Opioids (Exam 2) Flashcards
Opioids for Pain Releif
-Morphine
-Hydromorphone
-Fentanyl
-Meperidine
-Codeine
-Oxycodone
-Hydrocodone
-Narcan/nalaxone (antidote)
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%
3 chemical classes of opioids:
-Morephine-like
-Meperideine-like
-Methadone-like
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
morphine: interactions
Alcohol and CNS depressents
Morphine: Indication
-Moderate to severe pain
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
morphine: nursing consideration
All opioids:
May impair the mental/physical abilities required for operating machinery or car
hydrmorphone
-Opioid similar to morphine
-synthetic formulation
-Schedule II
Hydromorphone: indication
-SEVERE PAIN
-7x more strong than morphine
hydromorphone: side effects
same as other opioids
Fentanyl: Indicaitons
Synthetic opioid for moderate-severe pain, surgical indication, and chronic pain
-PO (buccal) (IV) (IM) and Transdermal (chronic cancer)
Fentanyl potency
-EXTREMELY POTENT
-0.1 mg = 10 mg of morphine
DOSES IN MICROGRAMS
merpedridine
-Synthetic opioid and schedule 2
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
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
- Fentanyl: Severe pain. Small dosages. Given transdermal for cancer patients
- Hydromorphone: Severe pain. 7x more strong than morphine.
- Morphine: Moderate-Severe pain
- Oxycodone: Moderate-Severe Pain. Most common.
- Mereperidene: Moderate-Severe. Migrane and Stop shivering
- Codeine and Hyrdocodone: Mild-Moderate. Used for coughing
- Methadone: Mild-moderate. Used as a detoxification drug due to long half life
