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Opioid agonists
- naturally occuring opium alkaloid
- produces profound analgesia
- causes euphoria produces sedation
- constricts the pupils
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Morphine indications
- relieves SOB in MI
- cardiac failure
- PE
-
Relieves chest pain associated with
Myocardial infarction
-
relief of serious
acute and chronic pain
-
other indications
pre-operative medication smooth muscle relaxant
-
morphine causes peripheral vasodilation
- by decreasing SVR
- decreases MO2 demand
-
morphine causes profound
orthostatic hypotension
-
morphine pharmacokinetics
-
morphine adverse effects
- hallucinations
- nausea
- constipation
- dizziness
- itching
- sensation
- urinary retention
- ** BPH exacerbated physical/psychological dependence
- high doses long duration
-
Morphine overdose
- respiratory depression
- cardiac arrest
- increased ICP from CO2 retention
- secondary to respiratory depression
- seizures from increased ICP
- cross tolerance with other opioids
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Morphine contraindications
- may mask gallbladder disease
- pain
- do not give in suspected
- gall bladder disease or pancreatic disease
- biliary tract spasm sphincter of Oddi acute asthma
- upper airway obstruction
- GO obstruction
- decreases persitalisis
- severe hepatic or renal disease
- respirations <12/min
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Nursing Considerations Morphine
- Monitor clients health condition
- educate pt on drug Tx
-
Nursing Considerations Initial Assessment Morphine
- Resp
- BP
- liver function renal function
- UOP
- Allergy
- CBC
- Current Med usage
- ETOH safety
- BR up
- Bed-low
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Nursing Interventions Morphine
- Assess LOC following medication administration
- Monitor VS Pain Levels
- Respiratory rate and depth
- monitor injection sites
- IV sites
- Offer additional pain relief measures
- massage
- hot packs
- ice packs
-
narcotic antagonist
- Narcon available if resp fall to 10 or less
- may need to repeat doses
-
Nursing interventions morphine education
- Reassure risk of addition is minimal
- provide thorough patient education
- drug name
- prescribed dose
-
S/S of adverse effects when to call physician
- Monitor client response to morphine
- pain levels
- pain relief
- cough suppressant
- sedation decreased
- GI motility
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Evaluation Morphine
- Monitor for adverse effects
- evaluate teaching effectiveness
- monitor compliance with pain management
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Codeine
Naturally occuring opium alkaloid
-
Codeine is a Schedule ____ drug
II
-
Codeine is an
Analgesic/Antitussive(weaker than morphine)
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What is mode of administration?
Effective PO, subq, IM
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Codeine has a strong _________ effects antitussive
less likely to cause abuse & dependency
-
codiene is usually given with
acetaminophen for additive effects but causes nausea & vomiting
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Demerol pharmacologic action
is similar to MS04
-
Demerol - 80-100 mgm =
10 mg of morphine
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Is Demerol natural or synthetic?
synthetic
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What is the generic name for Demerol?
Meperidine
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What is the route for Demerol for children?
PO/subQ/IM
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What is the dosage of Demerol for children?
50-150 mg q3-4h PRN, max: 100 mg q4h
-
What is the route for Demerol for adults?
-
What is the dosage of Demerol for adults?
1-1.5 mg/kg q3-4hr PRN
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Demerol produces what kind of sedation?
respiratory depression
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Demerol has a _______ duration of action than morphine.
shorter
-
Demerol requires more or less adm?
more
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Demerol has _____ antitussive effect
Less
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demerol causes smooth muscle
spasms
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Demerol uses
treatment of severe pain
-
what is the preferred analgesic for clients with renal or biliary colic?
Demerol
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what is used as a short term pain management in healthy clients?
Demerol
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Demerol is contraindicated in
- CA pain management
- requires increased doses
-
Demerol is not recommended for pain control longer than
48 hrs
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Demerol is considered ______ line agent
second
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What does the active metabolite of Demerol cause?
tremors and seizures
-
Is Demerol reversed by Narcan?
no
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Why is Demerol NOT recommended for PCA use?
half life too short frequent dosing required q3-4 hrs
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How do opioid antagoinist work?
- competes with opioid receptors sites in the brain
- prevents opioid binding
- displaces opioids already occupying receptor sites
- neutralizes opiods
-
what is dose of Narcan?
- 0.4 - 2.0 mg
- repeat q 2-3 minutes due to short half-life
-
Opioid Antagonists
Natoxone (Narcan)
-
Reverses or blocks analgesia
- reverses CNS depression
- reverses resp depression
-
Nursing interventions of opioids antagonists
- administer small doses often
- repeated until client exhibits reversal of opiate effects
- IV dose last 1 hr
- maintain airway resuscitation
- equipment immediately available
-
Routes for opioids antagonists
subq, IV, IM
-
Pharmacokinetics of opioid antagonists
- Hepatic metabolism renally excreted
- hepatic metabolism onset of action - IV 1-2 minutes
- duration of action - IV, 1 hr IM, up to 4 hrs
-
Adverse effects of opioid antagonists
- no common
- but serious include tachycardia
- dysrhythmias
- HTN
- N/V
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