22 Questions
What is the primary concern when administering morphine to premature infants during and after delivery?
Respiratory depression
What medication is used as an alternative to morphine for clients with a history of biliary colic?
Meperidine
What is the purpose of administering an antiemetic such as promethazine (Phenergan)?
To treat emesis
Why is meperidine contraindicated for clients with renal failure?
Due to accumulation of normeperidine
What should the client do to prevent accumulation of secretions in the airway?
Cough at regular intervals
What is the opioid overdose triad?
Coma, respiratory depression, and pinpoint pupils
Why is stool softener administration important for clients receiving opioids?
To prevent constipation
What should the nurse do to assist clients who experience orthostatic hypotension?
All of the above
Which of the following clients is at risk of respiratory depression when administered opioid agonist-antagonist medications?
Clients who have asthma
What is the primary advantage of using opioid agonist-antagonist medications compared to pure opioid agonists?
They have a lower potential for abuse and cause little euphoria
Which of the following is a precaution to consider when administering opioid agonist-antagonist medications to clients in labor?
Risk of respiratory depression in the newborn
What is the expected pharmacological action of opioid agonist-antagonist medications?
They act as antagonists on mu receptors and agonists on kappa receptors
Which of the following clients is at risk of acute urinary retention when administered opioid agonist-antagonist medications?
Clients with an enlarged prostate
Which of the following is a common adverse effect of opioid agonist-antagonist medications?
Constipation
What is the effect of acetaminophen on warfarin?
Slows the metabolism of warfarin
What is the mechanism of action of opioid agonists?
Binding to proteins in the brain and spinal cord
What is a common indication for the use of codeine?
Cough suppression
What is a common route of administration for fentanyl?
Intravenous and transmucosal
What is a potential adverse effect of morphine sulphate?
Respiratory depression
What should be done if a client's respiratory rate is less than 12/min while taking opioids?
Stop the opioids and notify the provider
What can help manage constipation in clients taking opioids?
Increased fluid intake and physical activity
Why should opioids be avoided with CNS depressant medications?
To prevent respiratory depression
Study Notes
Opioid Analgesics/Narcotic Analgesics
- Opioids are classified as agonists, agonist-antagonists, and antagonists.
- Examples of opioid agonists: morphine sulfate, Fentanyl, Meperidine, Methadone, Codeine, Oxycodone.
Mechanism of Action
- Opioid agonists produce analgesia by binding to specific proteins-coupled receptors in the brain and spinal cord regions involved in pain transmission and modulation.
Indication/Therapeutic Uses
- Relief of moderate to severe pain (postoperative, myocardial infarction, cancer)
- Sedation
- Reduction of bowel motility
- Codeine: cough suppression
Route of Administration
- Morphine sulfate: Oral, subcutaneous, IM, rectal, IV, epidural, and intrathecal
- Fentanyl: IV, IM, transmucosal, and transdermal
- Meperidine: Oral, subcutaneous, IM, and IV
- Codeine: Oral, subcutaneous, IM, and IV
- Methadone: Oral, subcutaneous, and IM
- Oxycodone: Oral, rectal
- Hydromorphone: Oral, subcutaneous, IM, IV
Adverse Effects
- Respiratory depression
- Monitor client's vital signs
- Stop opioids if respiratory rate is less than 12/min
- Have naloxone (Narcan) and resuscitation equipment available
- Avoid use with CNS depressant medications
- Constipation
- Increase fluid intake and physical activity
- Decreased bowel motility
- Administer stimulant laxative (e.g., Bisacodyl) or stool softener (e.g., docusate sodium)
- Orthostatic hypotension
- Advise clients to sit or lie down if symptoms of lightheadedness or dizziness occur
- Avoid sudden changes in position
- Provide assistance with ambulation as needed
- Urinary retention
- Advise clients to void every 4 hours
- Monitor I&O
- Assess client's bladder for distension every 4-6 hours
- Cough suppression
- Advise clients to cough at regular intervals
- Auscultate client's lungs for crackles
- Instruct clients to increase fluid intake to liquefy secretions
- Sedation
- Advise clients to avoid hazardous activities
- Biliary colic
- Avoid giving morphine to clients with a history of biliary colic
- Use meperidine as an alternative
- Emesis
- Administer antiemetic (e.g., promethazine)
- Opioid overdose triad (coma, respiratory depression, pinpoint pupils)
- Monitor client's vital signs
- Provide mechanical ventilation
- Administer opioid antagonists (e.g., naloxone or nalmefene)
Contraindications/Precautions
- Morphine is contraindicated after biliary tract surgery
- Morphine is contraindicated for premature infants during and after delivery
- Meperidine is contraindicated for clients with renal failure
- Use cautiously with:
- Clients who have asthma, emphysema, and/or head injuries
- Infants
- Older adults
- Clients who are pregnant
- Clients in labor
- Clients who are extremely obese
- Clients with inflammatory bowel disease
- Clients with an enlarged prostate
- Clients with hepatic or renal disease
Opioid Agonist-Antagonist
- Examples: Butorphanol, Nalbuphine hydrochloride, Buprenorphine hydrochloride
- These medications act as antagonists on mu receptors and agonists on kappa receptors
- Compared to pure opioid agonists, agonist-antagonists have:
- A low potential for abuse causing little euphoria
- In fact, high doses can cause dysphoria
This quiz covers the administration of stimulant laxatives and stool softeners to counteract decreased bowel motility, and managing side effects such as orthostatic hypotension and urinary retention.
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