Opioids Pain & Depression – Pharmacology Test
The key terms of Pharmacology Test include Opioids, Pain, Depression, Chronic.
Routes of Administration
oral
Oral
-Preferred route for pain control
–Especially chronic
-Expect onset in 30 minutes
-Long acting and controlled release available
–May not be crushed
Routes of Administration
Intramuscular
Intramuscular
Variable absorption rates
Tissue fibrosis and abscess can form after repeated injections
Onset 30-45 minutes
Not recommended for pain control
Intravenous
Onset within minutes
Most efficient
Routes of Administration
Transdermal
Transdermal
Fentanyl (Duragesic)
Long duration of action (48-72 hours)
Rectal Suppository
Absorbed through the rectal mucosa
Many opioids can be administered via this route
Slower onset of action
Sublingual/ Buccal
Sublingual-placed under tongue
Buccal: Fentanyl (Actiq) oral transmucosal system
Intranasal
Butorphanol (Stadol) agonist-antagonist
Sumtatriptan for migraines
Good for out-patient use
Opioids
-Opioid Agonists: Bind and cause analgesia. By binding to pain receptors they block the transmission of pain to the brain.
–Example: Morphine Sulfate
Opioid antagonists: bind to receptors but do not cause analgesia.
–Example: Naloxone (Narcan). It is used for overdose, oversedation secondaryto opioids.
Opioids
There is no analgesic dosage ceiling (limit)
Side effects include:
Respiratory depression
Sedation
Constipation
Itching
Nausea & vomiting
Urinary retention
Postural Hypotension
-Also have antitussive and antidiarrheal properties
Equalanalgesic Dosing
Not all opioids are the same strength
Morphine sulfate is the gold standard
standard against all other opioids are measured
Weak Opioids
Used for moderate pain and are often found in combination medications
Codeine and Tylenol (Tylenol#3)
Hydrocodone and Tylenol (Vicodin, Loratab)
Oxycodone and Tylenol (Percocet,Tylox).
Strong Opioids
Opioids for moderate to severe pain
Morphine Sulfate
Hydromorphone (Dilaudid)
8 times stronger than morphine
Fentanyl (Duragesic)
IV (acute pain, on pump)
Patches, oral (chronic and cancer pain)
Meperidine (Demerol)
Methadone (Dolophine)-chronic pain or drug dependent patients
Meperidine-Demerol
Synthetic opioid
Toxic metabolite, normeperidine that can cause seizures.
Meperidine half life 2-4 hours
Normeperidine half life 24-48 hours with normal renal function.
Should only be used for a short period of time (2-3 days)
Meperidine Toxicity
-Older adults at high risk
-People with decreased renal clearance
-Assess patients for complaints of numbness, twitching, confusion and seizures
Professional Role of Nurse:
Ensure Comfort and Safety
-Assess for pain
–Monitor BP & Respirations prior to administration
-Believe the patient
-Medicate with appropriate medication
-Assess for adverse effects
-Expected Outcomes: Pain relief and drowsiness
Sedation occurs before respiratory depression
Respiratory Assessment
Monitor rate and depth of respirations
Especially while sleeping
Severe respiratory depression usually seen with IV administration or in patient with no tolerance to opioids
Treatment for Respiratory Depression
1.Attempt to arouse patient
2.Administer opioid antagonist Naloxone (Narcan) IV
-Fast acting
-Reverses opiod effect
-Pain will quickly return
3.Continue to monitor as effects of respiratory depression will outlast the Narcan and respiratory depression can reoccur
Nursing Interventions to Prevent Side Effects of Opiods
-Ongoing assessment for over sedation and respiratory depression
-Assess for constipation
–Push fluids & encourage ambulation
–Administer stool softeners & laxatives as ordered
-Nausea & vomiting
Administer antiemetics as prescribed
Routes of Administration
oral
Oral
-Preferred route for pain control
–Especially chronic
-Expect onset in 30 minutes
-Long acting and controlled release available
–May not be crushed
Routes of Administration
Intramuscular
Intramuscular
Variable absorption rates
Tissue fibrosis and abscess can form after repeated injections
Onset 30-45 minutes
Not recommended for pain control
Intravenous
Onset within minutes
Most efficient
Routes of Administration
Transdermal
Transdermal
Fentanyl (Duragesic)
Long duration of action (48-72 hours)
Rectal Suppository
Absorbed through the rectal mucosa
Many opioids can be administered via this route
Slower onset of action
Sublingual/ Buccal
Sublingual-placed under tongue
Buccal: Fentanyl (Actiq) oral transmucosal system
Intranasal
Butorphanol (Stadol) agonist-antagonist
Sumtatriptan for migraines
Good for out-patient use