Module 2 - opioid analgesics

Question 1

Analgesic

Answer 1

A medication that relieves pain without causing loss of consciousness

Question 2

Classes of Analgesics

Answer 2

1) opioid analgesics
2) nonsteroidal anti-inflammatory drugs (NSAIDS)
3) non-opioids

Question 3

what do opioids do?

Answer 3

• relieve moderate to severe pain
• suppress medullary cough centre –> cough suppression (use codeine but only with non-productive coughs
• treat diarrhea (diphenoxylate/atropine (Lomotil))

Question 4

where do opioids come from?

Answer 4

opium plant - synthetic pain reliever

Question 5

types of opioids

Answer 5

1) Agonists
2) partial agonists (agonist-antagonist)
3) antagonist

Question 6

Opioid Agonists

Answer 6

completely bind to opioid receptors in the brain and cause an analgesic response resulting in reduction of pain sensation
ex) morphine, fentanyl, hyrdromorphone, oxycodone, meperidine

Question 7

Opioid partial agonists

Answer 7

bind to pain receptors but cause a weaker neurological response
ex) buprenorphine, butorphanol, nalbuphine

Question 8

opioid antagonists

Answer 8

bind to pain receptor but does not reduce pain signal

ex) Narcan

Question 9

Analgesic Ceiling effect

Answer 9

• occurs when a drug at a specific dosage produces a maximal analgesic effect that does not improve even if dosage is increased (dangerous, unpredictable, and has no benefit if increased further)
• associated with agonist-antagonists

Question 10

opioid receptors

Answer 10

-5 types  in body
 most responsive to drug therapy : opioids bind to reduce pain
-µ (mu)
-ƙ (kappa) 
-δ (delta)

Question 11

opioid antidote

Answer 11

Naloxone (Narcan) - (antagonist)

Question 12

diphenoxylate

Answer 12

structurally related to opioid analgesics but has no analgesic properties

Question 13

opioid contradictions

Answer 13

-Severe asthma
-Extreme caution needed with:
respiratory insufficiency (including COPD)
elevated intracranial pressure
(ICP) (d/t increased drowsiness)
morbid obesity (sleep apnea, increased and tissue puts pressure on lungs)
myasthenia gravis
paralytic ileus (decreased bowel motility)
pregnancy

Question 14

opioid allergies

Answer 14

rash, swelling, Angioedema (swelling of mucous membranes – mouth and eyes, throat)

Question 15

Why do you have to be cautious with opioids, especially µ-receptor opioids

Answer 15

increased potential for psychological and physical dependence

Question 16

what is the result of opioid tolerance

Answer 16

• Diminished drug effects over time

- Common with addiction or use for control of severe pain

Question 17

µ (mu) receptors

Answer 17

drugs: morphine, codeine
onset: rapid and produce marked euphoria

Question 18

signs of psychological dependence

Answer 18

impaired control over drug use, compulsive use and craving, continued use despite harm

Question 19

signs of physical dependence

Answer 19

physiological adaption, will cause withdrawal syndrome if: abrupt cessation, rapid dose reduction, decreasing blood levels of the drug or administration of an antagonist

Question 20

tolerance

Answer 20

the client requires higher drug dosages to reach therapeutic effects, risk of withdrawal also greater

Question 21

opioid side effects

Answer 21

opioids release histamine thought to be responsible for side effects.

1) Flushing (redness) and orthostatic hypotension
2) CNS depression, may lead to respiratory depression
3) Sedation and euphoria
4) Nausea and vomiting
5) Urinary retention
6) Itching
7) constipation (esp c/ codeine)

Question 22

treating opioid side effects

Answer 22

nausea (d/t gi tract irritation) - gravol
itching (d/t histamine)- benadryl
constipation (slowed peristalsis and increased absorption)- laxitives, fibre
urinary retention(increased bladder tension) - catheterization or bethanechol (a cholinergic agonist – relaxes bladder)

Question 23

opioid adverse effects

Answer 23

RESPIRATORY DEPRESSION
monitor resps and LOC prior to administration and during.

Know antidote - narcan

Question 24

how does Naloxone work to reverse opioid effects?

Answer 24

Will bind to opioid receptor sites and reverse respiratory depression (will also reverse pain control)

****usually only lasts about 1 hour, so if the Narcan wears off before the opioid is eliminated from the body, the respiratory depression will reappear - RE-ADMINISTER

Question 25

Opioid naïve

Answer 25

describes patients who are receiving opioid analgesics for the first time and who therefore are not accustomed to their effects. GIVE LOWEST DOSE

Question 26

what causes additive depressant effects when administered with opioids

Answer 26

``` alcohol Antihistamines Barbiturates benzodiazepines phenothiazine other CNS depressants ```

Question 27

Codeine

Answer 27

``` 10-20 mg q4-6h when used alone When mixed with Tylenol: -Tylenol #1: 8 mg of codeine -Tylenol #2: 15 mg of codeine -Tylenol #3: 30 mg of codeine -For all above: 1-2 tablets q4-6h -Tylenol #4: 60mg of codeine (1 tablet q 4-6 h) Available as injectable, usually only used in oral form (tablets and available as syrup) ``` **T3 - used for moderate pain

Question 28

Morphine

Answer 28

IV for PRN pain: 1-10 mg SC: 1-8 mg q3h Rectal: 10–20 mg every 4 hours (not a common route) Oral immediate release (MS-IR): 2.5-20 mg q3h Oral slow release (MS Contin): 15-30 mg q8-12h Oral slow release (Kadian): 10-100 mg q24h

Question 29

MS-IR

Answer 29

oral immediate release

Question 30

MS Contin

Answer 30

oral slow release Morphine MS Contin: is available in 60 mg, 100 mg and 200 mg tablets as well, higher doses usually for those who are opioid tolerant and/or with severe chronic pain (i.e. cancer patients).

Question 31

Kadian

Answer 31

oral slow release; Once Daily dosing | NOT interchangeable with Contin

Question 32

Administration routes of morphine

Answer 32

oral IV SubQ _not often gave IM due to tissue injury and pain (histamine release)

Question 33

HYDROmorphone (Dilaudid)

Answer 33

**7-10x stronger than morphine Oral immediate release: 0.5-4 mg q 3h -Up to 8 mg per dose for some patients Oral slow release (Hydromorph Contin): - Initially 3 mg q8-12h - Can titrate up to 30 mg q12h IV hydromorphone: 0.25-2 mg SC: 0.25-2 mg q3h oral to SC dosage formulations varies from 4:1 to 2:1

Question 34

parenteral

Answer 34

injection meds

Question 35

Fentanyl

Answer 35

route: IV/ transdermal patch (changed Q3D) should not be given to opioid naive pt's

Question 36

where should transdermal patches be places?

Answer 36

- Patches can be applied to intact, non-irritated, dry skin on flat surface: chest, back, flank or upper arm - Irritation or skin damage will cause more drug to be absorbed - Fatty sites causes less to be absorbed sites must be rotated, old patch removes, watch skin for contact dermatitis

Question 37

Meperidine (Demerol)

Answer 37

- usually only used with morphine allergies - long term use not recommended d/t toxin metabolite normeperidine build up - used to treat rigours (shaking)

Question 38

oxycodone (Oxy IR, OxyNEO, Percocet)

Answer 38

* high potential for abuse - treat moderate to severe pain - long-acting or time-released pain medication - could impair judgment

Question 39

Opioid Nursing Process

Answer 39

1) Assess: allergies, pain (intensity (0-10), character, location), LOC (sedation scale), vitals, route and time of last administered dose, kidney status, presence of head injury (med masks change in LOC)

Question 40

Mornitoring When administering Dilaudid or MORPhine by the PO, PR, SC or IM route

Answer 40

- Baseline RR, sedation scale, and pain scale | - Check RR, sedation and pain scales at 45-60 minutes after every dose

Question 41

Monitoring when administering Dilaudid or MORPhine by the IV route:

Answer 41

- Baseline RR, sedation scale, and pain scale | - Check RR, sedation & pain scale at 5, 15 and 30 minutes after every dose

Question 42

sedation scale

Answer 42

``` s- normal sleep, easy to rouse 0- alert 1- sometimes drowsy 2- frequently drowsy, easy to rouse 3- somnolent, difficult to round ```

Question 43

analgesic used for mild to moderate pain

Answer 43

nonopioids (tylenol) | NSAIDS

Question 44

analgesic used for moderate to severe pain

Answer 44

moderate - codeine | moderate to severe pain - morphine, hydromorphone, meperidine

Question 45

when do you administer opioids?

Answer 45

before pain becomes too severe, when pain is beginning to return. know onset, peak, and duration

Question 46

when shouldn't opioids be administered

Answer 46

pt is in respiratory depression or vitals are decreased

Question 47

SR

Answer 47

sustained release

Question 48

why are opioids given with NSAIDS or Tylenol?

Answer 48

NSAIDS - analgesic and anti-inflammatory effects Tylenol - synergistic effects--> coordinated or correlated action of two or more agents so that the combined action is greater than the sum of each acting separately

Question 49

what do you do if opioids aren't managing pain?

Answer 49

other drugs: -corticosteroids--> antiinflammatory, antiemetic and appetite stimulation effects -Anticonvulsants ex)gabapentin treats neuropathic and phantom limb pain -Tricyclic antidepressants for neuropathic pain and opioid potentiating effects ex) Amnitriptaline (blocks receptors) -Hydroxyzine (Atarax) antianxiety, antihistamine and antiemetic properties, muscle spasms

Question 50

Adjuvant

Answer 50

that which assists; esp. a drug added to a prescription to hasten or increase the action of a principal ingredient.

Question 51

Equianalgesic dose

Answer 51

- a dose of one form of analgesic drug equivalent in pain-relieving effect to another analgesic. - switch drugs to avoid undesired side effects from another. - important to know to adequately control pain, nd avoid OD

Question 52

immediate release and a slow release pain medication be given at the same time

Answer 52

relieves immediate pain as well as pain later on.