NURS 321: Ch 34, Opioid Agonists and Antagonists (part one)

What are OPIOIDS?

medications used mainly for moderate to severe pain

What are SAFETY concerns with OPIOIDS?

respiratory depression, sedation, constipation, hypotension, dependence, and overdose

What are OPIOID AGONISTS?

medications that attach to opioid receptors and activate them

What EFFECTS are caused by OPIOID AGONISTS?

Pain relief, Sedation, Euphoria, Respiratory depression, Decreased GI motility, Cough suppression

What are examples of OPIOID AGONISTS?

Morphine, Fentanyl, Codeine, Methadone, Oxycodone, Hydromorphone, Hydrocodone, Meperidine

What are OPIOID ANTAGONISTS?

medications that reverse opioid effects by blocking opioid receptors

What do opoid antagonist help with

Respiratory depression, CNS depression, Opioid overdose

What is the most COMMONLY used OPIOID ANTAGONIST?

Naloxone aka Narcan

What is the biggest PRIORITY CONCERN for OPIOID use?

respiratory depression

What is the NURSE'S ROLE in PAIN MANAGEMENT?

advocate and educator for effective pain control

What TWO steps should NURSES take to MEASURE PAIN?

1.) measure pain level on a continual basis and provide necessary interventions

2.) depending on setting and route of analgesia, nurse may have to reassess pain TEN to SIXTY minutes after administering the medication

What are NON-OPIOID ANALGESICS used for?

Treat mild to moderate pain

What are examples of NON-OPIOID ANALGESICS?

• NSAIDs

• Acetaminophen

• Salicylates

What are OPIOID ANALGESICS used for?

Treat moderate to severe pain

What are examples of OPIOID ANALGESICS?

• Morphine

• Fentanyl

• Codeine

What types of PAIN do clients who are prescribed OPIOID ANALGESICS?

postoperative pain, myocardial infarction pain, and cancer pain

What are ADJUVANT ANALGESICS used for?

Enhance the effects, help alleviate other manifestations that aggravate pain

What are examples of ADJUVANT ANALGESICS?

gabapentin, lorazepam, dexamethasone, ondansetron

What types of MANIFESTATIONS do ADJUVANT ANALGESICS alleviate?

depression, seizures, inflammation

What kind of medication is GABAPENTIN?

anticonvulsant

What kind of medication is LORAZEPAM?

antianxiety

What kind of medication is DEXAMETHASONE?

glucocorticoid

What kind of MEDICATION is ONDANSETRON?

antiemetic aka anti vomiting

What is another name for ONDANSETRON?

Zofran

Why might gabapentin be used in pain management?

It can help with neuropathic or nerve-related pain

Why might ondansetron be included in a pain regimen?

It can treat nausea, which may be caused by opioids or illness and can worsen discomfort

How is CANCER PAIN MANAGED?

needs a layered pain regimen; starting with non-opioids and adjuvant medications, THEN adding an opioid when pain becomes moderate to severe

What TWO medications do CANCER PATIENTS usually take?

Naproxen and Gabapentin

What is NEUROPATHY PAIN?

nerve-related pain; feels like burning, tingling, shooting pain, pins and needles

When should an OPIOID be ADDED to CANCER TREATMENT?

for moderate pain that cannot be controlled with naproxen and gabapentin

What is OXYCODONE?

stronger than non-opioid analgesics and can be used when pain is no longer mild and reached moderate to severe pain

What should the NURSE MONITOR for in OPIOID use?

Respiratory depression

Sedation

Constipation

Hypotension

Nausea/vomiting

Dependence risk

Why might a cancer pain regimen include naproxen and gabapentin?

Naproxen can help inflammatory pain, while gabapentin can help neuropathic nerve pain

What is a AGONIST-ANTAGONIST?

Causes an analgesic response when administered alone and prevents an analgesic response when administered with a pure agonist

What does ANTAGONISTS NOT produce?

analgesia or any other effects of opioids

What is the MAIN USE of ANTAGONISTS?

to reverse respiratory and CNS depression caused by overdose of opioids

What is MORPHINE?

An opioid agonist used for moderate to severe pain

What is FENTANYL?

A very potent opioid agonist available IV or as a transdermal patch

What is CODEINE?

An opioid agonist used for pain or cough suppression

What is METHADONE?

An opioid agonist used for severe chronic pain and opioid withdrawal/maintenance therapy

What is DILAUDID?

A strong opioid agonist used for pain relief

What is another name for DILAUDID?

Hydromorphone

What is HYDROCODONE?

An oral opioid agonist used for pain relief

What is MEPERIDINE?

An opioid agonist not preferred for cancer pain due to toxic effects with repeated dosing

What is a SCHEDULE II CONTROLLED SUBSTANCE?

A drug with accepted medical use but high abuse potential and severe dependence risk

Why is constipation common with opioids?

Opioids decrease GI motility

What is the normal range for TEMPERATURE?

97-99F

What is the normal range for HEART RATE/PULSE?

60-100 BPM

What is the normal range for RESPIRATORY RATE?

12-18 breaths per minute

What is the normal range for BLOOD OXYGEN?

95-100%

What is the normal range for BLOOD PRESSURE?

lower than 120/80

What is the PARENTERAL ROUTE used for?

IMMEDIATE, SHORT-TERM relief

of acute pain

What is the ORAL ROUTE used for?

chronic non-fluctuating pain

What is the ADMINISTRATION ROUTE for MORPHINE?

Oral, IV, epidural

What is the ADMINISTRATION ROUTE for FENTANYL?

IV, transdermal

What is the ADMINISTRATION ROUTE for CODEINE?

Oral, IV

What is the ADMINISTRATION ROUTE for METHADONE?

Oral, IV

What is the ADMINISTRATION ROUTE for OXYCODONE?

Oral

What is the ADMINISTRATION ROUTE for HYDROMORPHONE/DILAUDID?

Oral, IV

What is the ADMINISTRATION ROUTE for MEPERIDINE?

Oral, IV

What is the ADMINISTRATION ROUTE for HYDROCODONE?

Oral

What is the ADMINISTRATION ROUTE for OPIUM?

IV, oral

What RECEPTORS do OPIOID AGONISTS act on?

mu and kappa receptors

What does the ACTIVATION of MU RECEPTORS produce?

analgesia, sedation, respiratory depression, euphoria

What is the DANGER of the ACTIVATION of MU RECEPTORS?

linked to physical dependence

What does the ACTIVATION of KAPPA RECEPTORS produce?

produces analgesia, sedation, and decreased GI motility

What is the THERAPEUTIC use of OPIOID AGONISTS?

analgesia, sedation, decreased GI motility

How can OPIOIDS be used for REDUCTION OF BOWEL MOTILITY?

relief of diarrhea

When can OPIOIDS be used for RELIEF of MODERATE TO SEVERE PAIN?

postoperative, myocardial infarction, childbirth, cancer

What is the THERAPEUTIC use of CODEINE?

cough suppression

What are Schedule I (C-I)?

High abuse potential, no accepted medical use

What is an example of Schedule I (C-I) drugs?

heroin, LSD

What are Schedule II (C-II)?

High abuse potential, severe dependence liability

What is an example of Schedule II (C-II) drugs?

narcotics, amphetamines, and

barbiturates

What are Schedule III (C-III)?

Less abuse potential than schedule II, moderate dependence liability

What is an example of Schedule III (C-III) drugs?

nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics

What are Schedule IV (C-IV)?

Less abuse potential than schedule III, limited dependence liability

What is an example of Schedule IV (C-IV) drugs?

some sedatives, antianxiety agents, and nonnarcotic analgesics

What are Schedule V (C-V)?

Limited abuse potential.

What is an example of Schedule V (C-V) Drugs?

small amounts of narcotics (codeine) used as antitussives or antidiarrheals

HOW is MORPHINE/HYDROMORPHONE IV ADMINISTERED? Why?

Administer 4-5 minutes IV to prevent hypotension and respiratory depression

Why does the amount of TIME taken to push MORPHINE/HYDROMORPHONE IV matter?

do NOT push over 4-5 SECONDS because it can cause respiratory depression and chest wall rigidity causing a FAST DEATH

WHEN does IV MORPHINE PEAK?

20 minutes

WHEN does PO MORPHINE PEAK?

60 to 90 minutes

When should a patient be REASSESSED after administrating MORPHINE/HYDROMORPHONE IV?

After 15-30 minutes, NOT after 60 minutes

What kind of COUGH is CODEINE used for?

dry cough, not wet/productive cough

Why CAN'T CODEINE be used for WET COUGH?

wet/productive cough helps clear mucus from the airway so using codeine is suppressing it, secretions can build up in the lungs

What should the nurse monitor with codeine?

Respiratory rate, sedation, blood pressure, constipation, and GI upset

What should be used to MEASURE CODEINE?

a measuring spoon

What should NOT be used to MEASURE CODEINE? Why?

a kitchen spoon; does not measure dose correctly

What respiratory rate should make the nurse hold an opioid?

Less than 12 breaths per minute.

What is the MOST POTENT narcotic?

fentanyl

What TWO FORMS does FENTANYL come in?

IV and patches

What TYPE of PAIN are FENTANYL PATCHES used for?

chronic pain, not acute pain

Why are FENTANYL PATCHES used for CHRONIC PAIN?

the patch works slowly and does not provide immediate relief

HOW LONG does it take for FENTANYL PATCHES to reach FULL EFFECT?

17 hours

What might adverse symptom might FENTANYL cause? What is given to mediate this?

constipation; administer stool softeners daily

What MEDICATION should be administered to a patient that is CONSTIPATED due to FENTANYL?

colace aka docusate sodium

How are FENTANYL PATCHES applied?

remove old patch before new one, clean the area, place patch on dry skin

HOW LONG does OXYCODONE last?

extended release over 12 hours