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Analgesic Agents
| Question | Answer |
|---|---|
| Agonist | Binds with receptors to activate and produce MAXIMUM response to individual receptors. |
| Partial agonist | Binds with receptors to produce PARTIAL response. |
| Agonist/Antagonist | Produces mixed effects; acts as agonist at one type of receptor and competitive agonist at the other |
| Agonist drugs | (Pure); Morphine. (Semi-synthetic);Oxymorphone, Hydromorphone, Heroin. (Synthetic); Meperidine, Levorphanol Tartrate, Methadone |
| Partial Agonist | (Pure); Codeine. (Semi-synthetic); oxycodone, hydrocodone. (Synthetic) Propoxyphene. |
| Agonist/Antagonist mix | (Semi-synthetic) Nubain. |
| Indications for use of Morphine | MI (peripheral vasodilation, decrease cardiac workload). Acute pulmonary edema (peripheral vasodilation, decreased cardiac workload, increased cardiac function, decreased lung fluid). |
| Morphine w/ Codeine | Depression of cough center |
| Opiods (in general) | to alleviate mild - moderate pain, antidiarrheal, reduce pre-op anxiety |
| Effects | analgesia, drowsiness, change in mood and euphoria |
| How it works | Decrease pain by stimulating opiate receptors in the CNS, producing analgesia and altering perception of and emotional response to pain. |
| Administration | PO, IM , IV, PCA, intraspinal, transdermal (patches), transmucosal (rectal, nasal, sublingual). |
| Methadone | Used for detox and maintenance of Heroin, Opium, and other opiod addictions, to decrease intensity of withdrawal symptoms. |
| Step 1: non-opiods | initial for mild pain. (Acetaminophen, Aspirin, Ibuprofen, Naproxen, Ketorolac) |
| Step 2: opiods for mild to moderate pain | pain persists or increases, add step 2 . (Codeine, Oxycodone, Hydrocodone, Meperidine, Propoxyphene HCL, Tramadol). |
| Step 3: opiods for moderate to severe pain | pain persists or increases, replace step 2 with 3 and continue step 1. (Morphine, Oxycodone, Methadone, Hydromorphone, Oxymorphone, Levorphanol, Fentanly, Stadol, Nubain, Dalgan) |
| Adjuvant Drugs | Used in conjunction to enhance effects. (Tricyclic, Antidepressants, Anticonvulsants, Antihistimine, Caffeine, Cortocosteroids, Benzodiazepines, Dextroamphetamines) |
| Most common side effects | Faintness, Fatigue, Constipation, Sedation, Nausea, Vomiting, Diaphoresis, Hypotension, Itching with epidurals. |
| Least common side effects | Dry mouth, headache, urinary retention, abdominal cramping, respiratory depression (especially with epidurals, and PCA's). Pt's with CNS injury, head injury, and COPD have resp problems most frequently. |
| Adverse Reactions | Seizures, Tinnitus, Jaundice, Pruritus (facial edema, swelling, hives, itching), resp depression, confusion, tachycardia. |
| Tolerance | Need for increased opiod dose overtime to acheive same effects. |
| Agents that interact with opiods | Morphine & Cimetidine (increased CNS, decreased RR). Morphine &Esmolol (esmol toxicity, bradycardia, hypotension). Morphine & other CNS depressants (increase RR & decrease CNS). Talwin and Darvon and tobacco (increased dose needed) |
| Contraindication | Pt's with acute respiratory distress |
| Caution | Clients with impaired hepatic or renal function |
| Implementation | Monitor response to drug, VS (RR Q2), LOC, bowel sounds (usually slowed by meds), U/O, s/s overdose. |
| Education | Orthostatic BP and safety, driving, increased fluid intake, stool softener prn, no alcohol |
Created by:
hgladle
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