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33 Cards in this Set
- Front
- Back
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What is the MOA of Morphine?
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Pure opoid, binds to mu receptor and promotes analgesia and respiratory depression in CNS; decreases gastric, biliary, and pancreatic secretion, induces vasodilation
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What are some side effects of Morphine?
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Peripheral edema, pruritis, rash, N/V/D/C, dizziness, respiratory depression, sedation
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What is the MOA of Hydromorphone (dilaudid)?
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Pure opiod agonist; therapeutic effects mechanism unknown.
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What are some side effects of dilaudid?
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N/V, dizziness, sedation, los of appetite, hypotension, respiratory depression.
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What is the MOA of Fentanyl (Sublimaze, Duragesic, Actiq, Fentora)?
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Opioid agonist exerting effect at mu receptor; increases tone and decreases smooth muscle contractions
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List some side effects of Fentanyl?
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N/V/C, dizziness, sedation, pruritis, respiratory depression, cardiac dysrhythmia, CP, hypotension.
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What is the MOA of Oxycodone (OxyIR, Oxycontin)?
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Pure opioid agonist similar to morphine
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What are some side effects of oxycodone?
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N/V/C, pruritis, lightheadedness, dizziness, hypotension, respiratory depression, sedation
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How is absorption affected with oxycodone?
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High-fat foods can delay time to peak (IR), will increase peak concentration (CR).
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What is the MOA of Methadone?
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Synthetic opioid agonist at mu receptor, effects similar to morphine.
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List the indications for use of Methadone.
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Drug detoxification, opioid abuse, pain
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List the side effects of Methadone.
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N/V/C, hypotension, dysrhythmias, dizziness, sedation, respiratory depression, edema, TdP
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List the MOA of Nalbuphine (Nubain).
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Opioid agonist at kappa and delta receptors and partial opioid agonist at mu receptors
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How does food affect the absorption of Morphine?
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Food can delay extended release of oral time, but not extent
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List side effects of Nalbuphine (Nubain).
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N/V, dizziness, sedation, respiratory depression, immune hypersensitivity reaction
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List the main drug interactions of Methadone.
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MAOI's (serotonin syndrome), Thioridazine, dofetilide, quinidine, FQ's, amiodarone, droperidol (QTc prolongation).
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What severity of pain is Hydrocodone is used for?
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Especially for moderate pain.
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What other medications is Hydrocodone combined with?
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APAP, ibuprofen, giving Vicodin, Lortab, Vicoprofen
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What is the MOA for Hydrocodone?
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Opioid analgesic and antitussive with unknown MOA related to opiate receptors.
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List the side effects associated wtih Hydrocodone.
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Rash, pruritis, sedation, urinary retention, N/V/C
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What are the common drug interactions wtih Fentanyl?
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PI's (increase fentanyl toxicity), Beta blockers and calcium channel blockers (increase hypotension), muscle relaxants, BZD's, barbiturates, fluconazole, amiodarone (cardiac toxicity).
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How do you handle the side effects of N/V from an opioid?
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Take with food, or consider pre-medicating with antiemetic.
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How do you handle the side effects of constipation from an opioid?
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Begin stool softener or stimulant laxative (avoid fiber due to increased bloating, cramping).
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How do you handle the side effect of itching from an opioid?
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Consider switching opioid classes or pre-medicate with antihistamine (diphenhydramine)
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How do you handle the side effect of myoclonus from an opioid?
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Consider switching opioid classes or use BZD to treat
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How do you handle the side effect of respiratory distress from an opioid?
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Give Naloxone IV
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How do you handle the side effect of GI upset from a NSAID?
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Take with food, consider adding PPI
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How do you handle the side effect of bleeding from a NSAID?
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Consider changing to NSAID with no effect on platelet aggregation
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How long should you wait before reassessing pain med administration after giving IV/IM/SQ, PO, and non-pharmacological treatment?
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IV/IM/SQ - 30 min post-dose
PO med (IR) - 60 min post-dose Non-pharm - 30-60 min post therapy |
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List the criteria for opioid dose titration
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Pain score >/equal to 3 on a 0-10 scale. RR >/equal to 10 (awake) or 8 (asleep). SBP >/= 90 mmHg. Alert, easily aroused, responds to commands.
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List the criteria for opioid dose reduction.
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Lethargic, difficult to arouse, slow response to commands. Respiratory depression.
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What is the MOA of Naloxone (Narcan)?
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Opioid antagonist with highest affinity for mu receptor, also competes for kappa and sigma receptors in CNS.
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List the SE of Naloxone?
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HTN, hypotension, V. fib, dysrhythmias, hepatotoxicity, pulmonary edema, withdrawal signs and symptoms.
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