NURS 180 Key Points for Quiz 3- West Coast University/NURS 180 Key Points for Quiz 3- West Coast University/NURS 180 Key Points for Quiz 3- West Coast University/NURS 180 Key Points for Quiz 3- West Coast University/NURS 180 Key Points for Quiz 3- West Coast University/NURS 180 Key Points for Quiz ...
nurs 180 key points for quiz 3 west coast universitynurs 180 key points for quiz 3 west coast universitynurs 180 key points for quiz 3 west coast universitynurs 180 key points for quiz 3 west c
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
*** 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
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)
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