CH 49: Drug Therapy with Opioids

Patient Concerns with Opioids:

• history of addiction

• negative view of opioids (weakness)

• fear of addiction

Opioid Agonists

Prototype: Morphine Sulfate (Duramorph)

schedule 2 controlled drug

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Uses:

moderate to severe acute or chronic pain

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Routes of Administration:

• IV

• PO

• IM

• Topical

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Actions:

binds to receptors in the brain, spinal cord and peripheral tissues

decreases transmission of pain impulses from one nerve cell to the next

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Effects:

• analgesia

• CNS depression

• sedation

• euphoria

• decreased GI mobility

• physical dependence

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Patient Related Variables:

• age

• pregnancy/lactation

• abnormal kidney function

• hepatic impairment

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Adverse Effects:

• CNS and GI systems

• CNS depression: drowsiness to unconsciousness

• decreased mental and physical activity

• respiratory depression

• N/V

• pupil constriction

• constipation

Opioid Agonists

Prototype Morphine Sulfate (Duramorph) Contraindications:

• hypersensitivity

• use of MAOIs (Monoamine oxidase inhibitors: used to treat depression)

• patients with hypotension, elevated intracranial pressure, seizure disorders, alcoholism, use of benzodiazepines-use caution

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol)

• may also see buprenorphine (Subutex)

• opioid agonists/antagonists are considered second-line drugs for treatment of moderate to severe pain

• partial antagonistic properties that may result in opioid withdrawal in physically dependent patients

• should not be given to people who have been receiving analgesics

• black box warning: accidental exposure via buccal or transdermal methods, especially in children

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol) Pharmacokinetics:

• rapidly and well absorbed following IV, IM, and nasal administration

• onset of action occurs within a few minutes with IV administration and within 15 minutes with the other routes

• time to peak concentration is 20-40 minutes (IM) and 30-60 minutes (nasal), and the duration of action is usually 3-4 hours with IV and IM routes and 4-5 hours with nasal administration

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol) Action:

• the drug alters the perception of pain and procedures analgesia

• like morphine, it has a sedative effect

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol) Use:

• used to treat moderate to severe pain that has not been adequately managed with alternative treatments

• the drug is also used as a preoperative medication and as a supplement to multimodal anesthesia

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol) Adverse/Side Effects:

• headache

• dizziness

• drowsiness

• constipation

• nausea and/or vomiting

• euphoria

• restored effects with the nasal spray include nasal congestion, cough, dyspnea, and rhinitis

Opioid Agonists/Antagonists

Prototype: Butorphanol (Stadol) Patient Teaching:

• patients are instructed to notify the prescriber if the pain does not disappear, becomes worse, or changes in location or type

• patients should not stop taking butorphanol abruptly

• patients should take care when changing positions quickly or operating equipment that requires mental alertness

Opioid Antagonists:

Prototype Naloxone (Narcan) Pharmacokinetics:

therapeutic effects occur within minutes after injection

• IV about 2 minutes

• IM 2-5 minutes

• subcutaneous 2-5 minutes

• intranasal administration 8-13 minutes

they last 1-2 hours

Opioid Antagonists:

Prototype Naloxone (Narcan) Action:

• reverses analgesia and the CNS and respiratory depression caused by agonists

• it competes with opioids for receptor sites in the brain and thereby prevents binding with receptors or displaces opioids already occupying receptor sites

Opioid Antagonists:

Prototype Naloxone (Narcan) Use:

• drug of choice to treat respiratory depression caused by an overdose of opioids

• given intravenously, naloxone begins to reverse CNS and respiratory depression induced by opioids in minutes

Opioid Antagonists:

Prototype Naloxone (Narcan) Adverse Effects/Side Effects:

• tremors

• drowsiness

• sweating

• decreased respirations

• hypertension

• nausea and vomiting

Opioid Antagonists:

Prototype Naloxone (Narcan) Nursing Implications: Therapeutic Effects

assess for reversal of opioid effects including improved respiratory function and decreased sedation

Opioid Antagonists:

Prototype Naloxone (Narcan) Nursing Implications: Adverse Effects

assess for decreased respirations and elevated blood pressure

Opioid Antagonists:

Prototype Naloxone (Narcan) Nursing Implications: Stay Close For Monitoring

Narcan lasts for 1-2 hours and re-dosing may be required