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22 Cards in this Set
- Front
- Back
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indications for opioid use
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indicated for all types of acute and chronic pain
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what types of pain are opiates not as good for?
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neuropathic and sympathetic pain
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other uses for opiates besides pain
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-as an anesthetic -as an antitussive -as an antidiarrheal |
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mechanism of action of opioids
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-interact with opioid receptors in the CNS and peripherally |
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types of opioid receptors
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-mu -kappa -delta |
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mu receptors
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supraspinal analgesia seen with most natural and synthetic opioids
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kappa receptors
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usually stimulated by agonist-antagonist opioids leading to spinal analgesia
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delta receptors
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actions not well understood, may mediate dysphoric and psycho-mimetic effects of partial agonists
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what other effect do opioids have that may be useful?
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anxiolytic effect
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what may this anxiolytic effect lead to?
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could lead to misuse in chronic pain
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adverse effect of opioids
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-sedation and other CNS effects -nausea and vomiting -reflux -constipation -peripheral edema -itching -respiratory depression -supression of cough reflex -sweating -urinary retention -decreased libido -constipation (regardless of length of exposure) |
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management of constipation
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-prophylactic bowel regimen like a stool softener plus senna, Miralax, lactulose -or switch to transdermal fentanyl |
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management of nausea and vomiting
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-antiemetics -switch opioid |
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management of refleux
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-antacids -H2 antagonists -PPIs |
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management of sedation
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-decrease dose of opioid -add a psychostimulant -switch opioid or route of administration (go transdermal/intrathecal) |
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management of itching
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-diphenhydramine -oatmeal baths |
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management of urinary retention
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-usually more prevalent with spinal delivery, but can also occur with oral -rule out other causes, like BPH or caused by other meds like antidepressants or antihistamines |
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management of decreased libido
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-occurs with chronic use -usually see decrease in hormone levels -treat males with testosterone -females harder to treat |
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opioid routes of administration
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-oral -IV -SQ -IM -epidural -intrathecal -transdermal -transmucosal -buccal |
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IM opioids
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-absorption is variable -can get pain at injection site -can get tissue damage |
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intraspinal opioids
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-usually use morphine, fentanyl, or dilaudid -allows lower dose resulting in less side effects -for post-op pain or OB, has been associated with a decrease in ICU and hospital length of stay -for chronic pain, implanted pump allows increased mobility and decreased chance of infection |
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what was the first opioid available through the transdermal route?
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fentanyl |
