Unit 7: Controlled Substances, Opioids, and Corticosteroids: Nursing and Pharmacology

Controlled Substances Act of 1970

An act that recognized the abuse and dependency potential of specific drugs and categorized them into schedules.

Schedule I Drugs

Highest potential for abuse; no currently accepted medical use in the US (e.g., heroin, LSD).

Schedule II Drugs

High potential for abuse and dependence; accepted for medical use, usually with no refills (e.g., morphine, hydrocodone, cocaine).

Schedule III Drugs

Moderate potential for abuse; 5 refills allowed in 6 months (e.g., anabolic steroids, ketamine, lower doses of codeine).

Schedule IV Drugs

Low potential for abuse; 5 refills in 6 months (e.g., benzodiazepines, zolpidem, tramadol).

Schedule V Drugs

Lowest potential for abuse; can be OTC with refills as authorized (e.g., cough syrups with codeine, antidiarrheals).

Nursing Responsibility - Storage

Controlled substances must be in a secure, locked container; narcotics require a double lock.

Nursing Responsibility - Counting

Two licensed nurses must count medications at the change of each shift.

Nursing Responsibility - Wasting

A licensed nurse must witness and sign when a medication is discarded or wasted.

Addiction

A pattern of compulsive drug use characterized by a continued craving for an opioid for its effects rather than for pain management.

Tolerance

When a larger dose of an opioid is required to maintain the original therapeutic effect.

Physical Dependence

When abrupt discontinuation of an opioid produces physical withdrawal symptoms.

morphine sulfate

Class: Opioid analgesic.

morphine sulfate - MOA

Binds to mu and kappa opioid receptors in the brain and spine, altering pain perception and producing analgesia and euphoria.

morphine sulfate - Indications

Treatment of severe pain, including cancer pain and end-of-life care.

morphine sulfate - Adverse Reactions

Respiratory depression, constipation, nausea, sedation, orthostatic hypotension, and physical/psychological addiction.

morphine sulfate - Nursing Considerations

Hold the medication and notify the provider if the respiratory rate is less than 12/min. Keep naloxone available. Prevent constipation and falls.

morphine sulfate - Patient Teaching

Change positions slowly to avoid dizziness. Avoid alcohol and other CNS depressants. Do not drive or operate machinery.

naloxone (Narcan) - MOA

An opioid antagonist that competes with opioid receptors.

naloxone (Narcan) - Therapeutic Effect

Reverses all effects of narcotics, including respiratory depression and analgesia. It has no effect if opioids are not present in the body.

tramadol (Ultram)

Class: Opioid analgesic (Schedule IV) with a mixed mechanism of action.

tramadol (Ultram) - MOA

Binds weakly to the mu opioid receptor and inhibits the reuptake of norepinephrine and serotonin in spinal neurons.

tramadol (Ultram) - Adverse Reactions

Dizziness, fatigue, headache, seizures, and some respiratory depression.

tramadol (Ultram) - Overdose Note

Naloxone can reverse some overdose symptoms but may also precipitate seizures.

tramadol (Ultram) - Patient Teaching

Do not discontinue abruptly to avoid withdrawal symptoms. Avoid driving.

gabapentin (Neurontin)

Class: Antiepileptic drug (Schedule V as of May 2024).

gabapentin (Neurontin) - Therapeutic Effects

Used as an anticonvulsant and for treating neuropathic pain.

gabapentin (Neurontin) - MOA

Unknown, but it interferes with GABA neurons.

gabapentin (Neurontin) - Adverse Reactions

Drowsiness and fatigue; abrupt discontinuation may cause an increase in seizures.

gabapentin (Neurontin) - Patient Teaching

Do not discontinue abruptly. Do not take within 2 hours of an antacid, as it reduces absorption.

Corticosteroids

Powerful medications that are widely used to suppress inflammation and the immune response in a variety of conditions.

prednisone (Deltasone)

Class: Corticosteroid.

prednisone (Deltasone) - MOA

Acts as a synthetic hydrocortisone to provide immunosuppressant and anti-inflammatory effects.

prednisone (Deltasone) - Adverse Effects

Increased risk of infection (with masked symptoms), poor wound healing, hyperglycemia, osteoporosis, weight gain, insomnia, mood changes, and Cushing's syndrome.

prednisone (Deltasone) - Nursing Considerations

Give with food to prevent GI upset. Monitor blood glucose for hyperglycemia.

prednisone (Deltasone) - Patient Teaching

Do not discontinue abruptly; the dose must be weaned down. Avoid live vaccines. Prevent and monitor for signs of infection.