ch 24 highlights Flashcards
what cannot be taken with opioids due to the risk of resp depression?
Benzos (ie Ativan, Valium, Xanax, Klonopin)
Important teaching when using transdermal patches
- Avoid prolonged exposure to sun
- Caution against use of heat, heating pads, hot baths, saunas
- This increases release of drug from patch and can result in overdose and death
- Clean site with water only prior to application
- remove hair by clipping not shaving prior to application
How often is Butrans transdermal patch changed out
7 days
Yawning
Sneezing
Sweating
are symptoms of
Withdrawl
When giving morphine what should you monitor and perform
- monitor respirations
- encourage physical activity
- offer fluids
- palpate lower abd every 4-6 hours to feel bladder for urinary retention
If you have biliary colic, can you take an opiod?
no
What pain med is appropriate when you have biliary colic
demerol
what opioid is respiratory depression limited beyond a certain dose
Pentzocine
transmucosal fentanyl is approved for what patient population
18 years old and older with breakthrough cancer pain who are already taking opioids around the clock
if you need to change products with a transmucosal fentanyl, can you use the same dosing?
no, due to differences in bioavailability
Blackbox for codeine
In the liver, about 10% of each dose of codeine undergoes conversion to morphine, the active form of codeine. The enzyme responsible is CYP2D6. Among ultra rapid metabolizers which carry multiple copies of the CYP2D6 gene, codeine is unusually effective and has led to death in some children.
Severe toxicity can develop in breastfed infants whose mothers were taking codeine. causes high levels of morphine in breast milk, due to ultra rapid codeine metabolism
What can happen if you give Pentazocine to a pt who is physically dependent on a pure opioid agonist
Can precipitate(trigger) withdrawal
Pentazocine withdrawal
cramps, fever, anxiety, restlessness
mild, treatment is rarely required
Pentazocine reversal agent
Narcan (Naloxone)
Do you see severe resp depression in Butrans
no
Can you develop physical dependence on Butrans
yes, but symptoms of abstinence are delayed. Peak responses may not occur until 2 weeks after the final dose was taken.
what is combined with Butrans to prevent toxicity
Naloxone (narcan)
What do you give for Butrans toxicity
cannot readily reverse toxicity once it develops.
what is drug of choice for treating overdose for pure opiod agonist
Naloxone (Narcan)
What meds are used for opioid induced constipation
Methylnaltrexone
naloxegol
naldemedine
what pure opioid antagonist is used for opioid and alcohol abuse
Naltrexone (ReVia, Vivitrol) to prevent euphoria
what is Embeda
a fixed dose combo of morphine and naltrexone designed to discourage morphine abuse
What would you be concerned for if a pt was taking tramadol and a MAOI
hypertensive crisis
What would you be concerned for if a pt was taking tramadol and SSRI/SNRI, tricyclic antidepressants, MAOIs, triptans
Serotonin syndrome
what opioids cause QT prolongation
Butrans and Methodone
opioid that causes less constipation than other opioids
Tapentadol (Nucynta)
what drug should never be administered to a person who is physically dependent on a pure opioid agonist
Pentazocine (Talwin)
Buprenorphine (Butrans)
opioid side effects
resp depression constipation orthostatic hypotension urinary retention emesis sedation neurotoxicity
symptoms of opioid tox
delirium
agitation
myoclonus
hyperalgesia
what schedule is codeine
alone
combo preps
cough med
alone its a schedule II
combo preps are a schedule III
cough is schedule V (antitussive dose is 10mg)
codeine blackbox
in the liver 10% undergoes conversion to morphine. The enzyme is CYP2D6….there are ultrarapid metabolizers that carry multiple copies of this enzyme. has led to death
oxycodone (OcyContin) is schedule
II
Hydrocodone products such as vicodin, lortab, Vicoprofen are all schedule
II
blackbox for hydrocodone
Products that contain acetaminophen are associated with hepatotoxicity
Tapentadol is a
moderate to strong opioid agonist
what class
Pentazocine (Talwin)
Buprenorphine (Butrans)
Agonist-antagonist opioid
Pentazocine (Talwin) and resp depression
resp depression is limited. Beyond a certain dose, no further depression occurs
switching from a pure opioid agonist to Pentazocine (Talwin)
a pt who is physically dependent on a pure opioid agonist, pentazocine can precipitate withdrawal
physical dependence for Buprenorphine (Butrans)
Physical dependence develops but symptoms of abstinence are delayed. Peak responses may not occur until 2 weeks after final dose was taken
Buprenorphine (Butrans) and tox
pretreatment with narcan can prevent tox, however this med binds very tightly to its receptors and cannot be readily displaced by narcan.
Buprenorphine (Butrans) is a schedule
III
drug of choice for treating overdose with a pure opioid agonist
Naloxone (narcan)
meds used for opioid induced constipation for chronic pain pt who are not responding to standard laxative therapy
opioid antagonists
Methylnaltrexone (Relistor)
Naloxegol (Movantik)
Naldemedine (symproic)
opioid antagonists used for constipation should be used with caution in pat taking
CYP3A4 inhibitors
pure opioid antagonist used for opioid and alcohol abuse
Naltrexone (ReVia, Vivitrol)
goal is to prevent euphoria if abuser takes an opioid
combo drug designed to discourage morphine abuse
Morphine/naltrexone (Embeda)
Non opioid centrally acting analgesic
Tramadol
drug interactions for tramadol
intensify responses to CNS depressants (alcohol, benzodiazepines)
MAOI - hypertensive crisis
SSRI - serotonin syndrome
tramadol is a schedule
IV
