Opioids

Question 1

opioid classifications

Answer 1

• 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

Question 2

opioid indications

Answer 2

• 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

Question 3

opioid adverse effect

Answer 3

• 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

Question 4

opioid caution/contraindication

Answer 4

• existing resp. depression
• acute/chronic lung disease
• liver or kidney disease
• prostatic hypertrophy
• increased icp/head injury
• hypersensitivity to morphine
• pregnancy

Question 5

opioid teaching

Answer 5

• dont take drugs with similar effects
• no etoh
• fall/safety risk
• constipation (increase fibers and liquids)
• take with water, with or without food

Question 6

dosing guidelines

Answer 6

• small: constant, dull pain

- moderate: intermittent, sharp paon

Question 7

adjuvant drugs

Answer 7

• NSAIDS
• antidepressants
• anticonvulsants
• corticosteroids

Question 8

codeine

Answer 8

• bbw: can cause death bc it metabolizes so quickly
• analgesic, antitussive
• schedule II
• additive effect with acetaminophen

Question 9

fentanyl

Answer 9

• duragesic: chronic and long term use, given another analgesic until effective, still effective 24 hrs after removal
• iv, iv drip, iv push

Question 10

meperdine

Answer 10

• short term

- metabolizes to a neurotoxin

Question 11

hydromorphone

Answer 11

given in small amounts

Question 12

methadone

Answer 12

• treatment for opidoid addicts
• 15-30 hr half life, the more doses, the larger the half life
• severe, chronic pain

Question 13

oxycodone

Answer 13

moderate pain

Question 14

oxycontin

Answer 14

bbw: fatal resp. depression

Question 15

oxymorphone

Answer 15

bbw: accidental injection can result in fatal overdose

Question 16

tramadol

Answer 16

• schedule iv, low potential for abuse
• oral
• less risk for constipation
• can cause serotonin syndrome (caution with SSRIs)
• more tolerated for older adults

Question 17

opioid agonists/antagonists

Answer 17

• butorphanol

- nalbuphine

Question 18

butorphanol

Answer 18

• bbw: caution with acute asthma, sign of resp. depression
• ae: ha, dyspnea, dysphoria, hallucinations
• not for <18
• risk for resp. depression, ceiling effect

Question 19

nalbuphine

Answer 19

• not controlled

- ae: sedation

Question 20

opioid antagonist

Answer 20

• naloxone

- naltrexone

Question 21

naloxone

Answer 21

• acute management/acute overbase reversal
• try to wake up before giving
• push until they take a deep breath
• intensive care for large dose

Question 22

naltrexone

Answer 22

used to detox addicts

Question 23

opioid withdrawal/opioid abstinence syndrome

Answer 23

• anxiety
• irritability
• chills and hot flashes
• joint pain
• lacrimation
• rhinorrhea
• diaphoresis
• n/v
• abdominal cramps
• diarrhea
• confusion

Question 24

pca dose

Answer 24

pre set, self administered dose of pain med

Question 25

pca basal rate

Answer 25

continuous infusion to maintain analgesic blood level with in the comfort zone

Question 26

pca delay

Answer 26

-amount of time pt must wait between doses

Question 27

pca hour limit

Answer 27

total amount of analgesia the pt may receive in one hour

Question 28

antiemetic

Answer 28

• reglan
• phernergan
• zofran

Question 29

resp. depression antidote

Answer 29

naloxone

-iv push 0.2-0.4g