1. Lay person on back 2. peel packaging 3. Hold spray w thumb on bottom of red plunger and first and middle fingers on either side of nozzle 4. Tilt person's head back and provide support under neck w hand, insert tip into one nostril all the way 5. press plunger 6.remove 7. get emergency help -move person to side -repeat q2-3min if person does not respond

Opioids Flashcards by Brooke Thornburg

Opioid antagonist drugs

-Naloxone

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Opioid weak agonist drugs

-codeine
-tramodol

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opioid full agonist drugs

-Morphine
-Hydrocodone
-Hydromorphone
-oxycodone
-meperidine
-fentanyl
-methadone

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Tolerance

-meds become less effective over time and it takes a higher dose to achieve same effect

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Dependence

-when pt stops drug == withdrawal

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INSPECT report

-tracks controlled substance prescriptions
-available to registered healthcare providers and law enforcement

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slide 34?

nah

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Opioid overdose sx

-SEDATION/dec level of consciousness (LOC)
-PINPOINT pupils
-DEC respiratory rate
-BRADYcardia
-HYPOtension
-pale, clammy skin

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Withdrawal sx

-INSOMNIA/agitation
-DILATED pupil
-INC respiratory rate
-TACHYcardia
-HYPERtension
-sweating

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Naloxone

-opioid antagonist
-IV: 04-2mg IV q2-3min
-spray: 4mg q2-3min (alternate nostril)
-can precipitate withdrawal
-prescribe together w opioids in at risk pt

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Who gets co-prescription of naloxone

-hx of OD
-hx of substance use
-higher opioid dosages (>50mg morphine equivalents(MME)/day)
-concurrent benzo use

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How to use Naloxone

Lay person on back
peel packaging
Hold spray w thumb on bottom of red plunger and first and middle fingers on either side of nozzle
Tilt person’s head back and provide support under neck w hand, insert tip into one nostril all the way
press plunger
6.remove
get emergency help
-move person to side
-repeat q2-3min if person does not respond

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Opioid withdrawal onset

-short acting opioids (heroin): 8-24h after last use, duration 4-10days
-long-acting (methadone): 12-48h after last use; duration 10-20days

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Opioid withdrawal treatment

-Clonidine (helps w sx of HTN, sweating, vomiting, anxiety)
-Buprenorphine
-Methadone

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Opioid side efects

-antitussive
-constipation
-N/V
-itching
-orthostatic HYPOtension
-urinary retention
-sedation
-respiratory depression

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Opioid pearls

-consider stool softener/stimulant laxative
-potential for tolerance, dependence and addiction
-Schedule II (except tramadol, codeine)

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Codeine

-tab or cough syrup
-sometimes mixed w acetaminophen/guaifenesin
-metabolized to morphine (CYP2D6)
-poor metabolizers no effect
-rapid-metabolizers OD risk
-avoid in breastfeeding
-avoid in kids < 12

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Tramadol

-cap, tab, oral solution,
-combo w acetaminophen
-risk of serotonin syndrome w other serotonergic drugs
-adj for renal
-BOX warning: 3A4 inducers, 3A4 and 2D6 inhibitors requires caution
-Schedule IV controlled

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Morphine

Study These Flashcards

-cap, tab, oral, inj, suppository
-itching prominent
-renally excreted
-AVOID in CrCl <30-60
-BOX warning: AVOID alcohol w RE caps = inc morphine concentration = OD

Hydromorphone

Study These Flashcards

-tabs, oral, inj, suppository
-BOX warning: do not confuse mg and mL, do not confuse HIGH-potency (10mg/mL) w other solutions (1,2,4mg/mL)

Hydrocodone +/- acetaminophen

Study These Flashcards

-oral, tab
-w acetaminophen = 5/325, 7.5/325, 10/325mg
-counsel on acetaminophen
-BOX warning: 3A4 inhibitors may inc concentrations

Oxycodone +/- acetaminophen

Study These Flashcards

-tab, cap, oral
-combo: perc 2.5, 5, 7.5 /325mg
-ER are abuse-deterent
-BOX warning: 3A4 inhibitors may inc concentrations

Fentanyl

Study These Flashcards

-Inj, patch
-BOX: monitor pt receiving 3A4 inhibitors or inducers
-can use in renal impairment
-less hypotension than morphine or hydromorphone at similar doses
-non-inj forms are ONLY for pt who are opioid TOLERANT (morpine 60mg qd or equivalent for at least one week)
-non-inj NOT converted from one fentanyl product to another on mcg-per-mcg basis

Fentanyl patch dosing

Study These Flashcards

Fentanyl patch counseling

-apply one patch q72h (3 days) -chest, back, flank, upper arm -DO NOT CUT = OD -do not use over broken skin -don't let it get too warm (inc absorption) -avoid heating pad, electric blanket, sauna, hot tub, heated waterbed, sunlight, hot weather

Methadone

-last line chronic tx -opioid detox -oral, inj, tab -BOX: QTc prolongation -BOX: monitor w 3A4 inhibitors/inducers -long t1/2 = 8-59h

Meperidine

-inj, oral solution, tab -AVOID in elderly -AVOID in renal -caution in hepatic -BOX: monitor 3A4 inducer or inhbitors -BOX: do not use within 14 days of MAOis -metabolized by liver into active metabolite -accumulation = delirium and seizures -not commonly used bc ADRs

Opioids with serotonergic activity

-lower seizure threshold -cause serotonin syndrome -Tramadol! -Oxycodone -Fentanyl -Methadone -Meperidine -Codeine -Buprenorphine

Codeine initial dosing

15-60mg PO q4h

Tramadol initial dosing

-25-50mg PO q4-6h

Morphine initial dose

-5-10mg PO q4h -2.5-5mg q3-4h IV

Hydromorphone initial dose

-2-4mg PO q4-6h -0.2-1mg IV q2-3h

Hydrocodone initial dosing

-2.5-10mg PO q4-6h

Oxycodone initial dosing

-5-15mg PO q4-6h

Fentanyl

-25-50mcg q30-60min

Natural opiates

-Morphine -Codeine -allergic cross reaction

Semi-synthetic opioids

-hydromorphone -oxycodone -oxymorphone -hydrocodone -buprenorphine -allergic cross reaction

synthetic opioids

-fentanyl -methadone -meperidine -tramadol -NO allergic cross reaction

Switching between opioids

-Calculate daily consumption (mg per day) -covert each opioid to oral morphine -add morphine doses together to get total daily morphine dose -due to cross-tolerance, reduce equal analgesic dose 25-50% -split otal daily dose into appropriate dosing interval based on opioids

Opioid equivalents

-Fentanyl 0.1mg IV -Hydrocodone 30mg PO -Hydromorphine 1.5mg IV, 7.5mg PO -Morphine 10mg IV, 30mg PO -Oxycodone 20mg PO

calculations in lecture

fkak

pt has CVA, unable to swallow. severe pain from hip fracture yesterday

-morphine IV -Dilaudid IV -Duragesic fent IV (NOT patch- opioid naive)

KP on NORCO 10mg q6h for 2 weeks, we want to switch to long acting

-tramadol ER (not as strong) -morphine ER cap or tab -hydromorphone (ER) -hydrocodone ER tab -Oxycodone ER tab

29 YOM car accident, allergic to amox and codeine

-fentanyl IV -tramadol oral -NOT metahdone (not for acute) -NOT meperidone (side effects)

Switch from Hydromorphone 0.5mg IV q2h prn (3 doses in past 24h) pt also on NORCO 5/325 (5 doses in 24h)

-hydrocodone*5mg*2tabs*5 dose = 50mg PO per day *30mg MME/30mg hydrocodone = 50mg morphine/day -hydromorphone 0.5mg*3doses =1.5mg IV per day* 7.5mg oral/IV = 7.5mg PO hydromorphone *30mgPO moprhine/7.5 = 30mg PO morphine =80mg PO morphine per day -reduce by 0.25-0.5 -80*0.5 or 80*0.75 = 40-60mg PO morphine per day -morphine 10mg q4-6h PRN -Norco 10mg q4-6h PRN -Oxycodone 5mg q4h -Oxycodone 10mg q6h

Opioids Flashcards

(45 cards)