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Analgesic Agents

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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