NUR312 Opioids, Anesthetics, Seizures, Muscle Relaxants

What are the general effects of opioids?

Respiratory depression

Addiction

Constipation

Sedation

Urinary Retention 

Constrict Pupils 

True or False: The way it is given affects how it affects the person

True

Routes for Opioids

SL (second most likely)

PO- 15-30 minutes 

Patch

IV- most likely, the effects are quicker, assess vitals RR in particular in opioids. HR, BP, and o2 sat can all be affected. MOnitor IV site for things like phlebitis. Quicker results but also quicker side effects. 

Topical 

IM 15-20 

SubQ

Enema(not so common)

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Nasla- takes 8 minutes

What is the antidote to an opioid overdose?

Naloxone (Narcan)

What happens in an opioid overdose?

RR decreases, they stop breathing. If you administer Narcan they wake up immediately. 

What are the three categories of opioid analgesics?

Agonists, Agonist/Antagonist, Antagonist

What is the job of an agonist?

Agonists- promote drug actions. Meds go to receptors and promote the action. In this case morphine targets pain receptors and reduces pain.

What is the prototype of the opioid agonists?

Morphine Sulfate

How is morphine given?

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 given IV push slowly or else vitals will plummet. They could also vomit. Some people will vomit anyway.  Ex. 5mg , given 1 mg/min 

What does morphine do?

IT also dilates coronary arteries and allows for more perfusion and blood flow and oxygenation. This lowers BP, HR, RR, and it increases oxygenation. It is also used for sedation(although not the first line of sedation). It relieves anxiety… good if they have an emotional crisis in addition to something else. It is an opioid with addictive qualities too.

What does the dose depend on?

Dose depends on the person, age, weight, comorbidities. If the dose is too large they can go into something like respiratory depression.

Job of the agonist/antagonist

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facilitate absorption of the med and maybe the side effects aren't as great b/c they have the antagonistic actions too. 

What is the prototype of the agonist/antagonist group?

Butorphanol

How does butorphanol work?

What is the job of the antagonist group?

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blocks the receptor from accepting the medication

WHat is the prototype of the antagonsit group?

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Naloxone(narcan) 

Things to know about Naloxone(narcan)

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Only works for so long…pt must be monitored. If opioids are still in the system it may have to be given agaihn. 

If given because of cardiac event then monitor pain, vitals signs, perfusion, wtc

What are the two types of anesthetics

Local and general

Which type so anesthetics fall under the category: Local

Epidurals

Spinals- surgery, spinal cord injury. Even if they patient doesn't feel it the body still reacts.  The higher up the injury the more it will impair. T6-T5 and higher these people are at increased risk even they dont feel pain their body still sends signals to the brain. They would still get a med to interfere with brains reaction.

Dental

Topical

What are the two categories of local anesthetics?

Amides and Esters

What is the prototype of the Amides

Lidocaine

Lidocaine Indications

WHen given IV for cardiac reasons it numbs it and decreases automaticity to whatever is tilting it 

When giving it to numb the area it can be given with epi or w/out epi(vasoconstrictor) 

Why should you be careful about giving epi with lidocaine?

If you have laceration at end of your body: toes, face, etc you don’t give it with epinephrine 

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You may cause death to that area

What is the prototype for the Esters?

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__Chloroprocaine__

Things to know about general anesthesia

we intubate so we are not really worried about RR). Still monitor vitals for all these types of meds. If on these meds they should be sleeping 

What are the five types of general anesthetics?

Benzodiazepines, Opioid Analgesics, Inhalation Agents, IV, and Neuromuscular Blocking Agents

What is the prototype for benzodiazepines?

Midazolam

What is the prototype of inhalation agents?

Isoflurane

What is the prototype of opioid analgesics in general anesthesia?

Fentanyl

IV general anesthesia prototype

Propofol- works quickly, characteristics are short lasting, once you stop the iV it no longer works, just stop the IV if there is a problem … monitor all the same side effects as..

What is the neuromuscular blocking agent prototype?

Verconium

What does Verconium do?

This paralyzes muscle and makes you lose the airway

Things to know about General Anesthesia meds

If these meds do not work it may be b/c the If IV is not working properly meaning infiltration leaking out the vein.  If this happens they have to call the provider in order to inject an antidote to save the tissue. Sometimes they will take a syringe and needle into the site and pull out the substance.

What did Radonda do wrong?

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Mixed up versed with vecuronium

Do you give a sedative or a paralytic first?

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When you are intubating. First you must give a sedative then the paralytic. Or else they will be paralyzed and awake

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What are the four categories of meds used in seizure disorders?

Barbiturates, Benzodiazepines, Gamma-Aminobutyric Acid Structural Analog, Hydantoins 

How do seizure medications affect people?

All of these decrease stimulation in the brain 

Decreased ability to focus, slower reaction time, fatigue, sleepy, relaxed, weight gain, constipation, mood altering 

Patient Teaching for seizure medication

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be careful driving and operating machinery due to decreased reaction time. Take it and drive w/ someone in the car until you see how it affects you .. ease into it. 

What is the prototype for barbituates?

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Phenobarbital

What is the prototype for benzodiazepines for seizure medications?

Diazepam(Valium)

What is Diazepam used for?

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Used for anxiety , used in acute setting iV, acute alcohol withdrawal. Sedation is the biggest side effect

Routes for Administration of Diazepam

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Rectal, IV, PO 

What is the prototype for Gamma-Aminobutyric Acid Structural Analogs?

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Gabapentin

Gabapentin Indications

Used in seizures and is used in people with chronic pain too 

Anticonvulsant

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5-7 hour half-life

Prototype for Hydantoin

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Phenytoin(Dilantin)

Rectal is in response to a breakthrough seizure 

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Half-life 7-42 hours 

Other things to know about seizure meds

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Clients on these meds sneed routine bloodwork to see therapeutic levels. We know there are food and drug interactions that could interfere with these medications' ability to work. 

What are skeletal muscle relaxants for?

Pain

What are the four categories of skeletal muscle relaxants?

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Carbamate, GABA,  Direct Actina, Tricyclic Antidepressant 

What is the prototype of Carbamates

Prototype- Carisoprodol 

FOr acute not chronic. DOnt use for more than 2-3 weeks 

Abuse potential

Half life is 2 hours

Worried about CNS  depression 

Make sure they are not on any any other CNS depressants 

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Pt must be weaned off med 

What is the prototype for GABA in skeletal muscle relaxants

Baclofen 

USed in people with spinal injury , chronic lower back pain which impinges spinal cord 

Multiple uses 

PO for MS 

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Withdrawal symptoms; wean off 

What is the prototype for direct acting skeletal muscle relaxants?

Dantrolene Sodium

What is the prototype for Tricyclic Antidepressants

Cyclobenzaprine Hydrochloride

Are GABA and Gamma-Aminobutyric Acid Structural Analogs the same thing?

No

Steven Johnsons is a reaction to med

Two levels: Less acute, TENS(doesn't clear up right away and more profound and skin is sloughing off, NSAIDs are usually the primary culprit, they msu absolutely avoid those meds) 

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Toxoplasmosis is a bacteria