NURS 180 Key Points for Quiz 3- West Coast University

Key Points for Quiz 3

OPIOID ANALGESICS (PHARMACOLOGICAL CLASSIFICATION)

Agonists (Therapeutic Classification)
*** All mechanism of action is the same for all agonists

Drug: Morphine
Drug: Codeine (higher does will not increase its effects)
Drug: Oxycodone

• Mechanism of Action: Acts as an agonist of the mu and the kappa opioid receptors producing
analgesia
• Therapeutic Use: Treats chronic and severe pain as well as pain associated with pulmonary
edema and myocardial infarction
• Pregnancy Category B (labor) & D (crosses blood brain barrier—will have a sedative type of a
reaction to the fetus)
• Schedule II Controlled Substance
• Available in PO, IM, IV, epidural, and rectal dosage forms
• Usual adult dose is 10 to 30 mg PO every 4 hours or 2.5 to 10 mg via IV, IM, or SubQ route every
2 to 6 hours as needed
• Contains a toxic metabolite known as morphine-6-glucuronide harmful for patients with renal
impairment
• Hydromorphone and fentanyl are safer options for patients with renal impairment
• Pharmacokinetics via IV route
• Onset 5 to 10 minutes
• Peak 30 minutes
• Duration 4 hours
• Adverse Effects:
• CNS: Euphoria, dysphoria, sedation, disorientation, and lightheadedness
• Respiratory: Bradypnea
• Cardiovascular: Hypotension, flushing, and bradycardia
• GI: N/V and constipation
• GU: Urinary retention, UTI
• Other: Itching, rash, and wheals
• Itching due to flushing of the skin (release of the histamine)
• Contraindications:
• Drug allergy
• Severe asthma or any respiratory problems such as COPD
• Extreme caution should be taken for patients with respiratory insufficiency, elevated
intracranial pressure, morbid obesity, sleep apnea, myasthenia gravis, paralytic ileus,
and pregnancy
• Liver and renal impairments
• Interactions: (most likely to enhance the effects)
• Alcohol
• Antihistamines
• Will enhance morphine effects (Benadryl)
• Barbiturates

, • Benzodiazepines
• Phenothiazines
• MAOIs
• Kava kava (helps with anxiety)
• Valerian root (relieves stress, promotes sleep)
• Kava kava & valerian roots: can cause some sedation (enhance)
• Patient Teaching
• Increase fluid intake
• Increase fiber intake
• Don’t do any high activity

Other Opioid Agonists:

Drug: Fentanyl
 Available in injectable, transdermal patches, buccal lozenges, and lozenges on a stick [lollipop]
 Very potent
 Safer for those with renal impairment
 A new patch should be applied every 72 hours
 Unused patches should be flushed down the toilet

Drug: Hydromorphone
 Very potent
 Safer for those with renal impairment

Drug: Methadone
 Used mainly for detoxification treatment of opioid addicts
 Safer choice for those with renal impairment but may cause cardiac dysrhythmias

Mixed [Partial] Agonist-Antagonist (Therapeutic Classifications)

*** weaker than opioid analgesics. Helps to relieve pain for persons who has additions.

Drug: Butorphanol (Stadol)

 Mechanism of Action: unknown
 Therapeutic Use: It can treat pain.
 Morphine-like medication

Drug: Pentazocine (Talwin)

 Mechanism of Action: is a synthetic opioid that is a partial agonist at μ-receptors as well as
being a κ-agonist. Its analgesic efficacy is 25–50% that of morphine
 Therapeutic Use: It can treat moderate to severe pain. It's sometimes given before or after
surgery

, OPIOID ANTAGONISTS (PHARMACOLOGICAL CLASSIFICATION)

Antidote (Therapeutic Classification)

DRUG: Naloxone hydrochloride (Narcan) is a pure opioid antagonist
Drug: Naltrexone is an opioid antagonist available PO and is used for alcohol and opioid addiction




 Mechanism of Action: Antagonizes the opioid effects by competing for the same receptor sites,
especially the mu-opioid receptor
 Therapeutic Use: Treats complete or partial reversal of narcotic depression, including respiratory
depression), induced by opioids including natural and synthetic narcotics, propoxyphene,
methadone and the narcotic-antagonist analgesics such as nalbuphine, pentazocine and
butorphanol
o It is also indicated for the diagnosis of suspected acute opioid overdose
o It may also be used as an adjunctive agent to increase blood pressure in the
management of septic shock
 Pregnancy Category B
 Available IV and intranasal spray
 Usual adult dosage range for opioid overdose is 0.4 to 2 mg via IV route [repeat in 2 to 8 minutes
if needed] and for postoperative anesthesia reversal is 0.1 to 0.2 mg via IV route [repeat at 2 to
3-minute intervals]
 It is the drug of choice for the complete or partial reversal of opioid-induced respiratory
depression as well as suspected acute opioid overdose
 Adverse effects include return of pain, raised or lowered BP, dysrhythmias, pulmonary edema,
seizure and withdrawal. Also, constipation and rash.
 Other adverse effects include muscle and joint pain, irritability, N/V, and anxiety
 Pain does come back – irritable, seizures may occur
 Administer if respiratory rate is less than 12 bpm
 Black Box Warning: May produce hepatic injury when taken in excessive doses or if taken by
patients with hepatic or renal disease
 Echinacea may increase risk of hepatotoxicity
 Overdoes may require the use of oxygen, IV fluids or vasopressors (epi & norepi)
 Pharmacokinetics via IV route
o Onset less than 2 minutes
o Half-life elimination 60 minutes
o Duration 0.5 to 2 hours


NONOPIOID ANALGESICS (works on the hypothalamus)