Week 8: opioids Flashcards
Pain scale
1-3?
4-6?
7-10?
Mild- ibuprofen
Moderate- morphine
Severe- fentanyl
MORPHINE AND MORPHINE LIKE DRUGS
morphine, codeine, hydromorphone, oxycodone, hydrocodone
Used for what kind of pain?
Also used for what?
Combined with?
MODERATE and/or SEVERE PAIN (NOT mild, review the pain ladder)
COUGH/ANTI-TUSSIVE (prescription only, generally liquid cough syrups)
Frequently combined with Non-opioids:
MORPHINE AND MORPHINE LIKE DRUGS
morphine, codeine, hydromorphone, oxycodone, hydrocodone
What kind of opioid agonist?
Black box warning for?
Pure opioid agonist receptors in the CNS and periphery (Mu + Kappa)
Black box warning for respiratory depression!!!
Adverse effects of
M.O.R.P.H.I.N.E.
NO ALCOHOL WITH OPIOIDS!!!
Miosis (constriction of the pupil)
Out of it (sedated)
Respiratory depression
Pruritus (common)
Hypotension (dizzy) & Head injury(avoid!)
Infrequency of urination and bowel movements (referring to urinary retention or constipation)
Nausea/Narcotics
Emesis
moRphine =Respiratory Depression
2 rules?
Do not mix opioids with what?
B AND Z rule? 6
1) Hold if respiratory rate <12
O2 <90% and notify provider
This is what KILLS people!!
*#2) Know what drugs NOT to mix/ what drugs can INCREASE the risk for respiratory depression
B AND Z RULE
*Don’t mix Opioids with:
*BOOZE/Alcohol/EtOH
*Back pain medication (Baclofen)
*Barbiturates (“itals” like phenobarbital)
*Benzodiazepines (diazepam, alprazolam, lorazepam, etc.)
*Zzzz drugs (Ambien®= zolpidem)
*Benadryl (diphenhydramine and other 1st generation antihistamines
morPhine=Pruritis (Itching)
Do not give if?
Sometimes this may lower blood pressure + HR.
Do not give if
HYPOTENSIVE (SBP<90, DBP<60) or BRADYCARDIA (HR<60)
morpHine= Hypotension + (Head pressure)
Don’t give if what?
What can occur?
Risk for what?
Do not give if
HYPOTENSIVE (90/60)
BRADYCARDIA (HR<60)
Dizziness can occur! CHANGE POSITIONS SLOWLY (Fall RISK!)**
*Due to vessel dilation from histamine, this may cause cerebrovascular dilation = elevated intracranial pressure (^ ICP)
*This means avoid in head trauma/injuries where elevating pressure in the brain would worsen it!
morphIne=Infrequency (bowel movements and urination)
Opioids cause what?
Do patients adapt?
Whats the rule?
Opioids will cause CONSTIPATION
*Patients never ADAPT to this, you will always have constipation
The rule is “All MUSH, no PUSH”
(CANT PUSH OUT POOP DUE TO NO PERISTALSIS)
This means that patients have soft stools, but their intestinal muscles aren’t working
morphiNe=Nausea/Narcotic and morphinE=Emesis
Opioids stimulate receptors where?
How is morphine taken?
Opioids stimulate receptors in the GUT and BRAIN and can make patients feel nauseated
Prescribers have anti-nausea drugs (called anti-emetics) ordered
Counsel patients to TAKE WITH FOOD
OTHER ADVERSE EFFECTS: Opioids
*Diaphoresis/Flushing/Sweating
*Tolerance / dependence
*EUPHORIA/ addiction
*Allergic Reactions (itching vs difficulty breathing!)
What is stronger?
Morphine or HYDROmorphone?
HYDROmorphone is 7x stronger than morphine
Non-Morphine Opioid Agonist
Prototypes:Tramadol, methadone, fentanyl, meperidine
what are they?
These drugs are still opioids used for moderate to severe pain
Non-Morphine Opioid Agonist
Tramadol
Increases risk for what?
Caution?
can increase risk for SEIZURES and SEROTONIN SYNDROME
Caution for: History of seizures
Non-Morphine Opioid Agonist
Meperidine
Used for what?
Increases risk for what?
May seen used in the OR to reduce SHIVERING
Postoperative shivering
can increase risk for SEIZURES and SEROTONIN SYNDROME
Non-Morphine Opioid Agonist
METHadone
Used for?
Also used for?
Can do what?
Patients require what?
SPECIAL USE: SUBSTANCE USE DISORDERS!!!
Also used in MODERATE/SEVERE PAIN
***can prolong the QT interval (dysrhythmia risk).
Patients require periodic EKGs
Non-Morphine Opioid Agonist
Fentanyl
Routes?
Used for?
MOST POWERFUL OPIOID
IV is only allowed in critical care areas (ICU, OR, ED). Should not be used in Med-Surg
Oral Pill= NONE
Sublingual/Buccal= Lollipops
-Actiq®
Works FAST for extreme pain. Prescribed for severe cancer pain or used by military for combat injuries/trauma
Fentanyl
Apply how often?
Do not apply what and why?
How to discard?
Only for what type of pain?
How long does it take to work?
Only for people who?
Change every 72 hours
Do not apply heating pads (why?) increases absorption
-Discard appropriately (sharps container/coffee grounds, FDA says OKAY to FLUSH!)
Only for Chronic Pain (not acute)
Take 12+ hours to work (again, not for acute pain)
Only for people who have been taking large doses of opioids
Partial / Mixed Opioid Agonists
Pros?
Cons?
They have what?
PARTIAL opioid activation
PROS: partial respiratory distress, ceiling effect
CON: Less pain relief
Partial Agonists have a HIGH AFFINITY for opioid receptor
Mixed/Partial Agonists types
BUprenorphine
Used for?
Pain management
BUPRENORPHINE- Addiction management (Substance Use Disorders
Route options for opioids
Immediate Release?
Extended Release (long-acting opioids)?
Fentanyl and Buprenorphine Patches?
Buccal Fentanyl Lollipop?
Immediate Release:
◦Pills, liquid, IV
Extended Release:
◦Do NOT Crush
Fentanyl and Buprenorphine Patches:
◦SLOW to work
◦Do NOT apply heating pads, throw away in sharps container or FLUSH patches
Buccal Fentanyl Lollipop
◦Works extremely fast for SEVERE acute pain (think cancer pain, combat injury)
◦Keep secured, Storage in original container, keep away from children
Opioid overdose
3 primary symptoms
Miosis
Respiratory distress
Coma
Opioid overdose antidote?
When to give?
NaloXone = X out the Opioids!
AKA Narcan
THREE primary s/s of opioid overdose
Give if RR< 12
Give if Oxygen Saturation <90% (SpO2)
Give if patient passed out and you cannot wake them/stimulate them
Naloxone
Symptoms needed to give naloxone?
How to give in the hospital and outpatient?
THREE primary s/s of opioid overdose
Give if RR < 12
Give if O2 less than 90%
Give if patient passed out and you cannot wake them/stimulate them
How to give:
Hospital= Administer IV
Outpatient= Nasal Spray, IM/SC Injection
Naloxone
Only works for what?
Can u give another dose?
Half life?
*Only works for opioids
*If it didn’t work, feel free to give another dose
*It will NOT harm someone
*Has short half life (less than 1 hour)
*Patient may need repeat doses (call 911 if outpatient)
*Continue to monitor RR and Mental status q 5 min
Peripheral Mu Opioid Antagonist (PAMORA):
MethylnaltreXOne
used for?
Only works where?
Don’t use in what?
Antidote for Opioid Induced Constipation (OIC)
MethylnaltreXone= X out the Opioids in the GI TRACT ONLY
Do not use in bowel obstruction
Anti-Diarrheal Opioids:
Loperamide, diphenoxylate
Used for what?
Don’t work in what?
Don’t use in patients with?
Used to treat diarrhea
Do not work in the brain/spinal cord and do NOT cause any pain relief (don’t cross the BBB)
Do not use in patient with C. DIFF
