULAR INTERVALS, but are commonly PRN and given when pain is assessed/reported: BUT NOT APPROPRIATE FOR CHILDREN  PRN dosing: requires child request pain meds, many children do not report pain (specific to dev., bc too young, or refusal to talk about pain)/fear pain med will be an injection, forget pain med is available at request  Nurse do “reverse PRN”: assess pt pain at prescribed time interval the med may be administered: med will be given if pain present: FAVORABLE METHOD  Also can do Around-the-Clock Dosing Schedule: Child receives pain med at preset intervals: effects of med is continually assessed to assure pt receiving adequate analgesia.  Also: continually monitor: *presence of side effects *level of analgesia *LOCx3. If side effects appear: Titrate, Discontinue, or Substitute analgesic is given Side Effects of Opioid Analgesics:  Nausea  Vomiting  Constipation  Pruritus (itching) Do not discontinue if these side effects (above) occur: instead side effects should be treated (with other medications) as long as analgesic is effective. **If child has severe side effects/not receiving adequate pain relief: nonopioid pain med should be added to pain management protocol: augment pain relief and minimize opioid side effects. Dangerous Side Effects: treat w/ Naloxone: to reverse respiration depression but not pain treatment.  Respiratory depression (below 12)  Hypotension Types of Opioid Pain Medications for Children

Morphine

Oral: 0-3-0-5mg/kg q 4hr = elixir/tabs. Elixir for young children cant swallow tabs Parenteral: 0.05-0.1mg/kg q 3-4 hr. Parental oral conversion = 1:3 ratio Known as Golden Standard: effectiveness, cost reasons why Parenteral: 0.5-2mcg/kg q 1-2hr. Side effect chest wall rigidity Transmucal/transdermal: 10-15mcg/kg. Transmucal (fentanyl oralet) single dose administration. Transdermal not recommended for children unless high opiod requirement (cancer pain) Parenteral: 1mg/kg q3-4hr , Oral: 1-1.5mg/kg q 6hrs Not recommended as metabolite accumulation (normeperidine) may cause CNS irritability/seizures Parenteral/oral: 0.1-0.2mg/kg q 8-12hr. Parenteral to oral conversion= 1:1. Oral available as elixir or tabs Parental: 0-015mg/kg q3-4hr Oral: 0-02mg/kg q 3-4hr Associated with less itching, nausea, vomiting than other opioids

Fentanyl Meperdine Methadone

Hydromorphone Codeine

Parenteral: *not recommended b/c poor/painful site absorption/high occurrence side effects. Oral: 1mg/kg q4-6hr. Elixir & Tabs: combined with acetaminophen. Less expensive. Parenteral: not available Oral: 0.1mg/kg q4-6hr. Elixir & Tabs combined with acetaminophen.

Oxycodone Hydrocodone

Parenteral: not available Oral: 0.1-0.2 mg/kg q4-6hrs. Exlixir & Tabs combined with acetaminophen or ibuprofen

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