Opioid AEs Flashcards
CNS
sedation, euphoria, dysphoria, mood change, mental cloud confusion, disorientation, cognitive impairment
Myoclonus in high doses
Neuroendocrine
Blocks hypothalamus from releasing hormones
Decrease T and cortisol, menstruation changes, sex dysfunction, convulsions in excess doses
Respiratory
Respiratory depression from making brainstem less responsive to CO2. Mu receptor is primary but kappa is involved
Agonist-antagonists have ceiling effect on resp depression
Cough depressed by affecting medulla cough reflex
Cardiovascular
Ortho HoTN:
Peripheral vasodilation (from histamine release), reduced peripheral resistance, blocks baroreceptor reflex
fentanyl does not release histamine so much
Torsades:
Methadone at 400 mg/day. Caution with QT-prolonging meds, ECG pre, at 30 days, and yearly.
GI
NV: direct medulla chemoreceptor stimulation mu agonist
GI slowing: delays gastric emptying, slows motility/ peristalsis, reduces secretions, ileus/impaction/obstruction
prophylactic bowel for around the clock opioids including fluid, fiber, stool softener, mild laxative. Severe needs mag citrate or MOM
Patch = less/no constipation
Vestibular sensitization
Genitourinary
Difficulty peeing or urinary retention (older men)
Increases sm muscle tone in bladder/ureters and may cause bladder spasm/urgency
Biliary
Increased sm muscle tone sphincter of Oddi (all opioids) can decrease biliary and pancreatic secretions, increase bile duct pressure. epgastric distress, biliary spasm
Caution biliary tract dz or pancreatitis
Skin and eye
Morphine: dilate cutaneous bl v., flushing face/neck/thorax, sweat, pruritus, worsened asthma. histamine release partial cause
Skin rash from patch. Miosis from toxic mu agonists but not diagnostic.
OD sx
respiratory depression, somnolence/stupor/coma, flaccid muscle, cold/clammy, miosis, pulm edema, bradyC, hoth, death
OD tx
Opioid antagonist (naloxone etc) given to reverse but can induce withdrawal. Dose q few min but after 15 mg naloxone, question the dx.
