Narcotic



Narcotics

Name |Classification |Action |Indications |Dosage |Side effects |Compatibilities |Nursing actions | |Fentanyl Citrate |Synthetic Opioid

• Narcotic analgesic |Primary effect on CNS and GI tract

• Respiratory depressant

• Causes muscular rigidity affecting the muscles used particularly in respiration 150X more potent than morphine |As an analgesic or sedative

• To aid in the mechanical ventilation of an agitated baby

• In conjunction with pavulon (pancuronium) for sedation in babies with P.P.H.N.

• For post-op pain management |Loading:

• 5 micrograms/kg IV push

• Drip:

2-10 micrograms/kg/h IV (according to the patient, can be up to 20 mcg/kg/h)

* may be given

intranasal for

palliative care |Respiratory depression (Apnea)

• CNS depression

• Hypotension

• Bradycardia

• Muscular rigidity

• Chest wall rigidity

• Tolerance |D5W, D10W, NS, TPN, Heparin, Dopamine, Dobutamine, Midazolam, KCl |Be ready to ventilate patient

• Do not flush IV – give over 10 min

• Monitor VS and BP, O2 requirements and O2 Sat

• Wean gradually. Tolerance may develop with prolonged use.

• Evaluation with Sun scale

• Significant withdrawal symptoms

• Narcan for overdose | |Midalozam (Versed) |Benzodiazepine

• Sedative

• Anxiolytic |CNS depressant – provides sedation without loss of consciousness

• Exact mode of action unknown |For conscious sedation (no analgesic properties)

• Used alone or in conjunction with Fentanyl (for pain relief) |Bolus:

• 0.07 to 0.2 mg/kg IV usual dose 0.1 mg/kg IV

• Drip:

1-5 micrograms/kg/min IV, Rapid onset of action, short acting |Respiratory depression

• Hypotension

• Bradycardia

• Seizure-like activity with rapid administration

• Withdrawal (tremors, insomnia, GI complaints)

• Hiccups |D5W, D10W, NS, TPN, Heparin, Fentanyl, Dopamine, Dobutamine, KCl |Establish etiology of agitation (respiratory insufficiency, pain, NICU environment, etc)

• Attempt non-pharmacologic ways of calming baby first

• Differentiate between pain and agitation

• Drugs such as chloral hydrate may be safer, more cost effective

• Monitor VS, BP, O2 Sat

• Be ready to ventilate

• Evaluate with Sun scale

• Assess for s/s withdrawal | |

Name |Classification |Action |Indications |Dosage |Side effects |Compatibilities |Nursing actions | |Morphine |Narcotic analgesic |Narcotic analgesic |Sedative

• Anxiolytic

• Not a pain relief |For infants ( 3 months: requiring opiods, doses should be reduced as morphine

• 0.02 mg/kg/dose IV

• For infants > 3 months:

0.05 mg/kg,

max 2.5 mg/dose |Marked respiratory depression

• Hypotension, bradycardia or tachycardia due to histamine release |TPN

• Midazolam, Dobutamine, K+ |√ resp. + cardiovascular status closely

• Observe for abdominal retention + loss of bowel sound

• √ VS, BP, O2 need, Sat.

• Evaluation with Sun scale | |Narcan

(Nalaxone) |Narcotic antagonist |Pure opiate antagonist |Prevent or reverse the effects of opiods including respiratory depression, sedation, hypotension, pruritus and urinary retention

• Low dose infusion elevated pruritus whilst also maintaining adequate analgesia |0.1 mg/kg IV (SC if IV route is not available)

• Repeat q 2-5 min PRN

if no response

• Drip:

1-2 mcg/kg/hour |Tachycardia

• Tachypnea

• Elevated BP

• Tremor

• Lethargy

• Elevated pH

• Excessive dose may = excitement + significant reversal of analgesia

• Hypotension

• Hypertension

• Ventricular tachycardia

• Fibrillation

• Pulmonary edema |NS

• D5W

• Nalaxone should not be mixed with other medications |Support resp. first

• Duration of action can be shorter than morphine action

• May precipitate withdrawal symptoms to infants born to narcotic-dependant mothers.

• Evaluation with Sun scale | |

Name |Classification |Action |Indications |Dosage |Side effects |Compatibilities |Nursing actions | |Dopamine |Catecholamine (naturally occurring) |Responses may be individualized

Low Dose

(Dopaminergic Effect)

2-5 micrograms/kg/min

• Increases renal blood flow (vasodilatation of renal vascular bed) and increases urinary output. Very little effect on cardiac output or heart rate

Moderate Dose

(Beta Effect)

5-15 micrograms/kg/min

• Increases cardiac contractility and heart rate

High Dose

(Alpha Effect)

> 15 micrograms/kg/min

• Increases cardiac output and blood pressure (increased systemic and pulmonary vascular resistance – vasoconstriction). May decrease output if alpha effects predominate. |Treatment of cardiac failure, pump failure. Cardiogenic shock is most frequently brought on by asphyxia, sepsis, and/or myocarditis

• Treatment of hypovolemic shock in conjunction with volume expanders

• Used in neonates with severe circulatory disturbances leading to renal dysfunction. Increases blood flow to the kidney, thus increasing urine output

• May be used to enhance mesenteric blood flow for infants at risk for NEC, following GI surgery |Drip:

• 2-20micrograms/kg/min IV |Hypotension / Hypertension depending on dose

• Arrhythmias |D5W, D10W, NS, TPN, Heparin, Fentanyl, Dobutamine, Midazolam, KCl

• Incompatible with calcium, sodium, bicarbonate, furosemide and insulin |Continuous monitoring of VS, ABP, urine output, O2 Sat, tcpCo2

• Complete cardiac assessment: pulses, perfusion, capillary refill, etc

• Correct hypovolemic states prior to initiating drug

• Never bolus or interrupt infusion (short ½ life)

• Watch IV sites closely. Tissue sloughing and necrosis due to local ischemia may occur with infiltration. Some blanching at the site with high doses may be “normal”.

• Wean gradually | |

Name |Classification |Action |Indications |Dosage |Side effects |Compatibilities |Nursing actions | |Dobutamine |Catecholamine (synthetic) |(Beta Effect):

• Increases cardiac contractility and cardiac output, has little effect on heart rate and blood pressure. Increases conduction through the AV node. No dopaminergic receptors however may increase renal perfusion by increasing cardiac output. |Treatment of CHF and cardiogenic shock to improve myocardial function. To treat cardiac failure secondary to loss of contractility. Low dose is 4X more potent that dopamine for improving contractility. |Drip:

• 2-15 micrograms/kg/min IV |Hypotension / Hypertension depending on dose

• Arrhythmias

• Increased myocardial O2 consumption |D5W, D10W, NS, TPN, Heparin, Dopamine, Fentanyl, Midazolam, KCl

• Incompatible with calcium, sodium, bicarbonate, furosemide, insulin |Continuous monitoring of VS, ABP, urine output, O2 Sat, tcpCo2

• Complete cardiac assessment: pulses, perfusion, capillary refill, etc

• Never bolus or interrupt infusion (short ½ life)

• Wean gradually | |Epinephrine (Adrenaline) |Adrenergic Agonist Agent

• Bronchodilator |Low Dose:

• 0.05-0.15 micrograms/kg/min

Increases HR and contractility

• High Dose:

0.2-0.3 micrograms/kg/min

Causes increased systemic vascular resistance, increases BP, may decrease renal blood flow

• For Use in Neonatal Resuscitation:

0.1-0.3 cc/kg IV, ETT

Use 1:10 000 solution |Short term use in cardiac failure resistant to other drug management |Drip:

• 0.05-0.3 micrograms/kg/

min |Arrhythmias

• Hypertension

• Hypokalemia

• Renal vascular ischemia |D5W, D10W, NS, Heparin, KCl

• Usually given alone on 9C despite being compatible with other agents (Dopamine, Dobutamine, Fentanyl, Midazolam, TPN)

• Incompatible with sodium bicarbonate or other alkaline solutions |Continuous monitoring of VS, ABP, urine output, O2 Sat, tcpCo2

• Complete cardiac assessment: pulses, perfusion, capillary refill, etc

• Never bolus or interrupt infusion (short ½ life)

• Given through a CVL on 9C

• IV infiltration may cause tissue ischemia or necrosis | |

Name |Classification |Action |Indications |Dosage |Side effects |Compatibilities |Nursing actions | |Prostaglandin E1 (PGE, Prostin, Alprostadil) |Prostaglandin produced endogenously in tissues |Causes relaxation of ductal smooth muscle, thereby maintaining patency of the ductus arteriosus |To preserve ductal flow until palliative or corrective surgery in neonates with congenital heart disease characterized by:

• Ductus-dependant pulmonary blood flow: pulmonary stenosis or atresia, tricuspid atresia, severe Tetralogy of Fallot (TOF)

• Ductus-dependant systemic blood flow: aortic stenosis or atresia, coarctation of the aorta, hypoplastic left heart syndrome

• Poor arterial-venous mixing: transposition of the great vessels (TGV) |Drip:

• Start at 0.005 to 0.01 micrograms/kg/min, increase by increments of 0.05 micrograms/kg/min until acceptable saturation is reached or until femoral pulses are palpable

• Maintain lowest effective dose once response achieved |Apnea

• Hyperthermia

• Hypotension

• Seizure like activity

• Cutaneous vasodilation

• Bradycardia |D5W, D10W, NS

• Do not mix directly with any other medications

• Via Y connector with maintenance only in extreme circumstances |Be ready to ventilate patient

• Continuous of VS (To), BP, O2 Sat

• Increased infant temperature is not an indication to stop therapy, but my respond to decreasing the dose

• Complete cardiac assessment for ductal patency: heart murmur, peripheral pulses (femoral), perfusion, capillary refill, urinary output, acid-base balance, etc.

• If infant deteriorates, check IV

• Second IV must be available

• Notify MD immediately for any decrease in saturation: for example if the baby is unable to maintain his saturation above a desired level, or if the baby is desaturating frequently

• PGE should not be bloused or interrupted

• Judicious use of oxygen | |

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