Chapter 25: Opioids

Question 1

what are bad side effects opioids?

Answer 1

-decreased LOC (sedation/drowsiness)/confusion
-decreased resp (decreased LOC and resp are the reason why you use narcan on someone)
-n/v (1/3 experience)
-constipation
-urinary retention
-with higher doses: pruritis
-with toxicity or accumulation: myoclonus (muscle twitches)

Question 2

what is a positive effect of opioids?

Answer 2

-decreases cardiac workload by decreasing venous return and arterial pressure = helps with CHF and pulmonary edema
-but also can causes orthostatic hypotension = caution pt to get up slowly

Question 3

what is tramadol?

Answer 3

-used for moderate pain, centrally acting nonopioid analgesic, weak opioid agonist activity

Question 4

what are important drug interactions you need to be aware about for tramadol?

Answer 4

-if taken with MAOIs or certain antidepressants, it can increase risk for seizures (tramadol&maois increase serotin levels which can cause serotonin syndrome causing seizures) (some antidepressants also increase serotonin levels)
-if taken with alcohol you can have seizures or sudden death (alcohol and tramadol slow down breathing, potentially leading to resp depression) (tramadol lowers seizure threshold and alcohol increases the risk)
-cyp2d6 (enyzme) converts tramadol into active form, but inhibitors of CYP2D6 will reduce analgesic effect
-two drugs using the same CYP will decrease effect
-txt of overdose: naloxone (but can lead to convulsions/seizures)

Question 5

what is a naloxone?

Answer 5

-also known as narcan
-its a pure opioid antagonist which all narcotic agonist activity for a short period of time by competing at the opioid receptor sites
-doesn’t work if the pt took meds that weren’t opioid based

Question 6

can you give a lot of narcan to someone with chronic pain?

Answer 6

-no, you should only give a small amount, just enough to have a partial, gentle reversal, not a full one (meaning just enough to prevent resp depression but not ot block off all opioid receptors)
-if you give too much, you risk blocking off all opioid receptors, which are the primary receptors for pain relief, potentially causing the indiviudal to not have any pain relief for the duration of narcan

Question 7

what is the txt for respiratory depression?

Answer 7

narcan