Narcotics (opiates)

Question 1

Introduction Narcotics (opiates)

Answer 1

• Pain is an unpleasant seasation disturbing patient’s comfort, thought sleep or normal daily activity and is symptomatic of an underlying disease process
  
  • analgesics use:
    
    • acute pain
    • trauma
    • terminal patient
    • procedure done
• Fifth vital sign
  
  • ask what is the pain from score of 1-10 prior to prescripting meds and giving it to them and after giving it to them
• precipitating factor, quality, radiating, severity, and time of pain
• endorphans

Question 2

Mechanism of action

Answer 2

• Endorphan receptor
  
  • Stimulate endorphan receptor
• by stimulating endorphan receptor it blocks perception of pain

Question 3

Therapeutic uses

Answer 3

• anagelsia
  
  • from moderate- severe pain
• antitussive- blocks cough reflex
  
  • (brain has reflex system)
  • stops a reflex for people (wanted)
  • dry chronic cough
  • person gets no rest
• antidiarrheal
  
  • constipation needed
  • decrease bowel movement
  • toxic diarrhea bacteria in the intestinal track

Question 4

pharmacology (CNS)

Narcotics

Answer 4

• analgesia without loss of consciousness
  
  • no toxic doses
• drowsiness
  
  • sleepiness
• Behavioral changes- Euphoria (feeling really good) and dysphoria (feeling miserable and dirty about self)
• depress cough reflex
• nauseant and emetic (vomiting)
  
  • May last up to 3 days but body gets tolerance
  • mix narcotics with nauseant

Question 5

Pharmacology CNS

Narcotics 2

Answer 5

• Toxic effects
  
  • respiratory depression
  • miosis (pupil constriction
    
    • people who OD
    • people who OD will not have pupil dilation which means that narcotics are involved
• Head Injury
  
  • decreases respiratory drive
  • head injury depress respiratory drive cant be together with narcotics
  • respiratory equipment is needed

Question 6

Pharmacology Cardiovascular

Answer 6

VIA INTRAVENOUS MORPHINE ONLY

• orthostatic hypotension
• Morphine effects
  
  • intravenous administration decreased cardiac workload during myocardial infarction
    
    1. inc blood venous pooling
    2. dec venous return of blood to the heart
    3. dec volume to pump
    4. dec workload
    5. dec oxygen demand

NOTE:

• Dec myocardial workload which is good
• Treating the cause of the pain

Question 7

Pharmacology gastrointestinal

Answer 7

• Dec peristalsis- stomach and intestines
  
  • Constipation
    
    • antidiarrheal
• INC biliary pressure
  
  • severe pain
  • stone growing inside
  • cant use normal narcotics

Question 8

Pharmacology misc

Answer 8

Uterus- prolongs labor

• relaxes uterus which stops labor which then leads to c-section

Question 9

Narcotic anagesics

Answer 9

• Morphine
  
  • Intermediate action, but can be given sustained release. dec cardiac workload
• Meperidine
  
  • Short acting
• Fantanyl
  
  • extremely potent
  • patch for terminal patients
  • more patients are not terminal patients and to just regular

Question 10

Narcotic Antagonist

Answer 10

• Blocks opiate receptor
  
  • reverse opiate toxic effects
• displaces opiates on receptors
• short acting
• precipitates withdrawal
• naloxene
  
  • extremely short acting
  • utilize post operatively

NOTE:

• Not treatment for addiction
  
  • severe withdrawal
• effective via intravenously

Question 11

Narcotic agonist/ antagonist

Answer 11

• stimulates or blocks receptors
• not effective in severe pain
• advantages
  
  • dec abuse potential
  • dec addictive potential

NOTE:

• not most powerful analgesic drug
• 50% stimulates and other 50% blocks
• Usefor biliary pressure and labor

Question 12

antidiarrheal

Answer 12

• effective in non-infectios diarrhea
• dec GI motility to dec diarrhea BUT will retain toxins and bacteria

Question 13

antitussive

Answer 13

• a drug that dec cough reflex
• dec sternal pain to encourage deep breathing

Notes:

• Found in cough medicines
• lossen up mucus –> expectrin

Question 14

Pain control concepts

Answer 14

• patient controlled analgesia
  
  • leads to less use
• Chronic terminal pain
  
  • addiction is not a concern
• Post- operative use
  
  • not adequately utilized to promote healing

NOTE:

• Make patient comfortable
  
  • long acting pain med
  • tolerance build up
  • short acting narcotic for break through pain
  • addiction
• few days post operative (3 days) with narcotics addiction does not occur then
  
  • heal faster
  • home faster
  • work faster