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22 Cards in this Set
- Front
- Back
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What are narcotics used for?
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Moderate to severe pain, suppression of respiration and coughing, antidiarrheal effects
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Which opioid does not have an antitussive (cough suppression) effect?
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meperidine (Demoral)
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What are common side effects of most opioids?
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nausea and vomiting, constipation, moderate decrease of blood pressure, orthostatic hypotension with high doses, respiratory depression with high doeses, urinary retention (usu in older adults), antitussive effects (except meperidine)
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Which age group requires adjustments in opioid doses to avoid severe side effects? What are examples of drugs that are more toxic in older adults?
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Older adults 65yrs or older. Adverse reactions must be closely monitored.
meperidine (Demoral), pentazocine (Talwin), propoxyphene (Darvon) |
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What is morphine effective for?
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Acute pain from acute MI, cancer and dyspnea from pulmonary edema, preop med
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What are the side effects of morphine and an antidote for morphine overdose?
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Respiratory depression, orthostatic hypotension, miosis, urinary retention, constipation
Nazolone (Narcan) |
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What are examples of Patient-controlled analgesia?
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Morphine, Meperidine (Demoral), hydromorphone (Dilaudid)
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What are contraindications for morphine?
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Severe respiratory disorders, inc intracranial pressure, severe renal disease, cau cause seizures
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What are drug-drug interactinos of morphine?
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Morphine increases the effects of alcohol, sedatives, or hypnotics, antipsychotic drugs, and muscle relaxants and might cause respiratory depression.
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What are nursing interventions for morphine?
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1) Administer the narcotic before pain reaches its peak.
2) Monitor vital signs to detect respiratory changes. Respirations <10 min can indicate respiratory distress 3) Record client's urine output; should be at least 600ml/day 4) Check bowel sounds for decreased peristalsis 5) Check for pupil changes and reaction. Pinpoint pupils can indicate morphine overdose. 6) Have naloxone (Narcan) available as an antidote in case overdose occurs 7) Validate child's dose of morphine; 0.1 to 0.2mg/kg/q4h IM or Subcut; max is 15mg/dose |
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When is meperidine preferred to morphine?
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During pregnancy, because it does not diminish uterine contractions and causes less neonatal respiratory depression. It also causes less constipation and urinary retention.
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What are the contraindications of meperidine?
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It is not indicated for chronic pain, severe liver dysfunction, sickle cell disease, a history of seizures, severe coronary artery disease (CAD) and cardiac dysrhythmias. Older adults and clients with advanced cancer have reported neurotoxicity.
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What is the dose for meperidine?
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It is limited to 600mg in 24-period no longer than 48-72hrs.
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For which clients must the dose for meperidine be decreased for?
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Hepatic or renal insufficiency because meperidine is metabolized in the liver to an active metabolite.
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What should be avoided when taking meperidine?
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Alcohol or sedative hypnotics because the combination causes CNS depression.
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What is a major side effect of meperidine?
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decrease in blood pressure
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How does hydromorphone compare to morphine?
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It is six times more potent with fewer hypnotic effects and less GI distress. It has a faster onset and a shorter duration o f action.
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How is hydromorphone given by IV?
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Dilution of each dose with 5ml of sterile water or normal saline.
Direct IV administration of 2mg or less given 2-5 minutes. |
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What are side effects and adverse reactions of narcotics?
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Respiratory depression, orthostatic hypotension, tachycardia, drowsiness, constipation, urinary retention. pupillary constriction (sign of toxicity), psychological and physical dependence
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What are withdrawal symptoms of narcotics?
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Irritability, sweating, restlessness, muscle twitching, increase in pulse rate and blood pressure
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What are contraindications of narcotics?
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Head injuries - narcotics decrease respiration leading to CO2 retention and vasodilation which causes increase intracranial pressure.
In shock or very low blood pressure Decreased dosage for older adult and debilitated state |
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What are nursing interventions for hydromorphone?
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1) Administer hydromorphone before the pain reaches its peak.
2) Monitor vital signs to compare blood pressure with baseline pressure. Hypotension is a side effect. 3) Have nalozone (Narcan) to reverse respiratory depression from narcotic overdose. 4) Determine urine output and bowel sounds. Urinary retention and constipation are side effects. 5) Check older adults for side effects. Confusion may occur. |
