Opioid Analgesics

Question 1

Morphine

Answer 1

• For severe pain
• High abuse potential
• Risk of toxicity with kidney impairment

Question 2

Codeine

Answer 2

• Not as strong as morphine
• Has ceiling effect
• Commonly used as a cough suppressant
• Causes GI upset

Question 3

Fentanyl

Answer 3

​​- Synthetic opioid for moderate to severe pain
- Available in parenteral, transdermal and sublingual forms
- The majority of patients may be controlled on every-72-hour administration with transdermal patches
- Should be used for long term pain management not short term (not for post-op pain)
- Long term control of persistent pain (eg. malignant pain)
- Used commonly for sedation during mechanical ventilation
- Cutting patches and heat can accelerate the distribution of medication, leading to overdose

Question 4

Methadone

Answer 4

• Synthetic opioid
• Absorbed through GI tract
• Can assist with the treatment of opioid use disorder
• Titrated based on withdrawal symptoms / side effects / level of tolerance

Nursing considerations for monitoring:
- Monitor for QT prolongation (ECG)
- overdose effects (ie respiratory depression, bradycardia, hypotension, etc) (BP, pulse, RR)
- pain level, withdrawal symptoms
liver function testing – review labs and flag if needed
- blood borne disease testing (baseline and as needed) – review labs and flag as needed
- glucose levels, if doses high

Question 5

Oxycodone

Answer 5

• structurally similar to morphine and has comparable analgesic activity
• Typically used for severe short term pain (eg. post-op) (morphine, oxy, hydromorphone)
• Often combined with nonopioid analgesics (ie acetaminophen with Percocets)
• Oxycodone is also available in immediate-release formulations (Oxy IR) and sustained-release formulations (OxyNeo)

Question 6

Tramadol

Answer 6

• Often combined with acetaminophen to make Tramacet
• For moderate to moderately severe pain
• Classified as a miscellaneous analgesic because it is similar to a opioid but with weak opioid receptor activity
• creates a weak bond to the μ (mu) opioid receptors & inhibits the reuptake of both norepinephrine and serotonin
• Not a controlled substance
• Can lead to serotonin syndrome, drowsiness, dizziness, headache, seizures, nausea, constipation, and respiratory depression