Opioids Flashcards
opioid classifications
- agonists: bind to an opioid receptor blocking pain response causing an analgesic effect
- agonists-antagoinsts: binds to pain receptor and causes a weaker neurologic response than full agonists (less risk & ae, pain relief not as great)
- antagonists: antidote, binds to pain receptors but exerts no response
opioid indications
- prevent/relieve acute or chronic pain
- pre/post operative phases
- acute mi
- biliary and renal colic
- traumatic injuries
- promote sedation
- helps facilitate production of anesthesia
- treat acute pulmonary edema
- l&d
opioid adverse effect
- cns: resp. depression, hypotension, cns depression (loc change), n/v, miosis, constipation, urinary retention, itching
- gi: constipation, n/v smooth muscle spasm in bowel and biliary tracts
opioid caution/contraindication
- existing resp. depression
- acute/chronic lung disease
- liver or kidney disease
- prostatic hypertrophy
- increased icp/head injury
- hypersensitivity to morphine
- pregnancy
opioid teaching
- dont take drugs with similar effects
- no etoh
- fall/safety risk
- constipation (increase fibers and liquids)
- take with water, with or without food
dosing guidelines
- small: constant, dull pain
- moderate: intermittent, sharp paon
adjuvant drugs
- NSAIDS
- antidepressants
- anticonvulsants
- corticosteroids
codeine
- bbw: can cause death bc it metabolizes so quickly
- analgesic, antitussive
- schedule II
- additive effect with acetaminophen
fentanyl
- duragesic: chronic and long term use, given another analgesic until effective, still effective 24 hrs after removal
- iv, iv drip, iv push
meperdine
- short term
- metabolizes to a neurotoxin
hydromorphone
given in small amounts
methadone
- treatment for opidoid addicts
- 15-30 hr half life, the more doses, the larger the half life
- severe, chronic pain
oxycodone
moderate pain
oxycontin
bbw: fatal resp. depression
oxymorphone
bbw: accidental injection can result in fatal overdose
tramadol
- schedule iv, low potential for abuse
- oral
- less risk for constipation
- can cause serotonin syndrome (caution with SSRIs)
- more tolerated for older adults
opioid agonists/antagonists
- butorphanol
- nalbuphine
butorphanol
- bbw: caution with acute asthma, sign of resp. depression
- ae: ha, dyspnea, dysphoria, hallucinations
- not for <18
- risk for resp. depression, ceiling effect
nalbuphine
- not controlled
- ae: sedation
opioid antagonist
- naloxone
- naltrexone
naloxone
- acute management/acute overbase reversal
- try to wake up before giving
- push until they take a deep breath
- intensive care for large dose
naltrexone
used to detox addicts
opioid withdrawal/opioid abstinence syndrome
- anxiety
- irritability
- chills and hot flashes
- joint pain
- lacrimation
- rhinorrhea
- diaphoresis
- n/v
- abdominal cramps
- diarrhea
- confusion
pca dose
pre set, self administered dose of pain med
pca basal rate
continuous infusion to maintain analgesic blood level with in the comfort zone
pca delay
-amount of time pt must wait between doses
pca hour limit
total amount of analgesia the pt may receive in one hour
antiemetic
- reglan
- phernergan
- zofran
resp. depression antidote
naloxone
-iv push 0.2-0.4g
