Opioids (Exam 2) Flashcards by Isaiah Smith

Opioids for Pain Releif

-Morphine
-Hydromorphone
-Fentanyl
-Meperidine
-Codeine
-Oxycodone
-Hydrocodone
-Narcan/nalaxone (antidote)

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General considerations for all Opioids

-All of them are HIGH ALERT DRIGS

-Assess LOC, BP, Pulse, and Respirations before and periodically during administration

-If RR is <10 min assess level of sedation (Respiratory depression is our BIGGEST CONCERN)

-Physical stimulation may be sufficient to prevent significant hypoventilation

-Subsequent does may need to be decrease by 25-50%

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3 chemical classes of opioids:

-Morephine-like

-Meperideine-like

-Methadone-like

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morphine

-Drug prototype

-MOA: mu agonist —- mimics the action of ednogenous opioids at the mu receptors

(morphine bids to the mu receptors and creates a response)

-SCHEDULE 2

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morphine: interactions

Alcohol and CNS depressents

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Morphine: Indication

-Moderate to severe pain

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Morphine: Adverse Reactons

SERIOUS:
-Respiratory Depression
-CNS depression

COMMON:
-Constipation
-Itching
-Dry mouth

-Do not give to patient who have not taken opioids medication before

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morphine: nursing consideration

All opioids:

May impair the mental/physical abilities required for operating machinery or car

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hydrmorphone

-Opioid similar to morphine

-synthetic formulation

-Schedule II

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Hydromorphone: indication

-SEVERE PAIN

-7x more strong than morphine

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hydromorphone: side effects

same as other opioids

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Fentanyl: Indicaitons

Synthetic opioid for moderate-severe pain, surgical indication, and chronic pain

-PO (buccal) (IV) (IM) and Transdermal (chronic cancer)

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Fentanyl potency

-EXTREMELY POTENT

-0.1 mg = 10 mg of morphine

DOSES IN MICROGRAMS

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merpedridine

-Synthetic opioid and schedule 2

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merperidine: indicaitons

-Moderate to severe pain

-Weaker than morphine and shorter duration

-Less respiratory depression

-PO is half as effective as IV

-LOTS OF DRUG/DRUG interactions

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Merperidine uses

-ED for migraines

-Post-opp to stop shivering

Merperidine: Concern

With repeated doses breaks down to TOXIC metabolite

Seizures (STAR)

Codeine

Schedule II alone and Schedule III when combined with acetaminophen

Codeine: Indications

Mild to moderate pain, reduce coughing (antitussive)

Codine: Precautions

Do not give to children younger than 18 related to life threatening breathing problems

Codeine: Side effects

Nausaea

Oxycodone

-Schedule II

# 1 drug used at UK on med-surg floor

-Semi-synthetic derivative of codeine

Oxycodone: Indications

-10x more potent than codeine

-Moderate to severe pain

-High potential of abuse

Time release oxycodone

OxyContin

Oxycodone and acetaminophen

Percocet

Hydrocodone: Indications

-Mild moderate pain and cough -Cough suppressant -Analgesic effect to codeine----6x more potent than codeine

Methadone

-Full synthetic opioid analgesic -Schedule II -Opioid of choice for DETOX treatment in opioid addiction -Long half-life than other opioids

Naloxone

Narcan = Opioid Antagonist

Naloxone: MOA

-Binds to opioid receptors but DOES NOT ACTIVATE (clogs them) Onset: <2 min Route: IV, IM, or intranasal

Naloxone: Indications

-Antidote to reverse effects of morphine and morphine-like drugs

Naloxone: Adverse Reactions

-Abrupt reversal of opioid effects with RECURRENT pain -Increased blood pressure

Nursing Consideration: Opioid Naive Patient

-Crucial to know your patient (Elderly and Younger are more likely to be opioid naive) -Know baseline neurological status -Always start with lowest does unless OVERT signs of SEVERE pain

Nursing Consideration: Opioids

CONSTIPATION: -give stool softeners, hydrate, nutrition -Can progress to paralytic ileus---especially in the post-op patient Nausea and Vomiting: -may need to give anti-emetic medication to help adress the N/V

Key Card Opioids Rank from strongest to weakest

1. Fentanyl: Severe pain. Small dosages. Given transdermal for cancer patients 2. Hydromorphone: Severe pain. 7x more strong than morphine. 3. Morphine: Moderate-Severe pain 4. Oxycodone: Moderate-Severe Pain. Most common. 5. Mereperidene: Moderate-Severe. Migrane and Stop shivering 6. Codeine and Hyrdocodone: Mild-Moderate. Used for coughing 7. Methadone: Mild-moderate. Used as a detoxification drug due to long half life