T3-Analgesics: Opioids-MJ

Question 1

The drugs mentioned in the PPT only activate __ & __ receptors.

Answer 1

Mu and Kappa

Question 2

What are the receptor locations?

Answer 2

GI tract–constipation

CNS- pain relief, sedation, decreased respiration

Question 3

If the dose is too high, what CNS issue may become problematic?

Answer 3

Decreased respiration–can lead to respiratory depression

Question 4

What opioids are strong opioid agonists?

Answer 4

Fentanyl
Hydromorphone
Meperidine
Morphine

Question 5

What opioids are moderate-to-strong opioid agonists?

Answer 5

Codeine
Hydrocodone
Oxycodone

Question 6

What two from the strong opioid agonists should we NOT give to the opioid naive?

Answer 6

Fentanyl and hydromorphone

Question 7

Which strong opioid agonist drug can not be given for more than 48 hours? Why?

Answer 7

Meperidine- toxic metabolites will build up; can cause seizures

Question 8

Out of the strong opioid agonists drugs, which do we like to give?

Answer 8

Morphine

Question 9

The moderate-to-stronge opioid agonists (codeine, hydrocodone, oxycodone) are usually joined with _____.

Answer 9

Tylenol products

Question 10

What are the 4 safety issues with opioids?

Answer 10

Respiratory depression (fatal)
Acetaminophen and hepatotoxicity
Risk for addiction, abuse
Extended release not for opioid naive

Question 11

What is important for us to do since we know that opioids may cause respiratory depression?

Answer 11

Check respiratory rate before giving drug and after

Hold drug (and contact prescriber) if respiratory rate is less than 12!

Question 12

Why do clients need to know the risk of acetaminophen and hepatotoxicity?

Answer 12

They may also be taking tylenol products and that is not a good combo!!

Question 13

Is risk for addiction and abuse with opioids common?

Answer 13

Not as common as we might think

Question 14

Who can take an extended release opioid?

Answer 14

Clients who have taken these meds for a long time

NOT FOR THE OPIOID NAIVE

Question 15

Head injuries and opioids:
Can increase _____
Complicates the ____

Answer 15

Increase ICP (inter cranial pressure)
Complicates the diagnosis

Question 16

ICP causes a decreased respiratory rate which causes ___ CO2 levels–> increased ______ and increased ___ in the brain

Answer 16

Decreased respiratory rate–> Increased CO2–> increased vasodilation –> increased pressure in the brain

Question 17

What are some other causes of ICP?

Answer 17

Nausea
Myosis (small pupil)
Mental clouding/confusion

Question 18

Opioids may be common but we need to know they are _____!

Answer 18

Dangerous

Question 19

Patient education for opioids: Bowel regimen

What is important to educate the patient on here?

Answer 19

The receptors these opioids work on are in GI tract and CNS. If the receptors in the GI tract get activated that can lead to constipation. Giving drugs to prevent constipation is important.

Question 20

Patient education for opioids: Why should clients avoid ETOH, benzodiazepines, or other CNS depressants?

Answer 20

The CNS receptors are acted on by opioids. They already cause CNS depression. We don’t need them to have double the CNS depression

Question 21

Patient education for opioids: Patients need to have caution with driving or other things that require _____ because some people are highly sensitive with these drugs!

Answer 21

Concentration

Question 22

Patient education for opioids:What are common S&S that patients need to be aware of?

Answer 22

Itching and N/V is COMMON

Question 23

Patient education for opioids: Is N/V common throughout the whole treatment?

Answer 23

No, only at the start.

Question 24

Patient education for opioids: If a patient is complaining about N/V. What can we tell them helps with it? What makes it worse?

Answer 24

Laying down=helps

Walking=worse

Question 25

Patient education for opioids: If a patient complains of itching from the opioid and saying they think they have an allergic reaction, should we be concerned?

Answer 25

No! ITCHING IS A COMMON SYMPTOM. They need to know that too!

Question 26

Patient education for opioids: Urinary retention is sometimes seen with patients taking opioids. What should we tell them regarding this?

Answer 26

Try to void q4h because you may not be aware of the sensation that you need to go

*We need to monitor the I&O

Question 27

What is a PCA?

Answer 27

Patient controlled analgesia

Question 28

What is a PCA used for?

Answer 28

So patients can control their pain

*used for severe pain

Question 29

What is the basal rate?

Answer 29

Amount machine gives patient continually

1mg/h

Question 30

What is the boost dose?

Answer 30

A docs order for an extra boost of med

Ex: 1/2 mg boost every 15 min

Question 31

What is a lockout?

Answer 31

The total amount (basal rate and boost rate) that the patient may receive

EX: 6mg over 4 hours

Question 32

When should we check the settings of the PCA?

Answer 32

the beginning of our shift!

Question 33

What is some PCA education we should tell the patient?

Answer 33

Let them know it is not immediate relief–usually a 10 min lag
ONLY THEY can push the button-NOT family
Tell them about the lockout period so they aren’t scared to use the PCA because fearful of an overdose

Question 34

Fentanyl patch: How long does it take for the patch to work?

Answer 34

1 day

Question 35

Fentanyl patch: Where should they put the patch?

Answer 35

Intact, clean, dry, hair free skin

Question 36

Fentanyl patch: If the patient is too hairy, is it okay to let them shave and then put the patch on?

Answer 36

NO! Shaving causes skin to NOT be intact–if they put the patch on skin that isn’t intact then absorption INCREASES

Question 37

Fentanyl patch: How does a patient dispose of the patch?

Answer 37

Fold and flush!

This is a safety issue for children and pets. It would be too toxic for them

Question 38

Fentanyl patch: What should patients avoid?

Answer 38

External heat sources