Opioids Flashcards
Why is there a higher dose for oral?
Due to first past effect
What are strong opioid agonists?
Morphine, Fentanyl, Meperidine (Demerol), and Methadone
What are moderate opioid agonists?
Codeine, oxycodone, and hydrocodone
What does PCA stand for?
Patient controlled analgesia
Why is it better to have a fixed drug schedule rather than PRN?
Better to manage pain instead of chasing it and ultimately needing to give higher doses
Clinical manifestations of toxicity?
coma, respiratory depression, and pinpoint pupils
What is the tx for overdose?
Ventilatory support and antagonist: Naloxone (Narcan)
MOA for Narcan?
Blocks receptor sites
Why is Narcan not given PO?
D/t first pass effect
Which drug is 100 times stronger than Morphine?
Fentanyl
Why is Meperidine (Demerol) not given as often?
It has toxic metabolite accumulations, short half life, and interacts adversely with other drugs
Why is Vicodin (Hydrocodone + Tylenol) the most abused medication?
It is not a scheduled narcotic
MOA of Tramadol (Ultram)?
inhibits reuptake of serotonin and norepinephrine
What drugs should be avoided when taking Tramadol?
MAOIs, SSRIs, TCA, Triptans, and SNRIs
T/F. Sedation comes before respiratory depression
True
What are the routes for Fentanyl?
IV, transdermal, and transmucosal
Why are IV opioids pushed slowly?
Too fast can cause the pt to experience hypotension or respiratory depression
Why do we need to assess for SI with the use of Tramadol?
It is often used as a vehicle for suicide
What 2 drugs make up Percocet?
Tylenol and Oxycodone
Routes for Naloxone?
IM, IV, Subcut, and nasal spray outpatient
What does opioid tolerant and naive mean?
Tolerant: pt has been taking at least 60mg of morphine or equal analgesic dose of another opioid for a week or longer.
Naive: pt’s who do not meet opioid tolerant criteria and have not had narcotics of at least 60mg for a week or more.
What is the most critical assessment we need to do in patients using PCA pump?
Sedation assessment (Pasero, Ramsay, or Richmond Agitation or Sedation Scale)
What are other assessments we need to do with PCA pump use?
- Is the patient able to effectively use the tool?
- opioid tolerant or opioid naive?
- consistent use of pain scale.
- Sedation assessment w/ resp assessment
