Opioid Agonist.docx

Opioid Agonist Morphine Fentanyl Meperidine Methadone Codeine Oxycodone Hydromorphone Purpose: act on the mu receptors and to a lesser degree on kappa receptors. When the mu receptors are activated they produce analgesia, respiratory depression, euphoria, and sedation. They can also be linked to phy...

Opioid Agonist Morphine Fentanyl Meperidine Methadone Codeine Oxycodone Hydromorphone Purpose: act on the mu receptors and to a lesser degree on kappa receptors. When the mu receptors are activated they produce analgesia, respiratory depression, euphoria, and sedation. They can also be linked to physical dependance. Kappa receptors activate analgesia, sedation, and decreased GI motility. Uses: relief of moderate to severe pain such as postop heart attack, after childbirth, cancer. Sedation reduction of bowel motility relief of diarrhea. Codeine is used for cough suppression. Complications Respiratory depression Constipation Orthostatic hypotension Urinary retention Cough suppression. Sedation Biliary colic Nausea/vomiting Opioid toxicity triad Contraindications Avoid chronic use while pregnant or lactating as opioids can cause withdrawals and respiratory depression. Morphine is Contraindicated for Biliary tract surgery. Morphine contraindicated for preemie babies. (resp. depression) Meperidine not for pts with kidney failure bc of the accumulation of normeperidine (causes seizures/neurotoxic) Caution Asthma, head injuries, emphysema Obese patients, infants, older adults IBD (risk of megacolon, or ileus) Enlarged prostate (urinary retention) Hepatic or renal disease Interactions CNS depressants avoid the use of both simultaneously. Avoid alcohol. Anticholinergic agents, antihistamines, antidepressants = constipation, urinary retention Antihypertensives have additive hypotensive effects. Other meds that have a CNS effect as they can increase opioid induced analgesia. Nurse administration Take baseline vitals, hold med if RR is less than 12/per min Double check dose with another nurse Administer IV opioids over 4-5 minutes and have Naloxone and resuscitation equipment ready. For cancer patients, administer on a fixed schedule Opioids should be withdrawn slowly, not abruptly. Taper off over 3 days Pca pump- 4 hour limit Fentanyl patch takes several hours to achieve the full effect. Administer short acting as needed.