Opioids “Morphine”

Question 1

MOA

Answer 1

Inhibits pain signal transmission from periphery to brain

Question 2

Indications

Answer 2

-mod to severe pain (MI, burn, cancer, renal/biliary, trauma, pulmonary edema)
-perioperative (balanced anesthesia, post op pain)
-labor and delivery
-GI cramp/diarrhea

Question 3

Contraindications

Answer 3

-respiratory depression
-acute/chronic lung dz
-liver/kidney dz
-prostatic hypertrophy
-ICP
-head surgery
-pregnancy
-hypersensitivity

Question 4

Adverse effects (CNS & GI)

Answer 4

-respiratory depression**
-hypotension**
-CNS depression/LOC
-miosis
-smooth muscle spasm in bowel and biliary
-N/V
-constipation
-itching
-diaphoresis
-urinary retention

Question 5

Nursing implications (IV, PO, PCA)

Answer 5

-full vitals (BP,O2,RR)
-safety (fall risk)
-IV (dilute!! Push slowly!!)
Reduce dose if with other CNS depressant

Question 6

Additional opioids

Answer 6

-codeine (ceiling effect and combo drugs)
-fentanyl (IV need airway management, RN can’t IVP)
-meperidine (short term 6 days, neurotoxin…seizure)
-hydromorphone (potent, smaller doses)
-methadone (long half life, detox)
-oxycodone
-OxyContin (illicit use)
-oxymorphone (fatal OD from ER)
-tramadol (wild scale pain, geriatric friendly, serotonin syndrome with SSRI, less addictive)

Question 7

Antidote to opioids

Answer 7

-naloxone (narcan): active overdose reversal
-naltrexone: detox addicts