Opioids

Nurse’s role in pain management

Advocate and educator for effective pain control.

Pain reassessment after analgesic

Reassess pain 10–60 minutes after giving medication, depending on route and setting.

What are the Non-opioid analgesics

NSAIDs, acetaminophen, and salicylates.

What are Opioid analgesics

Morphine, fentanyl, and codeine.

What are Adjuvant analgesics

Gabapentin (anticonvulsant)

lorazepam (antianxiety)

dexamethasone (glucocrticoud)

ondansetron (zofran)

Non-opioids treat

Mild to moderate pain.

Opioids treat

Moderate to severe pain, such as postoperative, myocardial infarction, and cancer pain.

Adjuvant analgesics purpose

Enhance pain control and treat symptoms that worsen pain, such as seizures, inflammation, anxiety, or nausea.

Cancer pain medication progression

Nonopioid plus adjuvant can be followed by an opioid if pain becomes moderate.

Oxycodone use

Used for moderate to severe pain.

What is a opioid agonist

Attaches to opioid receptors and produces effects such as analgesia, euphoria, sedation, and respiratory depression.

What is Agonist-antagonist

Produces analgesia alone but can block analgesia when given with a pure opioid agonist.

What is Opioid antagonist

Does not produce opioid effects; it reverses respiratory and CNS depression from opioid overdose.

Examples of opioid agonists

Morphine, fentanyl, codeine, methadone, oxycodone, hydromorphone, hydrocodone, meperidine, and opium.

What are Opioid agonist schedule classification

Schedule II controlled substances.

Schedule I

High abuse potential and no accepted medical use, such as heroin and LSD.

Schedule II

High abuse potential with severe dependence risk, including narcotics, amphetamines, and barbiturates.

USED IN HOSPITAL

Schedule III

Less abuse potential than Schedule II with moderate dependence risk.

Schedule IV

Less abuse potential than Schedule III with limited dependence risk.

Schedule V

Limited abuse potential; often small amounts of narcotics like codeine for cough or diarrhea.

Normal temperature

97°F to 99°F.

Normal heart rate

60–100 beats per minute.

Normal respiratory rate

12–18 breaths per minute.

Normal oxygen saturation

95%–100%.

Normal blood pressure

About 120/80 mmHg.

Oral opioid route

Better for chronic, non-fluctuating pain.

The parenteral route is best for

immediate, short-term relief of acute pain

Enteral routes

Tablets, capsules, liquids, suspensions, elixirs, lozenges, sublingual, buccal, NG tube, and G-tube.

Parenteral routes

Intradermal, subcutaneous, intramuscular, intravenous, and epidural.

Mu receptor activation

Produces analgesia, sedation, respiratory depression, euphoria, and physical dependence.

Kappa receptor activation

Produces analgesia, sedation, and decreased GI motility.

Therapeutic uses of opioid agonists

Moderate to severe pain relief, sedation, and decreased bowel motility

Cough suppression with codeine.

Opioids and constipation

Opioids decrease GI motility, which can cause constipation.

Especially activation of Kappa receptors

How long to administer IV morphine/hydromorphone

Give slowly over 4–5 minutes to prevent hypotension and respiratory depression.

Fast IV opioid push risk

Fast push can cause severe respiratory depression and death.

IV morphine peak

Peaks in about 20 minutes.

PO morphine peak

Peaks in 60–90 minutes.

Pain reassessment after IV morphine

Reassess in 15–30 minutes

Codeine cough use

Used for a dry cough

Codeine adverse effects

Sedation, respiratory depression, hypotension, constipation, and GI upset.

What is one thing to know when taking Codeine

Use a measuring spoon, not a kitchen spoon.

What is important to know for Fentanyl

Most potent narcotic

Main reasons for overdoses

Fentanyl patch use

Used for chronic pain, not acute pain.

Fentanyl patch onset

Does not provide immediate relief; may take up to 17 hours for full effect.

Fentanyl patch safety

Remove old patch before applying a new one.

Apply to clean, dry skin and rotate sites.

How to prevent Fentanyl constipation

Use stool softeners such as docusate sodium and brand name is Colace and take daily as ordered.

How is Oxycodone given

extended release that usually lasts 12 hours and is often given twice daily.

Scheduled oxycodone teaching

Give around the clock as scheduled, even if the client is not currently reporting pain.

Methadone uses

Opioid withdrawal, maintenance therapy for opioid use disorder, and severe chronic pain.

Methadone risks

Sedation, constipation, hypotension, and life-threatening respiratory depression.

Methadone antidote

Naloxone/Narcan.

Respiratory depression nursing action for opioid agonists

Monitor vital signs and withhold opioid if respiratory rate is less than 12/min.

Respiratory depression emergency preparation

Keep naloxone and resuscitation equipment available.

Opioids with CNS depressants

Avoid combining with barbiturates, benzodiazepines, or alcohol.

Morphine respiratory depression timing

Can occur as early as 7 minutes after administration.

Constipation nursing teaching

Increase fluids, fiber, and physical activity.

Constipation medications

Bisacodyl stimulant laxative to counteract decreased bowel motility

Docusate sodium stool softener to prevent constipation

Severe opioid constipation in end-stage disease

Methylnaltrexone can be used.

Orthostatic hypotension teaching

Change positions slowly and sit or lie down if dizzy.

Orthostatic hypotension nursing action

Assist with ambulation as needed.

Urinary retention nursing action

Monitor intake/output and assess bladder distention every 4–6 hours.

Urinary retention teaching

Void every 4 hours.

Cough suppression risk

Secretions can accumulate in the airway.

Cough suppression nursing action

Auscultate lungs for crackles and encourage fluids.

Cough suppression teaching

Cough at regular intervals.

Sedation teaching

Avoid driving.

What to do with Biliary colic

Morphine should be avoided.

Meperidine may be used as an alternative.

Nausea/vomiting treatment

Give an antiemetic such as ondansetron/Zofran.

Opioid toxicity triad

Respiratory depression, CNS depression, and pinpoint pupils.

Opioid toxicity treatment

Monitor vitals, provide ventilation, and give naloxone.

Meperidine cancer pain warning

Not used for cancer pain because toxic effects can occur after more than a few doses.

Opioids in pregnancy

Use with caution and avoid chronic use.

Opioids in lactation

Use cautiously and avoid chronic use.

Opioid risk to newborn

Can cause newborn withdrawal and respiratory depression.

Morphine contraindications

Biliary Tract Surgery

Premature infants during/after delivery.

Opioids used cautiously in

Asthma, hepatic disease, and renal disease.

Opioid administration assessment

Assess pain regularly and document response.

Before giving opioids

Take baseline vital signs.

When RR is less than 12/min when about to give opioid

Withhold opioid and notify provider.

Controlled substance procedure

Follow facility controlled-substance rules.

Opioid double-check

Double-check opioid doses with another nurse before administration.

IV opioid safety

Give slowly over 4–5 minutes and have naloxone ready.

Opioid client teaching

Do not increase dose without provider approval.

Physical dependence teaching

Do not stop opioids abruptly.

Opioid tapering

Withdraw slowly and taper over time.

Opioid agonist effectiveness for patients

Pain relief, cough suppression, or resolution of diarrhea.

What are the 3 Agonist-antagonist opioid examples

Butorphanol, buprenorphine, and nalbuphine.

Most agonist-antagonists mechanism

Antagonists at mu receptors and agonists at kappa receptors.

Buprenorphine mechanism

Agonist at mu receptors and antagonist at kappa receptors.

Agonist-antagonists vs agonists

Lower abuse potential, less euphoria, less respiratory depression, and less analgesic effect.

High-dose agonist-antagonist effects

Can cause anxiety and mental confusion.

Agonist-antagonist uses

Mild to moderate pain and labor pain.

Buprenorphine use

Treatment of opioid dependence and moderate pain.

Buprenorphine compared with methadone

Both can be used for opioid withdrawal/maintenance therapy.

Buprenorphine adverse effects

Sedation, constipation, hypotension, and life-threatening respiratory depression.

Agonist-antagonist antidote for Buprenorphine

Naloxone/Narcan.

Abstinence syndrome symptoms from Complications of agonist/antagonist opioids

Cramping, hypertension, vomiting, fever, and anxiety.

Agonist-antagonists and opioid dependence

Can trigger withdrawal in clients physically dependent on opioid agonists.

Before agonist-antagonist use

Assess for opioid dependence.

Agonist-antagonist respiratory depression action

Have naloxone and resuscitation equipment available.