Narcotic Analgesia PDF

HLTENN040 Administer & monitor medicines and intravenous therapy HLT54121Diploma of Nursing Acknowledgement of Country We respectfully acknowledge the Wurundjeri People of the Kulin Nation, who are the Traditional Owners of the land on which Swinburne’s Australian campuses are located in Melbourne...

HLTENN040 Administer & monitor medicines and intravenous therapy HLT54121Diploma of Nursing Acknowledgement of Country We respectfully acknowledge the Wurundjeri People of the Kulin Nation, who are the Traditional Owners of the land on which Swinburne’s Australian campuses are located in Melbourne’s east and outer-east, and pay our respect to their Elders past, present and emerging. We are honoured to recognise our connection to Wurundjeri Country, history, culture, and spirituality through these locations, and strive to ensure that we operate in a manner that respects and honours the Elders and Ancestors of these lands. We also respectfully acknowledge Swinburne’s Aboriginal and Torres Strait Islander staff, students, alumni, partners and visitors. We also acknowledge and respect the Traditional Owners of lands across Australia, their Elders, Ancestors, cultures, and heritage, and recognise the continuing sovereignties of all Aboriginal and Torres Strait Islander Nations. Narcotic Narcotic: Addictive drug Reduces pain Alters mood Usually induces sleep/drowsiness Narcotic Interactions with other prescribed drugs •CNS Depressants – increased sedation •Anti-hypertensive drugs – increase antihypertensive effect, e.g may cause hypotension and bradycardia •Anti-Epilepsy – increased risk of seizure Caring for a patient receiving narcotics Routine observations should include: •Respiratory rate, depth, effort •HR / BP (hypotension, bradycardia) •Sedation score ? over-sleepy? •Assess effectiveness post analgesia CNS: sedation, euphoria, dysphoria Resp: respiratory depression CVS: hypotension Renal: urine retention GIT: nausea, vomiting, constipation Eyes: pinpoint pupils sign of overdose Addiction with prolonged use!! Caring for a patient receiving narcotics Respiratory Depression Most serious effect of opioids Best judged by the degree of sedation -reduction of respiratory rate may be a late indicator of overdose Sedation can be monitored by using a sedation score 0 1 2 3 – – – – wide awake easy to rouse easy to rouse, but cannot stay awake difficult to rouse Aim: to keep sedation score < 2 Opiates & Opioids Opiates •Natural derivative of opium •Includes- morphine, codeine, heroin Opioids •Synthetic •“opium-like” action - pethidine Opiates & Opioids Opiates & opioids Also called narcotics Activate opioid receptors in the Central and Peripheral Nervous System(opioid agonist) to block the transmission of pain Cause analgesia, respiratory depression & sedation Opiates & Opioids Morphine •Binds with opiate receptors in the CNS •Alters the perception of pain •Alters the emotional response to pain •Still the most effective analgesia for severe pain •Available in oral and injectable forms Opiates & Opioids Morphine Route Onset Peak Duration Oral 1 hour 1-2 hours 4-12 hours Oral (SR or CR) 1-2 hours 4-8 hours 24 hours Intravenous 5 minutes 20 minutes 4-5 hours Intramuscular 10 -30 minutes 30-60 minutes 4-5 hours Subcutaneous 10-30 minutes 50-90 minutes 4-5 hours Epidural 15-60 minutes 15-60 minutes 24 hours Opiates & Opioids Buprenorphine “bew-pren-or-feen” • Synthetic opioid • More potent than morphine and lasts up to 6 hours • For short-term management of moderate to severe pain or to aid in opiate withdrawal • Routes of administration: IM, IV, patch, Sublingual • Example: Norspan patch/Norspan SL Opiates & Opioids Codeine •Closely related but less potent than Morphine •Codeine 120mg = Morphine 10mg. •Usually administered by oral route as a tablet •Codeine linctus given for cough suppression Opiates & Opioids Codeine • Different dosages fall into different drug schedules: • Paracetamol 500mg & Codeine 8mg tabs S4 • ( Panadeine) • Paracetamol 500mg & Codeine 30mg 20 tabs S4 • (Panadeine Forte) • Codeine 30mg any quantity uncombined S8 Opiates & Opioids Pethidine • Synthetic opioid analgesic • Pethidine 75-100mg = Morphine 10mg • Onset 10-15 minutes after IM injection • Duration of effect: 2-4 hours • For moderate to severe pain in obstetrics, post-op and anaesthesia • Adverse effects: drowsiness, respiratory depression Opiates & Opioids Dextropropoxyphene “dex-tro-prop-oxy-feen” S4 Synthetic opioid with similar potency as codeine • Similar pain control to codeine and is often combined with Paracetamol (Digesic, Paradex, Capadex) • Paracetamol should not be given with any of the above • Overdose will cause severe respiratory depression leading to death (easily absorbed from GIT) • Chronic use has been associated with dependence because of its weak opioid properties Opiates & Opioids • Semi-synthetic opioid • Longer half life than morphine- lasts 8-10 hrs • Available in tablet form, which can be crushed and given to patients with swallowing difficulty • Controlled release tablets have a duration of 12 hours Endone / Oxynorm Proladone (rectal formulation) Oxycontin CR Opiates & Opioids Targin • Oxycodone with naloxone controlled release • Duration of effect of 12 hours • The naloxone blocks opioid receptors in the gut that normally cause constipation→ reducing constipation from long term narcotic use • For severe pain not responding to non-opioid analgesia Opiates & Opioids • Potent opioid analgesic that acts on receptors in brain, spinal cord and smooth muscle • Useful for chronic pain disorders • Available as transdermal patches which lasts for three (3) days and lozenges for breakthrough pain • Also given IM and IV for pre-med, anaesthsia and for post-op pain Opiates & Opioids Tramadol •IV/IM tramadol is as effective as morphine for moderate postoperative pain •Similar side effects for opioids but less respiratory depression •Naloxone reverses respiratory depression (if it occurs) but not all symptoms of overdose •Of benefit for patients that have excessive respiratory depression, sedation, or constipation with other opioids Opiates & Opioids Tramadol Opioid Receptor Antagonists (Narcotic Reversal Agents) •Compete at opioid receptor to displace the opioid •Reverse action and adverse effects of opioid agonists such as morphine, codeine, fentanyl, methadone •May exacerbate pain and precipitate withdrawal •Initially fast to work but duration of effect may only last for as much as one hour – close monitoring of patient is advised and dose may need to be repeated Naloxone(Narcan) References Bochner, F., Misan. G M H., Royal Australian College of General Practitioners; Pharmaceutical Society of Australia.; Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, 2009. Australian Medicines Handbook AMH Australian Medicines Handbook Pty Ltd. Bullock, S., Galbraith, A. and Manias, E., 2006. Fundamentals of Pharmacology, 5th edition. Prentice-Hall Health, Pearson Education Australia. Funnell, R., Koutoukidis, G., Lawrence, L. 2009. Tabbner’s Nursing Care, Theory & Practice. 5th Edition. Elsevier. Sydney. Tiziani, A. 2011. Havard’s Nursing Guide to Drugs. 8E. Mosby Elsevier: Sydney