Allopurinol, morphine, nalaxone

What is Morphine

\-Opioid agonist

\-Binds with MU receptors

Morphine expected pharm action

\-mimics actions of naturally occurring opioids

\-binds with mu receptors producing analgesia, sedation, euphoria, resp. depression

Morphine therapeutic use

\-analgesia for moderate to severe pain, preoperative sedation & reduction of anxiety

Morphine complications

\-Respiratory depression \n - Sedation, dizziness, drowsiness, lightheadedness \n -Constipation \n -Nausea & vomiting \n - Itching

\- Orthostatic hypotension \n - Urinary retention \n - Cough suppression \n -Potential for abuse

Morphine contraindications

\-Pregnancy risk D \n - Kidney failure \n -Increased intracranial pressure \n - Biliary colic \n - Preterm labor

Morphine percautions

\n -It is a schedule II controlled substance \n - Older adults, infants \n - Reduced respiratory reserve \n - Head injury \n -Inflammatory bowel disease \n -Hypotension \n -Hepatic or kidney disease

Morphine interactions

\n -CNS depressants will increase CNS depression \n -Anticholinergic agents will increase anticholinergic effects \n - Antihypertensives will increase hypotensive effects \n - St. John’s Wort can increase sedation

Morphine med admin

\n -Get baseline vitals & monitor \n - Orally, IM, IV, SQ, rectally, epidermally \n - IV-dilute & give slowly (over 4-5 min.) \n - Have naloxone & recitative equipment nearby \n - Give to cancer patients on a schedule \n - Monitor PCA (patient controlled analgia) carefully

Morphine nursing interventions

\-Monitor vital signs, auscultate lunge \n - Respirations <12- withhold med, stimulate, possibly give narcan \n -Monitor when ambulating \n - Encourage fiber & stool softener \n - Monitor I&O, urinary retention

\- Encourage to urinate every 4 hours, may have to possibly cath.

Morphine client education

\-Take only when needed, PRN \n -Do not take prior to activities needing mental alertness \n -Sit or lie down-lightheaded \n - Change positions slowly \n - Increase fiber, fluid, activity \n - Take with food or milk \n - Rise slowly \n - Report unable to urinate \n - Cough regularly to clear secretions

Morphine effectiveness evaluation

decrease pain

What is Naloxone

an opioid antagonist

Naloxone expected pharm action

blocks opioid receptors

Naloxone therapeutic use

blocks opioid effects, reverses overdose

Naloxone complications

\n -Increase respiratory rate, blood pressure, pulse \n -Abstinence syndrome (HTN, vomiting, tremors) in opioid dependent people \n -Pain will be back full force

Naloxone contraindications

\-Opioid dependence \n -Respiratory depression

Naloxone percautions

\-Cardiac irritability \n -Head injury, increased intracranial pressure \n -Brain tumor \n - Seizure disorder

Naloxone interactions

opioid effects decrease

Naloxone med admin

\n -Give IM, IV, SC, nasally, oral, sublingually \n - Titrate doses carefully \n - Monitor vital signs

\-Be aware might have pain increase \n - Prepare to give every 2-3 minutes until reversed \n - Opioids last longer \n - Observe for N&V, tachycardia, diaphoresis

Naloxone nursing interventions

\n -Monitor vital signs \n -Monitor heart rhythm \n -Have O2 and recitative equipment ready

Naloxone client education

\n -If awake, inform patient of need for drug \n - Warn patient of possible side effects and return of pain

Naloxone effectiveness evaluation

The increased sedation decreases, pain returns

What is Allopurinol

antigout/antihyperuricemic

Allopurinol pharmacological action

inhibit the enzyme xanthine oxidase from converting \n hypoxanthine and xanthine into uric acid

Allopurinol therapeutic effect

treat the hyperuricemia that causes gout

Allopurinol complications

\-Hypersensitivity syndrome (fever, rash, eosinophilia, liver & kidney dysfunction) \n -GI: nausea, vomiting, diarrhea \n -CNS-drowsiness, headache, vertigo \n -Agranulocytosis or aplastic anemia \n -Potentially fatal skin conditions (exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) \n -Metallic taste \n -May develop cataracts if take > 3 years

Allopurinol contraindication

Hypersensitivity to medication

Allopurinol percautions

\n -Bone marrow depression \n -Liver or renal dysfunction \n -Peptic ulcer disease \n -Lower GI tract disease

Allopurinol interactions

\n -Increases the anticoagulant effect of warfarin \n - Potential for toxicity when given with mercaptopurine, heophylline, or azathioprine \n -Increased risk of rash when given with ampicillin

Allopurinol med admin

\-Orally or IV \n -Get baseline uric acid level and subsequent levels every 1-2 weeks until determine appropriate dosage \n -Obtain baseline CBC, liver and kidney function and obtain periodically \n -Can be crushed or mixed with food or fluid \n -IV-dilute and infuse over 30-60 minutes \n - Make sure client drink at least 3 liters of fluid per day

Allopurinol nursing interventions

\-Monitor for signs of hypersensitivity syndrome \n -For GI affects-give after meals & ensure adequate hydration \n -If having CNS affects-monitor when ambulating \n - Give mild analgesic for headache \n -Check CBC, liver, kidney function tests

allopurinol client education

\-Report fever, rash, abd pain, swelling, or low urine output and stop taking the drug \n -Use over the counter analgesics as needed to relieve headache \n -Report bleeding, easy bruising, sore throat to the provider (due to bone marrow suppression) \n - Warn that may develop a metallic taste \n - Minimize exposure of eyes to sunlight with sunglasses; watch for early signs of cataract development; obtain periodic eye exams \n -Can take with food or right after meal to help if cause nausea \n - Drink at least 3 liters of fluid per day-prevent nephropathy-

Allopurinol effectiveness evaluation

Decrease in the pain & inflammation in joints (small \n joints especially the big toe)