Avoid use with: MAOIs (increases BP; hyperpyretic coma), sedative effect drugs (increase sedation), Anticholinergics (Example: when used with Benadryl will increase sedation), pregnancy (result may be fetal addiction)
Reduce doses in elderly or with liver disease
DO NOT USE: Head injury or any condition where increased ICP iould be
problematic(will increase intracranial pressure)
Respiratory depression/decreased cough reflex
Pinpoint pupils (miosis) may be warning sign
Be alert to bronchocontriction – rare, but can result so if you see an increase in wheezing, you need to be alert and intervene.
Sedation (affects patient safety)
Decreased GI motility (constipation due to decreased peristalsis of gut)
Note: opioids will also prolong labor due to decrease tone of muscles
Vomiting (vomiting due to activation of vomiting center in brain)
Hypotension (causes vasodilation)
Be alert to orthostatic hypotension
This is part of why increased ICP results due to dilation of cerebral arteries
Urinary retention & decreased urinary output (due to increased tone of detrussor muscle – patients feel the urge but unable to void)
Seizure (especially meperedine)
Allergic response (causes histamine release – be alert to itching)
CODEINE: is 10 times LESS potent than Morphine and drug of choice for cough suppression.
FENTANYL: is 100 times more potent than its' prototype Morphine
DEMEROL: for adults do not use more than 600 mg in 24 hours and limit Demerol use to 48 hours.
Administration of opioids
1.Take or have recent baseline vital signs for comparison
2.Follow controlled substance procedures of the facility.
3.Double check doses
4.IV push doses should be slow push – 5 minutes
5.PCA dose set up – double check
6.When switching from PCA, assure adequate PCA dosing prior to discontinuation of PCA
Beaware: Tolerance does develop over time. Long time opiate users with chronic pain may require higher doses to achieve effect.
The side effects are the same as commonly observed with opioid analgesics:
Somnolence, dizzyness, nausea/vomiting are most common.
Hypotension within first hour after administration.
CNS depressants (e.g., alcohol, barbiturates, tranquilizers, antihistamines) may result in increased central nervous system depressant effects
Drug causes sedation = think safety of patients.
Not useful for severe pain.
Not recommended for use in patients dependent on narcotics (i.e., sends them into withdrawal right quick).
May increase the work of the heart, therefore use in patients with acute myocardial infarction, ventricular dysfunction, or coronary insufficiency should be limited to those situations where the benefits clearly outweigh the risk.
Prototype: Narcan (Naloxone)
Treat opioid overdose- Reverse effects of opioids such as respiratory depression
WATCH OUT: Dose adjustment needed if there is brain tumor or head injury; seizures; heart disease or a heart rhythm disorder; or a history of drug or alcohol addiction
Depade (Naloxone) should be used with caution in patients with pre-existing cardiac disease or patients who have received potentially cardiotoxic drugs, has special use in rapid detox
Administration: SQ, IM, IV
DO NOT GIVE ORALLY!
Evaluation of effectiveness: is respiratory rate improved? Is sedation improved? Is BP improved?
Purpose: to enhance the effect of opioids to allow use of lower doses and therefore less side effects from use of opioids
Some are very useful for neuropathic pain such as cramping, aching, burning
Tricyclic antidepressants: Amitriptyline (Elavil) Used primarily for neuropathic pain
Anticonvulsants: Carbamazepine (Tegretol); Gabapentin (Neurontin); Phenytoin (Dilantin) Used primarily for neuropathic pain
CNS stimulants: Methylphenidate (Ritalin); Dextroamphetamine (Dexedrine) using these drugs with opioids enhances breathing pattern without reducing the effect of the opioid for pain relief.
Antihistamines: Hydroxyzine (Vistaril) used for their antiemetic effects, can cause sedation therefore increased safety risk.
Glucocorticoids: Dexamethasone (Decadron); Prednisone (Deltasone) effective in reducing pain due to edema and pressure on nerves
Bisphophonates: Etidronate (Didronel); Panildronate (Aredia) used for relief of cancer-related bone pain
Evaluation: was there pain relief
Anti Gout Medication
Used for acute or chronic gout
WATCH OUT patients with serious gastrointestinal, renal, hepatic, cardiac, and blood disorders
Adverse Events: Bone marrow depression, with long-term therapy, peripheral neuritis, purpura, myopathy, allopecia, reversible azoospermia, N/V/D (Diarrhea is common).
Inhibits neutrophil motility and activity, leading to a net anti-inflammatory effect. It does not have direct pain reliefproperties nor does it decrease uric acid
As a preventive, it is taken 3 to 4 times a week – this is an important patient education factoid.