Narcotics: Opioids

Delta effects of Opioid Stimulation

(Enkephalins) Analgesia

Kappa effects of Opioid Stimulation

(Ketscyclazocine) Spinal analgesis, sedation, miosis

Mu effects of opioid stimulation

(Morphine) Supraspinal analgesia, respiratory depression, euphoria, sedation

Nursing interventions

- Assess dietary patterns, family history, history of allergies, use of other medications - Obtain baseline vitals sings - Assess for contraindications and drug interactions - Patients should NOT take other medications or OTC drugs w/out checking with physician - Inform physician of allergic reaction/adverse effects immediately -Follow directions for administration...record pain experience & response to treatment - Patients need to change positions slowly to prevent possible orthostatic hypotension

When would you withhold a patients opioid dose?

- If their condition has declined - If vital signs are abnormal - Or is respiratory rate is less than 10 breaths/min

What are the 5 total opioid receptors? and what are the three most responsive?

- Mu* - Kappa* - Sigma - Delta* - Epsilon * the three most responsive

Patient Education should include...?

- Opioids should not be used with alcohol or other CNS depressant unless ordered - Report adverse effects - Patient should share any history of addiction - If tolerance does occur check with physician if a new does may be needed...NEVER double up or change dosage w/out consent of physician.

A patient can become addicted to opiates within how long?

2 weeks

Antagonist

A drug that binds to a receptor and prevents (blocks) a response

Agonists

A substance that binds to a receptor and causes a response

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.) A) Decreased peristalsis B) Diarrhea C) Delayed gastric emptying D) Urinary retention

A) Decreased peristalsis C) Delayed gastric emptying D) Urinary retention FEEDBACK:Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention.

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic? A) naloxone (Narcan) B) acetylcysteine (Mucomyst) C) methylprednisolone (Solu-Medrol) D) protamine sulfate

A) naloxone (Narcan) FEEDBACK: Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient's A) respiratory rate. B) heart rate. C) blood pressure. D) mental status.

A) respiratory rate FEEDBACK: The most serious side effect of narcotic analgesics is respiratory depression.

What are the three mechanisms of action for Opioids

Agonists, Agonist-Antagonist, Antagonists

Indications for opioid use

Alleviates moderate to severe pain

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? A) Stimulation of the immune system B) Cough suppressant C) Expectorant D) Bronchodilation

B) Cough suppressant FEEDBACK: Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects

The nurse suspects that a patient is showing signs of respiratory depression. Which drug could be the cause of this complication? A) Naloxone(Narcan) B) Hydromorphone (Dilaudid) C) Acetamnophen (Tylenol) D) Ziconotide (Prialt)

B) Hydromorphone (Dilaudid)

A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication? A) Morphine B) Methadone C) Meperidine D) Naloxone

B) Methadone FEEDBACK: Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A) Administer a smaller dose and record the findings B) Notify the physician and delay drug administration C) Administer the prescribed dose and notify the physician D) Hold the drug, record the assessment, and recheck in 1 hour

B) Notify the physician and delay drug administration FEEDBACK: Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician.

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which of the following medications to prevent toxicity? A) naloxone (Narcan) B) acetylcysteine (Mucomyst) C) methylprednisolone (Solu-Medrol) D) vitamin K

B) acetylcysteine (Mucomyst) FEEDBACK: Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).

Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that A) massaging muscles decreases the inflammatory response that initiates the painful stimuli. B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. C) massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain. D) massaging muscles helps relax the contracted fibers and decrease painful stimuli.

B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. FEEDBACK: The gate theory of pain control identifies large sensory nerves that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore the patient is not having the sensation of pain even if the stimulus is still present.

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose? A) Renal failure B) Kidney stones C) Acute hepatic necrosis D) Metabolic alkalosis

C) Acute hepatic necrosis FEEDBACK:Acetaminophen in large doses over a short period is extremely hepatotoxic. The long-term ingestion of large doses of acetaminophen is more likely to result in nephropathy.

A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During round, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58mm HG. After stopping the opioid infusion, what should the nurse do next? A) Notify the charge nurse B) Administer oxygen C) Administer an opiate antagonist per standing orders D) Perform a thorough assessment, including mental status examination

C) Administer an opiate antagonist per standing orders

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? A) When pain recurs B) Every 24 hours C) Every 72 hours D) Once a week

C) Every 72 hours FEEDBACK: The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? A) Acute pain B) Risk for injury related to central nervous system side effects C) Impaired gas exchange related to respiratory depression D) Constipation related to gastrointestinal side effects

C) Impaired gas exchange related to respiratory depression FEEDBACK: Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of A) autonomic control over circulation. B) cough reflex center. C) chemoreceptor trigger zone. D) respiratory rate and depth.

C) chemoreceptor trigger zone. FEEDBACK: Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that A) narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction. B) analgesics should be administered as needed (prn) to minimize side effects. C) pain relief is best obtained by administering analgesics around the clock. D) patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.

C) pain relief is best obtained by administering analgesics around the clock. FEEDBACK: When pain is present, analgesic dosages are best administered around the clock and not "as needed," but dosages should always be within the dosage guidelines for each drug used. The around-the-clock (or "scheduled") dosing allows steady states of the medication and prevents drug dosage "troughs" and escalation of pain.

What is a common adverse effect when taking an opioid? how can it be avoided?

Constipation is a common adverse effect it can be avoided with adequate fluid and fiber intake

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by A) taking Lomotil with each dose. B) eating foods high in lactobacilli. C) taking the medication on an empty stomach. D) increasing fluid and fiber in the diet.

D) increasing fluid and fiber in the diet. FEEDBACK: Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses with that of A) meperidine. B) fentanyl. C) codeine. D) morphine.

D) morphine. FEEDBACK: The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine.

If patients experience severe respiratory depression?

Give Naloxone (Narcan) an opioid antagonist

It order to insure safety what might you do?

Put side rails up

Agonists-antagonists

Substances that bind to a receptor and cause a partial response that is not as strong as that caused by an agonist

Opioid analgesics

Synthetic drugs that bind to opiate receptor to relieve pain but are not themselves derived from the opium plant

You want to medication your patient with opioids when?

before pain becomes severe

Opioid withdrawal

can occur 2 weeks of opioid therapy....gradual dose reduction for overdose patients

Contraindications of opioids

drug allergies, severe asthma, respiratory insufficiency, severe head injury, morbid obesity, sleep apnea, myasthenia, gravis, paralytic ileus, pregnancy

Adverse Effects of Opioids

hypotension, palpitations, flushing, bradycardia, sedation, disorientation, euphoria, dysphoria, tremors, nausea, vomiting, constipation, urinary retention, itching, rash, wheal formation

Meperidine-like drugs

meperidine, fentanyl, remifentanil, sufentanil, alfentanil

Methadone-like drugs

methadone

Morphine-like drugs

morphine, heroin, hydromorphone, oxymorphone, levorphanol, codeine, hydrocodone, oxycodone

Pain management should include?

pharmacologic and non-pharmacologic approaches

Opioids (codeine)

suppress the medullary cough center for cough suppression

Strong opioids (fentanyl, sufentanil, and alfentanil)

used in combination with anesthetics during surgery. They relieve pain and maintain a balanced state of anesthesia

Strong Opioids (morphine, meperidine, hydromorphone, oxycodone)

used to control postoperative and other types of pain

Oral forms should be taken _____ _______.

with food