Opioids

narcotis summary

-Relieve pain by Binding with opiate receptor sites in the brain, blocking pain impulses from ascending neural pathways

-Different types of opiate receptors that account of differing levels of addiction & different kinds of side effects

-Naturally occur as endorphins or may be derived from opium or synthetically manufactured

*bind to opiod receptors and block pathway so don’t feel pain; Rx post surgery; class II

-Used to treat mod=severe pain, preop/postop pain releif, sedation; acute pain after surgies, etc.

-not chronic due to tolerence/addiction

scheduled drugs/controlled substances

-narcotics in every class

opiod receptors

u/“mu” big one

-Side effects/adverse rxn:

• analgesia (pain relief)

• miosis (restricted pupils)

• euphoria

• constipation

• respiratory depression (what die from)

• emesis (vomit)

• bradycardia (could have hypotension when sit up)

-other 2 receptors: kappa/k, delta

nociceptors

-3 types: chemical, mechanical, thermal

-delta fibers (fast, myleinated); c fibers (slow, unmyleinated)

endogenous opioids

“natural pain relievers”

opiod-induced analgesia

-Almost ALL analgesics target μ receptors

-Sites of action:

• Peripheral: inhibit activation of spinal cord afferents (*acts on dorsal root ganglions)

• Spinal cord: prevent activation of spinothalamic tract (*inhibits Ca and glutamate, K+ out of cell=hyperporlarization=decreased excitatory response)

• Brain stem: increase activation of descending pathway

  • contained high density of mu receptors; descending inhibitory control pathway

-Opioid receptor activation:

• Raised pain threshold

• Altered brain perception of pain 

opioids common side effects

Respiratory Depression

-all purse opiod agonists do

-assess for normal RR 12-20 (notify if < 20)

-death caused by respiratory arrest; tolerance → respiratory arrest

-high risk populations: young adults, elderly, respiratory disease

Constipation

-asses for BM last 3 days

-manage w/ laxative, fiber

Orthostatic Hypotension

-blunting of baroreceptor reflex

-management: educate lightheaded/dizzy, take their BP before

Urinary retention

-increases tone of bladder sphincter and detrusor muscles, suppress awareness of bladder stimuli

-assess for last urination; urinate even if you don’t have to

Depressed renal function

Pruitus/itchy skin

Opiod-Induced Hyperalgesia

-pain wrose

Cough suppression

-accumulation of secretions

Emesis

-greatest with initial dose

Biliary colic

-spasm in common bile duct

Elevation intracranial pressure

-issue with TBI

Euphorai/dysphoria

Sedation

-mental clouding/drowsiness

Miosis

-constricted pupils

comparing opiods: strong-weak agonist and antagonsist

-Strong Agonist: Fentanyl (*binds tightly; works really good)

-Mild/Mod Agonist:

• Codeine

• Oxycodone: by itself (=oxycontin) or combined w/ acetaminophen (=Percocet)

• Hydrocodone (=Norco or Vicodin)

-Weak Agonist: Tramadol

-Antagonist: Naloxone/Narcan

onset of action common opioid meds

-important for therapy timing! want them to do therapy when meds working

Hydrocodone-Acetaminophen (Norco, Vicodin)

-Moderate-severe pain

-Acetaminophen: 325 mg

• Caution combining w/ other acetaminophen products

-4-6h PRN

-Side effects/adverse reactions: dizzy

-Pregnancy caution

*can be adminstered lots of ways

combination drugs

-like to put 2 drugs together

-narcotic + nonnarcotic drug

Fentanyl vs oxycodone vs Tramadol

PT and Opioids

-Used in all settings

-Communication with patient & interdisciplinary team is crucial

• Registered nurses

• Physicians

• OT/PT/SLP

-“Sweet Spot”

• Enough Opioid to decrease pain

• Tolerable side effects

• Pain relief provided may allow rehab to progress

Consider Adverse Effects

-Monitor vitals: RR 12-20

-Assess cognition: due to seadtion affecct, naseau

-Adminsitered via patch: careful blood flow

-Schedule therapy at peak times

Terms

-Tolerance

-Physical dependence

-Addiction

-Opioid Withdrawl

-Tolerance: increased dose needed to produce an initial response

-Physical dependence: abrupt discontinuance of drug that causes “withdrawal symptoms”

-Addiction: continued use of psychoactive substance despite physical, psychological, or social harm

-Opioid Withdrawal:

• Early symptoms: yawning, rhinorrhea, diaphoresis

• Late symptoms: anorexia, irritability, tremor

• Peak: sneezing, weakness, N/V/D, muscle pain, spasms

Naloxone (Naltrexone)

-opioid receptor antagonist: reverses effects opiods (ex=respiratory depression)

-via NS, IM, IV

what do with medications not using anymore?

-dispose of them at disposal sites

-comman example=police stations

medical marijuana

-restrictions differ state to state

-THC and CBD

-WI: recreational illegal, medical NA, THC sold in local shops or online, CBD oil legal w/ physician letters

-Admin: smoke, vape, oral, spray or oral mucous membrane

-Adverse effects: cognitions/memoroy/balance, gateway drug, CV (increase HR and BP)

-Role PT: Education vs advise!; if using moniter pain and fall risk

Kahoot

-what is not an opiod side effect: respiratory depression, constipation, emesis, tachycardia

-site of action not…

-topical NSAID better and safer than oral?

-Narcan agonist or antagonist

-tachycardia

-PNS activate spinal cord

-true

-antagonist: increases RR, treats OD and addiction