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What pt variables (side effects) must be assessed with the use of narcotics?
- 1) respiratory distress
- 2) cardiac distress
- 3) baseline; severity of pain
- 1) severe pain
- 2) chronic pain
- 3) post-op
- Absorption: 30% oral; better w/ IV, subQ, rectal.
- Distribution: Crosses placenta, found in breast milk.
- Protein binding: 35% in adults.
- Metabolism&Excretion: liver, kidneys
Action: Binds with opioid receptors in CNS, altering perception and emotional response to pain.
Onset & duration?
Onset&duration: 10-30 minutes; 4-5 hours
Contra: hypersensitivity, head injuries, debilitated pts, pregnant/lactating, infants.
Side FX: CNS-confusion, sedation, hypotension, constipation, urinary retention, N/V
Adverse FX: RESPIRATORY DISTRESS
Interactions: many drugs; natural products-valerian, chamomile--increases CNS depression.
What type of pain?
Routes: parenteral, transdermal, transmucosal.
Pain type: moderate-severe pain requiring prolonged analgesic therapy.
- Ab: well absorbed
- Dist: crosses placenta, enters breast milk.
- Metab/Excretion: liver and kidneys
Onset & duration (transdermal)
Onset&duration: Onset-6 hrs; dur-72 hours
Contra: hypersensitivity, acute pain, post-op, breast feeding, peds
Sede FX: confusion, sedation, restlessness, bradycardia, constipation, N/V.
Adverse FX: APNEA
Interaction: drug-drug, MAO inhibitors, food-grapefruit juice.
Codeine: mild opioid agonist.
- Pain type: mild-moderate pain.
- Purposes: 1) diarrhea 2) suppresses cough reflex.
- Ab: 50% from GI tract
- Dist: crosses placenta, breast milk, 7% protein-binding.
- Met: liver
- Excretion: kidneys
Onset & duration
Adverse effects: none identified
Interactions (similar to morphine)
Onset: 30-45 minutes; duration: 4 hours
Contra: head trauma, hypersensitivity, alcoholism.
Side FX: confusion, sedation, hypotension, constipation, N/V.
Interactions: drug-drug-many; natural products-valerian, chamomile, hops--increases CNS DEPRESSION
- Moderate - severe
- A: well absorbed
- D: Crosses placenta, enters breast milk.
- M/E: liver, kidney
O&D: PO-30 min; 4-5 hours
Contra: pregnancy, breast-feeding, GERIATRiCS, INCREASED CRANIAL PRESSURE.
S FX: confusion, sedation, hypotension, blurred vision, constipation
A FX: RESPIRATORY DEPRESSION, bronchospasm, bradycardia
Interactions: anti-depressants, increase risk of CNS DEPRESSION