Non sedating anti emetic

(Dosing for elderly [ Improved levels of analgesia and patient satisfaction are achieved when repeated demands are minimized; therefore, caregivers should attempt to keep the average number of demands to approximately two per hour.(See the PCA Management Algorithm on the inside back cover.) Maintenance Dosing Examples: Lockout Interval The lockout interval is the period during which the PCA unit is refractory to further demands by the patient.Continuous Infusion Examples: Patient utilizes 72 mg morphine over the preceding 12 hours Average hourly usage = 6 mg (72 mg 12 hours) Titration Titration of maintenance (PCA) dose is based on pain and sedation scores.With the use of opioids, complete eradication of pain is often unattainable without an unacceptable incidence of serious side effects.Accumulation of normeperidine, a metabolite of meperidine, can precipitate seizures.Seizures have occurred after less than twenty-four hours of meperidine with less than 400mg Loading Dose The loading dose accelerates attainment of an effective blood level of the opioid at the initiation of therapy or for procedures.This period of time is a "moving window" that accounts for drug intake during the four hours preceding any given moment.

Patient weight is a useful guide in initiating PCA dosing, even though the correlation between analgesic requirement and weight is poor.The lockout interval (LOI) is a necessary safeguard to prevent patients from taking an additional dose before appreciating the effect of the preceding dose.The refractory period limits the potential of the patient administering an inadvertent overdose due to the "stacking" of opioid doses.The loading dose should be repeated every 5 -10 minutes (5 minutes for fentanyl) so that the effect of the dose is felt before the next dose is administered.The size of the initial loading dose is influenced by: If the initial 3 to 4 loading doses are ineffective the loading dose can be increased by 25 to 50 % after an appropriate assessment of the patient.The four hour limit is a safety feature to call attention to the amount of opioid required.

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