T3-Analgesics: Opioids-MJ Flashcards
The drugs mentioned in the PPT only activate __ & __ receptors.
Mu and Kappa
What are the receptor locations?
GI tract–constipation
CNS- pain relief, sedation, decreased respiration
If the dose is too high, what CNS issue may become problematic?
Decreased respiration–can lead to respiratory depression
What opioids are strong opioid agonists?
Fentanyl
Hydromorphone
Meperidine
Morphine
What opioids are moderate-to-strong opioid agonists?
Codeine
Hydrocodone
Oxycodone
What two from the strong opioid agonists should we NOT give to the opioid naive?
Fentanyl and hydromorphone
Which strong opioid agonist drug can not be given for more than 48 hours? Why?
Meperidine- toxic metabolites will build up; can cause seizures
Out of the strong opioid agonists drugs, which do we like to give?
Morphine
The moderate-to-stronge opioid agonists (codeine, hydrocodone, oxycodone) are usually joined with _____.
Tylenol products
What are the 4 safety issues with opioids?
Respiratory depression (fatal)
Acetaminophen and hepatotoxicity
Risk for addiction, abuse
Extended release not for opioid naive
What is important for us to do since we know that opioids may cause respiratory depression?
Check respiratory rate before giving drug and after
Hold drug (and contact prescriber) if respiratory rate is less than 12!
Why do clients need to know the risk of acetaminophen and hepatotoxicity?
They may also be taking tylenol products and that is not a good combo!!
Is risk for addiction and abuse with opioids common?
Not as common as we might think
Who can take an extended release opioid?
Clients who have taken these meds for a long time
NOT FOR THE OPIOID NAIVE
Head injuries and opioids:
Can increase _____
Complicates the ____
Increase ICP (inter cranial pressure) Complicates the diagnosis
ICP causes a decreased respiratory rate which causes ___ CO2 levels–> increased ______ and increased ___ in the brain
Decreased respiratory rate–> Increased CO2–> increased vasodilation –> increased pressure in the brain
What are some other causes of ICP?
Nausea
Myosis (small pupil)
Mental clouding/confusion
Opioids may be common but we need to know they are _____!
Dangerous
Patient education for opioids: Bowel regimen
What is important to educate the patient on here?
The receptors these opioids work on are in GI tract and CNS. If the receptors in the GI tract get activated that can lead to constipation. Giving drugs to prevent constipation is important.
Patient education for opioids: Why should clients avoid ETOH, benzodiazepines, or other CNS depressants?
The CNS receptors are acted on by opioids. They already cause CNS depression. We don’t need them to have double the CNS depression
Patient education for opioids: Patients need to have caution with driving or other things that require _____ because some people are highly sensitive with these drugs!
Concentration
Patient education for opioids:What are common S&S that patients need to be aware of?
Itching and N/V is COMMON
Patient education for opioids: Is N/V common throughout the whole treatment?
No, only at the start.
Patient education for opioids: If a patient is complaining about N/V. What can we tell them helps with it? What makes it worse?
Laying down=helps
Walking=worse
Patient education for opioids: If a patient complains of itching from the opioid and saying they think they have an allergic reaction, should we be concerned?
No! ITCHING IS A COMMON SYMPTOM. They need to know that too!
Patient education for opioids: Urinary retention is sometimes seen with patients taking opioids. What should we tell them regarding this?
Try to void q4h because you may not be aware of the sensation that you need to go
*We need to monitor the I&O
What is a PCA?
Patient controlled analgesia
What is a PCA used for?
So patients can control their pain
*used for severe pain
What is the basal rate?
Amount machine gives patient continually
1mg/h
What is the boost dose?
A docs order for an extra boost of med
Ex: 1/2 mg boost every 15 min
What is a lockout?
The total amount (basal rate and boost rate) that the patient may receive
EX: 6mg over 4 hours
When should we check the settings of the PCA?
the beginning of our shift!
What is some PCA education we should tell the patient?
Let them know it is not immediate relief–usually a 10 min lag
ONLY THEY can push the button-NOT family
Tell them about the lockout period so they aren’t scared to use the PCA because fearful of an overdose
Fentanyl patch: How long does it take for the patch to work?
1 day
Fentanyl patch: Where should they put the patch?
Intact, clean, dry, hair free skin
Fentanyl patch: If the patient is too hairy, is it okay to let them shave and then put the patch on?
NO! Shaving causes skin to NOT be intact–if they put the patch on skin that isn’t intact then absorption INCREASES
Fentanyl patch: How does a patient dispose of the patch?
Fold and flush!
This is a safety issue for children and pets. It would be too toxic for them
Fentanyl patch: What should patients avoid?
External heat sources
