-
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.
-
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
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