Final: Opioid Analgesics Flashcards
Morphine, Codeine, Oxycodone (Opioid Agonists)
Act at specific opioid receptor sites in the CNS
Indications: Relief of severe or acute chronic pain, analgesia and sedation during anesthesia, cough suppression
Adverse effects: Respiratory depression with apnea, cardiac arrest, shock, orthostatic hypotension, n/v, constipation, biliary spasm, dizziness, psychoses, anxiety, fear, hallucinations
Drug-drug: Barbiturates, benzodiazepines, alcohol, MAOIs, phenothiazines, SSRIs, TCAs, St. John’s Wort
Cautions: Respiratory dysfunction, GI or GU surgery, acute abdomen or ulcerative colitis
Codeine: 10% is metabolized to morphine in liver, some people lack this metabolizing gene so it is ineffective
Monitoring: Respiratory depression, increase fiber and fluids, orthostatic hypotension (time with position changes, falls precautions, caution with HTN medications), urinary retention (I&O, avoid anticholinergics, caution with BPH, decreased awareness bladder is full), sedation, take with food, give anti-emetic, risk of respiratory depression and dependence in newborn
Do not stop abruptly - withdrawal symptoms: Mood changes, insomnia, aches and pains, cravings, diarrhea, fever
Buprenorphine/Naloxone (Suboxone - Opioid agonists-antagonist)
Indication: Treatment of opioid use disorder (not analgesia)
Decreases withdrawal symtpoms
Safe during pregnancy/lactation
Goal: To be on Suboxone short term, but can be on long term
Less abuse potential, still has potential for chronic use, abuse, and overdose
No longer requires special prescribers license (DEA-X)
Short term adverse effects: Numbness, insomnia, dizziness, headaches, drowsiness
Long term adverse effects: Anxiety, confusion, digestive problems, increase in depression, decrease in pain tolerance
Naloxone (Narcan - Opioid antagonists)
Competes at opioid receptors, blocking action of opioid agonists or agonists-antagonists. No effect if no opioids in system
Indications: Reversal of opioid effects (overdose, respiratory depression, sedation), treats opioid abuse by preventing euphoria, reversal of severe opioid induced constipation (late state cancer)
Adverse effects: Tachypnea (monitor respiratory status), tachycardia (VTach risk), withdrawal/abstinence syndrome: vomiting, HTN, abdominal cramping.
Pentazocine (Opioid agonists-antagonist)
Ceiling effect - same side effects as opioids but at a lesser effect
