Chapter 25 opioids

Question 1

What are the three opioid receptors

Answer 1

OP3-MU
OP2-Kappa
OP1-Delta

Question 2

Do OP3 agonists have a ceiling effect

Answer 2

they do not have a ceiling effect

Question 3

what do nurses need to understand about opioids before administering them

Answer 3

-Onset
-peak(when will be the best pain management)
-Duration
-Dosing interval
-what is an equivalent dose in various opioids
-How to increase dose to achieve maximal analgesia with minimal side effects

Question 4

what are two contraindications of opioid use

Answer 4

Acute asthma
diarrhea due to infections from antibiotic therapy

Question 5

After administering an opioid what do you have to be very cautious of in regards to mobilizing***

Answer 5

watch for orthostatic hypotension since opioids lower blood pressure

Question 6

What are the 7 side effects of opioids***

Answer 6

LOC major change
Respiratory depression
Nausea Vomiting
Constipation
urinary retention
Pruritus
Myoclonus (muscle twitches)

Question 7

Would you discontinue step 1 analgesic medications if you were progressing up to steps two and three?

Answer 7

no you would continue step 1 drugs including adjuvant therapies (Remember it is an additive process of adding pain meds not a subtractive one)

Question 8

what dosing consideration must you make for smokers who are taking opioids

Answer 8

A person who smokes may require larger doses of certain opioids

Question 9

is there a set amount of an opioid that will produce pain relief for every patient

Answer 9

NO it is individual for every person

Question 10

What is a break through dose

Answer 10

Needed when pain control is not constant and the pain has “broken back through”

Question 11

What is a loading dose

Answer 11

Higher dose that is needed for parenteral infusions (IV or subcutaneous) to provide a prompt response from the patient

Question 12

which step of the analgesic ladder would be considered weak opioids and why

Answer 12

Step 2 drugs are usually considered weak opioids because they are not as potent and are available in fixed formulas

Question 13

What is a major side effect of codeine that is worse when compared with other opioids

Answer 13

Constipation (think C=C codeine=constipation)

Question 14

what level of pain is codeine used to treat

Answer 14

mild to moderate levels of pain

Question 15

what is the half life of codeine

Answer 15

2.5-4hrs

Question 16

How is codeine metabolized

Answer 16

breaks down in the liver into its active metabolite Morphine

Question 17

how is codeine excreted

Answer 17

mostly through the kidneys

Question 18

What is the morphine to oxycodone ratio

Answer 18

1.5 morphine:1 oxycodone

Question 19

what is one benefit of oxycodone compared to other opioids

Answer 19

may have less GI side effects for the elderly than other opioids

Question 20

What level of pain is hydrocodone used for

Answer 20

moderate to severe pain

Question 21

What age groups is hydrocodone used for

Answer 21

adults NOT children

Question 22

why is morphine dangerous for the elderly

Answer 22

Active metabolites accumulate very quickly

Question 23

what opioid may be more suitable for the elderly and people with renal failure

Answer 23

hydromorphone

Question 24

what is the hydromorphone to morphine ratio

Answer 24

5 morphine : 1 hydromorphone

Question 25

does fentanyl accumulate in patients with renal failure

Answer 25

NO

Question 26

if someone has a confirmed allergy to opioids which one is still considered safe***

Answer 26

Fentanyl

Question 27

what therapeutic class of drug is Tramadol

Answer 27

Non-opioid analgesic

Question 28

what is one very serious adverse reaction that can occur while taking tramadol **

Answer 28

Seizures (along with many other side effects that are similar to opioids)

Question 29

What are key interactions to be aware of with tramadol***

Answer 29

-Do not take in combination with Antidepressants and MAOI’s(old school antidepressant)
-DO NOt drink alcohol causes sudden death
-if taken with CYP2D6 inhibitors tramadol will have a reduced analgesic affect

Question 30

How do you treat a tramadol overdose***

Answer 30

Naloxone but administering this may still cause the patient to have seizures

Question 31

What is the generic name for narcan?

Answer 31

Naloxone

Question 32

what is a serious condition that Narcan is used to treat?***

Answer 32

respiratory depression

Question 33

How does narcan work to reverse respiratory depression***

Answer 33

It is a pure opioid antagonist that competes with opioid receptor sites and blocks all narcotic agonist activity

Question 34

when will Narcan not be effective to reverse OD symptoms***

Answer 34

if a patient is on street drugs or meds that are not opioid based

Question 35

If a nurse did have to administer Narcan what type of dose would they aim to administer***

Answer 35

Administer in small doses or else it will cause an immediate return of all the patients pain should aim for partial gentle reversal

Question 36

Analgesics may produce sedation but Sedatives _____________ fill in the blank

Answer 36

Analgesics may produce sedation but sedatives do not produce analgesia