Therapeutic

Class Medication

Mechanism of

Action Metabolism

Route of

Administration

(neonates) Dose and Frequency Reversal

Agent Comments

Heteroaryl acetic

acid NSAIDs:

Ketorolac Inhibition of

cyclooxygenase

enzyme and isoforms decreasing

prostaglandin

biosynthesis

(PGI2) resulting

in analgesia

Hepatic:

Phase I and II enzyme

biotransformation with

urinary and biliary

excretion. Metabolism

primarily by

CYP2C9 and CYP2C8.

↓ CYP2C9 activity in

newborn, increasing

over first year of life.

IV, IM, Oral

tablets,

IV: 0.5 mg/kg/dose q6–8h

Infants >1 mo and children <2 y of age

IM: Avoid—painful,

erratic absorption

None:

Maintain hydration,

avoid use of

nephrotoxins.

Discontinue anticoagulants, replace

blood loss if

needed, correct

low platelets.

No data for newborn on dosing for oral

tablets or nasal spray.

Not to exceed 48–72 h treatment

Labeling for >2 y: Limit therapy to ≤5 d;

↑ adverse effects and no data.h

Monitor: hematologic parameters (platelets, Hct, Hgb), clinical signs of bleeding, fluid status, BUN/Scr, urine output during therapy.

NSAID precautions as for ibuprofen.

Not recommended for routine analgesic

use in newborn.

Ophthalmic solution

(Acular LS): ≥3 y of age for postop pain/

inflammation nasal spray (Sprix)

Opioid Agonists

(μu) receptor

Morphine Binds to Mu opiate

receptors in

CNS inhibiting

ascending pain

pathways; altering the perception of and

response to pain;

generalized CNS

depression

Hepatic:

Glucuronide conjugation to morphine-6-

glucuronide (active)

and morphine3-glucuronide

(inactive)

Onset of action: 5 min

(lower lipid solubility)

Peak effect: 15 min

Neonates: delayed maturation of CYP enzyme/

conjugation resulting

in a longer half-life,

slower clearance, and

longer elimination.

Half-life:

Preterm neonates:

10–20 h

Neonates: 4.5–13.3 h

Oral, rectal, IM,

intranasal, IV,

SC, epidural

IV: 0.05–0.1 mg/kg/dose

q1–4h

Continuous infusion:

0.01–0.03 mg/kg/h

Intranasal: 0.2 mg/kg/

dose

Oral:

0.3 mg/kg/dose q1–4h

Naloxone:

Neonatal depression: 0.1 mg/kg/

dose IV/IM/SC.

May repeat q2–3

min minutes as

needed

Neonatal opiate