OPIOIDS

Opioid Analgesics

CNS‑acting pain medications used for moderate–severe pain; Schedule II controlled substances; cause sedation, respiratory depression, constipation, and pinpoint pupils.

Opioid Agonists

Activate opioid receptors (mu, kappa) → suppress pain impulse in CNS; also suppress respirations and cough.

CNS depression

Low & slow vitals (↓BP, ↓HR, ↓RR), sedation, respiratory suppression; worsened by alcohol, benzos, antidepressants, herbal depressants

Pinpoint pupils

Classic sign of opioid toxicity; severe CNS depression.

Morphine

Gold‑standard opioid; used for acute pain, MI, cancer, dyspnea; causes sedation, respiratory depression, constipation; antidote = naloxone

Hydromorphone

Dilaudid; 6× stronger than morphine; faster onset, shorter duration; IV push over 2–3 minutes; same risks but more potent

Meperidine

Demerol; opioid analgesic; CNS depressant effects similar to morphine

Fentanyl

High‑potency opioid; IV or transdermal patch for chronic pain; NOT for acute pain; continuous around‑the‑clock delivery

Codeine

Weak opioid; also used in cough syrups; causes sedation and respiratory suppression

Tramadol

Atypical opioid; weaker; still causes CNS depression and constipation

Methadone

Long‑acting opioid; used for pain and opioid use disorder

Hydrocodone

• Often combined with acetaminophen (Norco); allows lower opioid dose → fewer side effects.

Oxycodone

Often combined with acetaminophen (Percocet); moderate–severe pain.

Constipation

Most common side effect; opioids have antidiarrheal effects → decreased GI motility

Respiratory depression

RR < 12 = intervene; opioids suppress respiratory drive and cough reflex.

Orthostatic hypotension

Low BP due to CNS depression; fall risk

Urinary Retention

Opioids tighten urinary sphincter → decreased output

Tolerance

Need higher doses over time; may lead to physical dependence and withdrawal

Withdrawal

Irritable, diaphoretic, restless, ↑HR, ↑BP

Naloxone

Opioid antagonist [antidote]; covers opioid receptors → reverses CNS & respiratory depression; short half‑life → may need repeat doses; patient wakes up in pain.

Nursing considerations for patients taking opioid analgesics

respiratory assessment, safety precautions, CNS depressant interactions (avoid alcohol, benzos, antidepressants, herbal depressants → valerian root, kava, St. John’s Wort), head injury caution, bowel regimen

PCA pump

patient is able to push button; preset dosage, lockout interval, max limit, ONLY patient can push, helps to stay ahead of pain

monitors CO2 and ventilation (because opioids suppress respirations)

Fentanyl patch

transdermal opioids; Chronic pain only; continuous delivery; NOT for acute pain; slow onset.

Cardinal Signs of inflammation

Redness (prostaglandins)

Swelling

Heat

Pain

Loss of function

What do prostaglandins do?

a part of redness; vasodilation, relaxes smooth muscles, increase capillary permeability, sensitizes nerve cells to pain) → contributes to inflammation

COX help to make prostaglandins

• COX 1= protects stomach lining/regulates platelets

• COX 2= triggers inflammation/pain

NSAIDS

Nonsteroidal anti-inflammatory drugs

Analgesic

antipyretic

anticoagulant

• Inhibits COX= relieving inflammation

Mild/Moderate pain

PNS

EXAMPLES OF NSAIDS

Aspirin (ASA, Bayer), Ibuprofen (Advil, Motrin), Naproxen (Aleve), Indomethacin, ketorolac (Toradol), meloxicam (Mobic), celecoxib (Celebrex)

Aspirin side effects

COX 1 blocked (stomach ulcers), gastric distress, N/V/D/C, heartburn, dyspepsia, EC, bleeding, menstrual cycles may be heavier, dark tarry stools, petechiae (redness), bruising, purpura

Stop before surgery/procedures

Salicylate toxicity

tinnitus, vertigo, hyperventilation, bleeding

Foods to AVOID: prunes, raisins, paprika, licorice

T/F: You can give Aspirin (ASA) to any age group?

FALSE

Never give it to anyone under 18 during a viral illness/fever → Reye Syndrome

Use acetaminophen instead

Propionic Acid NSAIDS

ibuprofen (Motrin, Advil), naproxen (Aleve)

Caution:

cardiac (sodium content), lungs (worsens asthma), bleeding, GI, pregnancy

Which NSAID hasa longer half-life?

meloxicam

used for arthritis

DMARDS

Disease-Modifying Antirheumatic Drugs

Immunosuppressive/immunodulating

• anti-inflammatory

• delay disease progression

Ex: infliximab

What caution is indicated with infliximab (immunosuppressive DMARD)?

bone marrow suppression

liver

cardiac

infection/leukopenia

vaccines (live)

Antigout

When uric acid accumulates and body can’t metabolize

a risk for renal calculi

• seen in purine foods (organ meats, fish (salmon, sardines), alcohol, beer

Side effects of antigout

red, warm, swollen, pain, movement ability decreased

What are antigout meds used for?

“fixing the problem” not treating symptoms → will eventually relieve pain

Xanthine Oxidase inhibitors

allopurinol: acute attacks; reduces our bodies production of uric acid

• be mindful of vision changes/rash

probenecid: increases our bodies rate of getting rid of uric acid

• chronic, not acute attacks (prevention)

colchicine: acute gout attacks

• TOXIC

Bisphosphonates (-dronate)

Alendronate (Fosamax), risedronate, ibandronate

• take in AM on empty stomach, sit upright for at least 30 minutes

• prevents loss of bone density

Migraine Medications (Abortive/acute)

(-triptans)

STOPS the migraine

first line

Sumatriptan: vasoconstriction; impacts serotonin (serotonin syndrome alert)

Ergot alkaloids: Ergotamine, dihydroergotamine

• also vasoconstriction

Migraine Medications (Preventative/prophy)

(-numab)

reduce frequency/severity of migraine headaches

• beta blockers, antiseizure meds, antidepressants, blocks calcitonin gene-related peptide which plays a role in pain and migraine development

Erenumab → MAB= immunosuppression