Opioids / Non-Opioids Flashcards
3 opioid receptors and which are used/most important
Mu, Kappa, Delta
Mu is most important, Kappa also used
Mu receptors produce which effects? (6 things)
respiratory depression physical dependence decreased GI motility analgesia sedation euphoria
Kappa receptors produce which effects? (4 things)
analgesia, sedation, psychotic effects, decreased GI motility
most opioid analgesics activate which receptors?
Mu
what do pure opioid agonists do to the receptors?
activate Mu + Kappa receptors
what do agonist-antagonist opioids do to the receptors?
activate Kappa + block Mu
what do pure opioid antagonists do to the receptors?
BLOCK all receptors
what’s an example of an opioid antagonist? and what is it used to treat?
naloxone
opioid overdose, reversal of post-op effects
example of pure opioid agonist
morphine
if a person has been on a pure opioid agonist, and is then given an agonist-antagonist, what are you concerned about?
the Mu receptor is now being blocked and this person will experience withdrawal symptoms
name some “strong opioid agonists”
“fentanyl + the m’s”
fentanyl, morphine, meperidine, methadone, hydromorphone
name some “moderate to strong opioid agonists”
“co”
codeine, hydrocodone, oxycodone
name some “agonist-antagonist opioids”
“bu”
butorphanol, pentazocine, buprenorphine, nalbuphine
major SE of opioids (7)
- which one is most serious?
- which one will not go away, even with tolerance?
- respiratory depression - most serious
- sedation
- nausea
- itching
- constipation - doesn’t resolve
- postural hypotension
- urinary retention
re: administration of opioids, if RR is <12, what would you do? and which nursing interventions could you try?
DON’T GIVE MED.
elevate HOB, O2 therapy, naloxone
what is prevention and treatment for constipation with opioid use?
prevention: fluid + fiber + activity
treatment: enema, stool softener (colace), stimulant laxative (senokot)
prevention and treatment for nausea/emesis with opioid use?
prevention: antiemetic
tx: lay flat + avoid movement
teaching/safety points for hypotension r/t opioid use
dangle, switch positions slowly, ask for assistance
FALL RISK
tx for urinary retention r/t opioid use
void q4, closely monitor I+O
strong opioids should be given with pain rating of what?
7-10
which drug would we use to tx opioid addiction w/low doses?
methadone
meperidine brand name
demerol
what is the special concern with using meperidine for chronic pain control?
it creates a toxic metabolite (normeperidine) that can cause seizures. this drug should only be used for 2 days max and patients should be assessed for nervousness, tremors + seizures
moderate to strong opioids should be given with pain rating of what?
4-7
what is the prototype for non opioid centrally acting analgesics
tramadol
what is the MOA with tramadol?
weak action at Mu receptors and blocks norepinephrine + serotonin
what is the onset with tramadol? max? duration?
onset: 1 hour
max: 2 hour
duration: 6 hr
with tramadol, there’s a serious risk of ______ + should be AVOIDED with these patients
suicide
with an opioid agonist-antagonist, what happens with the receptors? what different effects would you see?
activates kappa, blocks mu receptors –> less respiratory depression and physical dependence, but have psychotomimetic effects
do opioid antagonists cause analgesia?
NO! they block both Mu + Kappa receptors
re: dosing, what is important to know with naloxone?
effects only last for 1 hour, need repeated dosing and to be taken for medical care
why is alvimopan (Entereg) used?
this drug blocks the Mu receptors in the gut, which blocks adverse effects on the bowel but still produces analgesia.
-preferred use to prevent ileus in bowel resection surgery and accelerate bowel recovery
mneumonic for entereg
entereg = enteral feeding = selective peripheral inactivation of mu (in gut)
entereg serious AE, and what is important to look for re: cessation of this med?
can cause MI - only use in hospital and STOP AS SOON AS CLIENT HAS BM!!!
NSAIDs work by inhibiting what?
Cyclooxygenase (COX)
COX 1 does what?
:)
prevents gastric ulceration + prevents bleeding and + prevents renal impairment
COX 2 does what?
:(
promotes MI, strokes, pain, fever, inflammation
1st generation NSAIDs do what?
block COX 1 + COX 2
re: 1st generation NSAIDs and the COX that are blocked, what effects would you see?
GI ulceration, bleeding risk, renal impairment, decreased stroke/MI, decreased pain, fever, inflammation
which drug has an IRREVERSIBLE inhibition of COX?
aspirin
5 therapeutic effects of aspirin
- analgesic
- anti-inflammatory
- anti-pyretic
- anti-platelet
- colon cx prevention
long term ASA side effects?
gastric ulceration, bleeding, perforation (esp. risky in elderly!!)
how do we prevent GI bleeding with ASA use?
take with food/milk
use proton pump inhibitors
what s+s would you see with salicylate toxicity? (ASA)
tinnitus, HA, dizziness, diaphoresis
what are 3 examples of 1st gen NSAIDs (non-ASA)
ibuprofen, naproxen, diclofenac
1st gen NSAIDs (non-ASA) major AE
gastric ulceration, MI/stroke
ibuprofen greatly impacts which organs?
kidneys
acetaminophen greatly impacts which organ?
liver
hi
you’re doing great :)
2nd gen NSAIDs do what? what’s an example?
inhibit COX 2
Celebrex
how does acetaminophen work?
blocks prostaglandins
does acetaminophen have anti-inflammatory action?
NO!!!
what drug is the leading cause of liver injury?
acetaminophen
what is the max dose of acetaminophen?
4g/day (healthy + no organ impiarment)
what is max dose of acetaminophen with person w/AUD?
2g/day
what drug can we administer for acetaminophen toxicity? and when should we give it?
acetylcystine (Mucomyst)
8-10 hours after ingestion is BEST (can be up to 24 hours)
rotten egg smell
