ch 24 highlights Flashcards
(49 cards)
what cannot be taken with opioids due to the risk of resp depression?
Benzos (ie Ativan, Valium, Xanax, Klonopin)
Important teaching when using transdermal patches
- Avoid prolonged exposure to sun
- Caution against use of heat, heating pads, hot baths, saunas
- This increases release of drug from patch and can result in overdose and death
- Clean site with water only prior to application
- remove hair by clipping not shaving prior to application
How often is Butrans transdermal patch changed out
7 days
Yawning
Sneezing
Sweating
are symptoms of
Withdrawl
When giving morphine what should you monitor and perform
- monitor respirations
- encourage physical activity
- offer fluids
- palpate lower abd every 4-6 hours to feel bladder for urinary retention
If you have biliary colic, can you take an opiod?
no
What pain med is appropriate when you have biliary colic
demerol
what opioid is respiratory depression limited beyond a certain dose
Pentzocine
transmucosal fentanyl is approved for what patient population
18 years old and older with breakthrough cancer pain who are already taking opioids around the clock
if you need to change products with a transmucosal fentanyl, can you use the same dosing?
no, due to differences in bioavailability
Blackbox for codeine
In the liver, about 10% of each dose of codeine undergoes conversion to morphine, the active form of codeine. The enzyme responsible is CYP2D6. Among ultra rapid metabolizers which carry multiple copies of the CYP2D6 gene, codeine is unusually effective and has led to death in some children.
Severe toxicity can develop in breastfed infants whose mothers were taking codeine. causes high levels of morphine in breast milk, due to ultra rapid codeine metabolism
What can happen if you give Pentazocine to a pt who is physically dependent on a pure opioid agonist
Can precipitate(trigger) withdrawal
Pentazocine withdrawal
cramps, fever, anxiety, restlessness
mild, treatment is rarely required
Pentazocine reversal agent
Narcan (Naloxone)
Do you see severe resp depression in Butrans
no
Can you develop physical dependence on Butrans
yes, but symptoms of abstinence are delayed. Peak responses may not occur until 2 weeks after the final dose was taken.
what is combined with Butrans to prevent toxicity
Naloxone (narcan)
What do you give for Butrans toxicity
cannot readily reverse toxicity once it develops.
what is drug of choice for treating overdose for pure opiod agonist
Naloxone (Narcan)
What meds are used for opioid induced constipation
Methylnaltrexone
naloxegol
naldemedine
what pure opioid antagonist is used for opioid and alcohol abuse
Naltrexone (ReVia, Vivitrol) to prevent euphoria
what is Embeda
a fixed dose combo of morphine and naltrexone designed to discourage morphine abuse
What would you be concerned for if a pt was taking tramadol and a MAOI
hypertensive crisis
What would you be concerned for if a pt was taking tramadol and SSRI/SNRI, tricyclic antidepressants, MAOIs, triptans
Serotonin syndrome
