Analgesics: Narcotic

Question 1

Morphine Sulfate

Onset: Immediate
Peak effects: 20 minutes
Duration: 2-7 hours
Half-life: 1-7 hours

MOA: CNS depressant that acts predominantly on opiate receptors in the brain, providing both analgesia and sedation. Increases peripheral venous capacitance, and decreases venous return. Morphine also decreases myocardial oxygen demand- due to both decreased systemic vascular resistance, and sedative effects.

Answer 1

Class: Schedule II Narcotic

Action: analgesia and sedation

Indications: severe pain

Contraindications: known hypersensitivity, volume depletion, severe hypotension, undiagnosed head injury, undiagnosed abdominal pain

Precautions: causes respiratory depression in higher doses

Side effects: N/V, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression

Interactions: the CNS depression can be enhanced when administered with antihistamines, antiemetics, sedatives, hypnotics, barbiturates, and alcohol

Route: IV, IM

Adult dose: IM- 5-15 mg based on pt weight
IV- 2-5 mg followed by 2 mg every few minutes, until the pain is relieved, or until respiratory depression ensues

Peds dose: 0.1-0.2 mg/kg IV

Question 2

Hydromorphone (Dilaudid)

Onset: 15-30 minutes
Peak effects: 30-90 minutes
Duration: 4-5 hours
Half-life: 2.6 hours

MOA: a CNS depressant that acts predominantly on opiate receptors in the brain, providing both analgesia and sedation

Answer 2

Class: Schedule II Narcotic analgesic

Action: CNS depressant and analgesic

Indications: severe pain

Contraindications: known hypersensitivity, undiagnosed head injury, undiagnosed abdominal pain, shock

Precautions: hydromorphone is a potent opiate, hypotension can occur, nausea can occur

Side effects: N/V, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression, bradycardia

Interactions: the CNS depression associated with hydromorphone can be enhanced when administered with antihistamines, antiemetics, sedatives, hypnotics, barbiturates, and alcohol

Route: IV, IM, PO

Adult dose: 1-4 mg

Peds dose: 0.015 mg/kg/dose IV

Question 3

Fentanyl Citrate (Sublimaze)

Onset: immediate
Peak effects: 3-5 minutes
Duration: 30-60 minutes
Half-life: 6-8 hours

MOA: Fentanyl is a narcotic analgesic with rapid onset and short duration of action. Alterations in RR and alveolar ventilation associated with narcotic analgesics, may last longer than the analgesic effect. Large doses may produce apnea. Fentanyl appears to have less emetic activity than other narcotic analgesics

Answer 3

Class: Schedule II Narcotic analgesic

Description: Fentanyl is 50-100 more times potent than morphine, but has a shorter duration of action

Indications: severe pain, maintenance of analgesia, or as an adjunct in RSI

Contraindications: known hypersensitivity, severe hemorrhage, shock

Precautions: Use in caution with pts with cardiac bradyarrhythmias. Fentanyl may produce bradycardia, which can be treated with atropine. Fentanyl should be administered with caution in pts with liver and kidney dysfunction because of the importance of these organs in the metabolism and excretion of meds.

Side effects: respiratory depression, apnea, muscle rigidity, bradycardia

Interactions: other meds with CNS depressant effects such as barbiturates, tranquilizers, narcotics, and general anesthetics, have an additive or potentiating effect with fentanyl. Severe and unpredictable potentiation by MAOIs has been reported with narcotic analgesics. Using in pts who have had MAOIs in the past 14 days is not recommended

Route: IV, IN

Adult dose: 25-100 mcg

Peds dose: for 2-12 years old- 1-2 mcg/kg/dose

Question 4

Others:
. Meperidine (Demerol)
. Nalbuphine (Nubain)
. Butorphanol (Stadol)