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Opioids
Objectives
Discuss the basic pharmacology of opioids
Discuss clinical implications of opioid use
Identify opioid antagonists
Explain nursing implications related to opioid use
Discuss non-opioid centrally acting analgesics
Endogenous Opioids Peptides
Enkephalins
Endorphins
Dymorphins
Opioid Receptors
Mu-morphine binds to mu
Analgesia, respiratory depression, sedation, euphoria, physical
dependence, and decreased GI motility
Kappa
Analgesia, sedations, and decreased GI motility
Delta
Opioid analgesics do not interact with delta
Classification
Pure opioid agonists
Agonist-antagonists
Codeine
10% of the codeine dose is converted to MSO4 in the liver
Some people lack the gene to metabolize codeine so it is ineffective
Nursing mothers should be alert for signs of infant toxicity such as excessive
sleepiness, breathing difficulties, poor feeding---seek medical attention
Moderate to Strong Opioids
Oxycodone, Oxycontin
Oxycontin was reformulated in 2010 due to abuse
New formulation bears the imprint OP the old formulation bears the
imprint OC
New formulation are harder to crush and if exposed to water or alcohol it
turns into a gummy blobcan not inject
Hydrocodone
Combined with acetaminophen or ibuprofen
Agonist-Antagonist Opioids
Pentazocaine still get pain relief, limited resp depression. If someone
is already taking opiotes and then take this, pt will go into withdrawl
Agonist at kappa receptors
Antagonist at mu receptors
Route
subQ
Adverse Effects
Diarrhea
Abdominal pain
Flatulance
Nausea
Dizziness
Nonopioid Centrally Acting Analgesics
Tramadol
Weak activity at mu receptors
Spinal inhibition of pain
Used for mild to moderate pain
Clonidine
Alpha 2 agonist
Blocks nerve pathways that transmit pain in the spinal cord
Used for severe cancer pain not relieved by opioids
Key Points
Patient/family education
Pain assessment
Identifying high risk patients
Continuous evaluation