Analgesics: Narcotic Flashcards
Morphine Sulfate
Onset: Immediate
Peak effects: 20 minutes
Duration: 2-7 hours
Half-life: 1-7 hours
MOA: CNS depressant that acts predominantly on opiate receptors in the brain, providing both analgesia and sedation. Increases peripheral venous capacitance, and decreases venous return. Morphine also decreases myocardial oxygen demand- due to both decreased systemic vascular resistance, and sedative effects.
Class: Schedule II Narcotic
Action: analgesia and sedation
Indications: severe pain
Contraindications: known hypersensitivity, volume depletion, severe hypotension, undiagnosed head injury, undiagnosed abdominal pain
Precautions: causes respiratory depression in higher doses
Side effects: N/V, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression
Interactions: the CNS depression can be enhanced when administered with antihistamines, antiemetics, sedatives, hypnotics, barbiturates, and alcohol
Route: IV, IM
Adult dose: IM- 5-15 mg based on pt weight
IV- 2-5 mg followed by 2 mg every few minutes, until the pain is relieved, or until respiratory depression ensues
Peds dose: 0.1-0.2 mg/kg IV
Hydromorphone (Dilaudid)
Onset: 15-30 minutes
Peak effects: 30-90 minutes
Duration: 4-5 hours
Half-life: 2.6 hours
MOA: a CNS depressant that acts predominantly on opiate receptors in the brain, providing both analgesia and sedation
Class: Schedule II Narcotic analgesic
Action: CNS depressant and analgesic
Indications: severe pain
Contraindications: known hypersensitivity, undiagnosed head injury, undiagnosed abdominal pain, shock
Precautions: hydromorphone is a potent opiate, hypotension can occur, nausea can occur
Side effects: N/V, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression, bradycardia
Interactions: the CNS depression associated with hydromorphone can be enhanced when administered with antihistamines, antiemetics, sedatives, hypnotics, barbiturates, and alcohol
Route: IV, IM, PO
Adult dose: 1-4 mg
Peds dose: 0.015 mg/kg/dose IV
Fentanyl Citrate (Sublimaze)
Onset: immediate
Peak effects: 3-5 minutes
Duration: 30-60 minutes
Half-life: 6-8 hours
MOA: Fentanyl is a narcotic analgesic with rapid onset and short duration of action. Alterations in RR and alveolar ventilation associated with narcotic analgesics, may last longer than the analgesic effect. Large doses may produce apnea. Fentanyl appears to have less emetic activity than other narcotic analgesics
Class: Schedule II Narcotic analgesic
Description: Fentanyl is 50-100 more times potent than morphine, but has a shorter duration of action
Indications: severe pain, maintenance of analgesia, or as an adjunct in RSI
Contraindications: known hypersensitivity, severe hemorrhage, shock
Precautions: Use in caution with pts with cardiac bradyarrhythmias. Fentanyl may produce bradycardia, which can be treated with atropine. Fentanyl should be administered with caution in pts with liver and kidney dysfunction because of the importance of these organs in the metabolism and excretion of meds.
Side effects: respiratory depression, apnea, muscle rigidity, bradycardia
Interactions: other meds with CNS depressant effects such as barbiturates, tranquilizers, narcotics, and general anesthetics, have an additive or potentiating effect with fentanyl. Severe and unpredictable potentiation by MAOIs has been reported with narcotic analgesics. Using in pts who have had MAOIs in the past 14 days is not recommended
Route: IV, IN
Adult dose: 25-100 mcg
Peds dose: for 2-12 years old- 1-2 mcg/kg/dose
Others:
. Meperidine (Demerol)
. Nalbuphine (Nubain)
. Butorphanol (Stadol)
