General actions (SE) of opioids (slide on p. 5) analgesia respiratory depression constipation urinary retention cough suppression emesis increased ICP ***watch for hypotension!!!** (decreased preload & afterload) Most common SE of opioids. constipation nausea Most SERIOUS ADR of opioids. (slide 29) Respiratory depression OD allergic rxn phys dependence S/S of opioid OD. cold clammy skin drowsiness, dizziness restlessness, confusion pinpoint pupils (miosis) decreased HR, BP, RR GIVE NARCAN Dilaudid has a ______ onset but shorter ______ of morphine and is 7-10 times _____ effective than morphine. faster duration more *high abuse potental Hydrocodone is often combined with ______ or _______. Considerations? acetaminophen (Vicodin) *non anti-inflammatory aspirin (Lortab-ASA) *anti-inflammatory *risk of liver toxicity Meperidine (Demerol) axn is _____ than morphine. shorter (more frequent dosing) If a pt comes in with pain from GI problems, what med is given and why? Demerol does not increase biliary tract pressure If a pt comes in with pain from acute asthma, what med is given and why? Demerol less likely to produce histamine release Problems with Demerol? Neurotoxicity with sickle cell, burn injuries, cancer Severe/fatal rxn with MAOIs increases HR resp depression in COPD pts increased ICP not good for elderly Common SE of Methadone that can last several weeks. orthostatic hypotension Nursing considerations with Fentanyl? clean, hairless site take old patch off b4 applying new one date patch "waste" it b/c it's a C/S -do not just throw in trash wear gloves Cautions with butorphanol (Stadol). (opioid agonist-antagonist) -hyptertensive clients -MI (increases wrkld) may increase CSF (monitor ICP) Caution with pentazocine (Talwin). (opioid agonist-antagonist) -cardiac fxn Use for nalbuphine (Nubain). (opioid agonist-antagonist) -preop as adjuct to anesthesia -L&D (obstetric analgesia) Reversal agent for opioid OD. naloxone (Narcan) *contraindicated in acute hepatitis* Cox-2 receptors are mainly at the _______ but also in the _____ and _____ site of injury (mediate local inflammation, sensitize pain) brain (fever & pain perception) kidney (renal vasodilation) Inhibiting Cox-2 receptors results in? inflammation suppression pain reduction fever reduction renal impairment possible Advantage of Cox-2 inhibitors over Cox-1? reduced GI effects (but no advantages r/t CAD or CVA risk) Anesthetic used for young children undergoing minor surgical & diagnostic procedures; problems during recovery? Dissociative anesthetic - ketamine (Ketalar) -hallucinations, disturbing dreams, delerium Nursing considerations for pts recovering after receiving ketamine (Ketalar). Reduce stimulation keep lights down reorient tell them what you're doing