Wk 9. Opiods & Analgesics Flashcards
- Define opioid.
Any drug that has actions similar to those of morphine.
- Define opiate.
Applies only to compounds present in opium.
- Explain the WHO three-step analgesic ladder.
Start with a nonopioid. If no pain relief, give an opioid for mild-moderate pain. If severe pain, give an opioid for moderate-severe pain. May use nonopioids and adjuvants with opioids to provide more pain relief.
- An equianalgesic dose of a pain medication is equivalent to how much morphine IM?
10 mg morphine IM
- Which receptors are stimulated by opioid analgesics?
Mu and kappa
- Stimulation of which receptors can result in severe respiratory depression and physical dependence?
Mu receptors
- Morphine works best for what type of pain?
Constant, dull pain
- Morphine binds to receptors which are located where?
Brain and spinal cord
- What is the toxic metabolite of meperidine (Demerol)? What effects may it have?
Normeperidine. Agitation, irritability, tremors, seizures.
- Meperidine (Demerol) may interact with a variety of antidepressants because it increases what neurotransmitter?
Serotonin
- Most mixed agonists/antagonists are agonists at what receptor? Antagonists at what receptor?
Agonist – Kappa
Antagonist – Mu
- Administering a mixed agonist/antagonist with an opioid may lead to what?
Pain or withdrawal
- Name a commonly-used opioid antagonist.
Naloxone (Narcan)
- To which side effects of opioids do patients NOT develop a tolerance? What interventions are warranted?
Constipation, miosis (pinpoint pupils). Stress safe environment and nightlights, as well as the use of laxatives and stool softeners.
- Cross tolerance exists between morphine and what other drugs?
Other opioids
- Define physical dependence.
Physical dependence is an abstinence syndrome which will occur if the drug is stopped abruptly.
- Define addiction.
A behavioral pattern characterized by using a psychoactive substance despite physical, psychological, or social harm.
- What is a common cause of death from opioids? Opioids should be withheld if the respiratory rate drops to ___ or below.
Respiratory depression. 12.
- What 6 interventions can be used to prevent constipation with opioid use?
Exercise, fiber, fluid, stool softener, stimulant laxative, methylnaltrexone
- Sedation commonly occurs with opioid administration. What can be expected with prolonged administration?
Decreasing sedation
- Nausea and vomiting may be avoided with opioid use by what two interventions?
Pretreatment with an antiemetic, lying still
- What three interventions should a nurse teach a patient about the risk of orthostatic hypotension from opioids?
Lie down or sit if dizzy or lightheaded, change positions slowly, use ambulatory assistance
- Itching from opioids is mediated by what chemical?
Histamine
- How do opioids affect vision?
Causes miosis which impairs vision.
- How can opioids increase intracranial pressure (ICP)?
Opioids can decrease respirations which increase the amount of CO2 in the bloodstream. Elevated CO2 causes vasodilation which increases ICP.
- How do opioids affect the mother and fetus/neonate?
Opioids may suppress uterine contractions and cause respiratory depression of the neonate. The fetus may develop a physical dependence with prolonged use by the mother.
- Why is the administration of opioids done with precaution in inflammatory bowel disease?
Opioids can cause toxic mega colon or a paralytic ileus.
- What are the three symptoms in the classic triad of opioid toxicity?
Coma, respiratory depression, miosis (pinpoint pupils)
- What fraction of the total daily dose of opioids is usually given as a supplemental dose for breakthrough pain?
1/6 of the total daily dose
- Which route is preferred for the administration of opioids? How will the dose compare to an intravenous dose?
Oral, oral doses are higher
