opiates

Morphine

Schedule II - moderate to high abuse potential

Morphine therapeutic use

Analgesia

More effective against dull pain, than sharp intermittent

Post operative pain, cancer pain, labor and delivery pain

Can be used for MI(causes vasodilation), dyspnea with heart failure, COPD

Reduces “Air hunger”

Morphine

Mechanism of Action

Binds to mu receptors

Prototype:  Morphine

Adverse Effects

Respiratory depression

Constipation

Orthostatic hypotension

Urinary retention

Cough suppression

Biliary colic

Emesis

Elevated intracranial pressure

Euphoria/Dysphoria

Sedation

Miosis

Birth defects

Neurotoxicity

Morphine adm

IV, IM, sub-Q, epidural, and intrathecal

IV administration IVP S-L-O-W-L-Y !!! (over 1-2 minutes)

PO

Can be short acting: Morphine Sulfate

Immediate Release (MSIR)

Or long acting: Morphine Sulfate Continuous Release (MSContin)

Poor lipid solubility

Does not cross the blood brain barrier easily

Metabolized by the liver

Excreted by the kidneys

Fentanyl adm

Fentanyl

Parenteral

Preferred for surgical anesthesia (conscious sedation) due to rapid onset and short duration of action

Transdermal (Patch)

Transmucosal

Lozenge on a stick AKA Fentanyl lollipop (Aqtiq)

Intranasal

fentanyl

Additional indication: Drug-induced rigors and post-anesthesia shivering

Otherwise avoided due to seizure risk (from toxic metabolite, normeperidine)

Do not give to children bc of normeperidine.

If on opioid drip for 7-10 days need to use methadone for withdrawn

Symptoms of withdrawing, diarrhea , yawning, vomiting .

PCA

Self delivery of medication

Drug and dosages

Bolus doses by pushing button

Preprogrammed “lockout” period prevents overdose

Continuous infusion

Patient and family education

ONLY THE PATIENT CAN PUSH THE BUTTON – NO ONE ELSE

Pain assessment

Prior to administration and I hour after

Oldchart Pain use 1-10 scale

Opioid treatment/interventions-Narcan

Blocks opioid actions

Will reverse effects of opioids if patient is receiving opioids

Analgesia, respiratory depression, sedation, euphoria

Can precipitate withdrawal in an opioid dependent patient

Routes

IV, IM, sub-Q, intranasal [NOT PO]

IV=effects immediately, lasts 1 hour

IM/SQ=effects 2-5 min, lasts several hours

Half life is 2 hours

Tolerance

A state in which larger doses are required to produce the same response that could formerly be produced with a smaller dose.

Because of tolerance, increased does are needed to maintain analgesic effects.

With Morphine, tolerance develops to analgesia, euphoria, sedation, and can lead to respiratory depression

Tolerance does not develop to constipation or miosis

Cross tolerance exists among other opioid agonists

(Oxycodone, methadone, fentanyl, codeine, heroin)

If switching between opioids, make sure dose is equianalgesic

  Morphine precautions

Decreased respiratory reserve

Labor and delivery (labor & fetus)

Head injury

Old and young

Liver impairment

Drug Interactions

CNS depressants, anticholinergic drugs, hypotensive drugs, MAO inhibitors, opioids,

Do not give if they have low RR or BP