Analgesics, Anti-anxiety, and Hypnotics Flashcards
Opioid **
general term defined as any drug, natural or synthetic, that has actions similar to those of morphine
Opiate
more specific; applies only to compounds present in opium (morphine, codeine)
Narcotic:
analgesic, CONS depressant (make you less alert), any drug capable of causing a physical depends
opioids are schedule
schedule II drugs
physical dependence *****
s state of physiological adaptation manifested by… Abstinence syndrome/withdraw
Abstinence syndrome/withdraw
occurs if drug abruptly stopped. yawning, rhinorrhea, sweating, anorexia, n/v, abdominal cramping, tremors, spasming, kicking movements, bone and muscle pain, mental agitation, tachycardia, elevated blood pressure
withdraw lasts
approximately 7-10 days
to lessen withdraw symptoms then its better to
taper the dosage over 7-10 days
typically you will not see a physical dependence when opioids are taken for
acute pain
endogenous opioid peptides
our bodies have opioid properties associated with 3 family peptides that are located in both CNA and peripheral tissues: enkephalins, endorphins, dynorphins
three main classes of opiod receptors
Mu, Kappa, Delta
which opioid receptor is most important and why**
Mu because opioid analgesics activate these
when mu receptors are activated:
analgesia, respiratory depression, sedation, euphoria, physical dependence, decreased GI motility (constipation);
so when activated 1. pain goes away 2. respiratory depression
adverse effect of opioids:
respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis, elevation of intracranial pressure, euphoria/dysphoria, sedation, neurotoxity, miosis
respiratory depression
(adverse effect of opioids) 7 minutes after IV injection, 30 min after IM, effects may persist 4-5 hrs; greater risk for young and old, and those with respiratory disease; greater risk with concurrent use of alcohol, barbiturates, benzodiaepines (don’t take zanax and morphine)
if respiratory rate is 12 or less than **
withhold opioid and notify MD
constipation
(adverse effect of opioids) encourage fluids, stool-softeners (docusate-Colace), osmotic laxatives (miralax)
orthostatic hypotension
(adverse effect of opioids) dilate peripheral arterioles and veins due to histamine release; use much caution when getting pts up instruct them to move slowly when changing positions; antihypertensive drugs will excerbate opioid induced hypotension (so check bp before given)
urinary retention
(adverse effect of opioids) morphine tightens bladder sphincter, increases anti-diuretic hormone release; anticholinergics will worsen urinary retention
cough suppression
(adverse effect of opioids) watch for increase accumulation of secretions, listen for increased rales
biliary colic
(adverse effect of opioids) epigastirc distress
emesis
(adverse effect of opioids) means to vomit, triggers chemoreceptor trigger zone in braine; first does the worst; subsides with subsequent doses (so going to get morphine with does of finagrin or zofran)
elevation of intracranial pressure
(adverse effect of opioids) with decreased respirations, carbon dixoide levels increase and cause dilation on cerebral vessels; do not administer to brain trauma pts
neurotoxicity
(adverse effect of opioids) delirium, agitation, muscle spasms, extreme pain sensitivity
miosis
(adverse effect of opioids) keep light low to prevent vision impairment
administered
oral, IM, IV, subq, epidural, and intrathecal; crosses blood brain barrier, enters CNS to relieve pain, inactived by hepatic metabolism
tolerance
increasing doses required to obtain same response or same analgesia, euphoria, sedation, respiratory depress; cross tolerance exists to other opioid agonists
drug interactions with morphine
CNS depressants; anticholingeric drugs (bc of risk of urinary retention), hypotensive drugs (would lower BP), monoamine oxidase inhibitors (combined w/ demerol - excitement, delirium, high fever, convulsions, severe respiratory depression) , agonist-antagonist opioids (Talwin) - will cause withdrawal syndrome, opioid antagonist - narcan
Demerol causes
increased hr and breaks down to toxic metabolites
toxicity/overdose
clinical manifestations: coma, respiratory depression (2-4 breaths/minute, pinpoint pupils)
treatment for overdose**
ventilatory support, Narcan (naloxone), or revex (nalmefene)
fentanyl parenteral
induction and maintenance of anesthesia
fentanyl transdermal
(duragesic patch) released slowly over time (effective levels in 24 hrs, lasting to 48 hrs) absorbed through the skin
CYP3A4 inhibitors (ketoconazole)
transmucosal;;; mepridine - short half life, frequent dosing, multiple interactions, toxic metabolites, use only for 48 hrs and no more than 600 mg/34 hrs
codeine
usually given PO, combined with aspirin or acetaminophen for “synergistic” action, also used for cough suppression
oxycodone (percodan, percocet)
analgesic actions equivalent to codeine; a long acting analgesic
percodan
codeine and aspirin
percocet
codeine and tylenol
hydrocodone
loratab, vicodin
proxyphene
(darvon, Darvocet)
dosing guidelines
accomodate to individual variation: 10mg might relive pain for 70% and not other 30%; opiods should be given on a fixed schedule
