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Opioid Analgesics

Just in Time Training September 2006


References: 2006 Mosbys Nursing Drug Reference Micromedex Healthcare Series Pain Clinical Manual, McCaffery & Pasero, 2nd ed Presentation by Chris Bangert RN, ED educator

Objectives
Upon completion of this course the participant will:
Identify three groups of analgesics used for pain management. Identify the 3 most common opioid analgesics used at Passavant Hospital for pain management. Be familiar with the side effects/adverse reactions of opioid analgesics. Identify nursing considerations for opioid analgesics. Identify reversal agents for selected opioid analgesics.

Clinical Practice Analgesics


Clinical practice analgesics are divided into 3 groups (McCaffery & Pasero, Pain:
Clinical Manual,1999) Nonopioids (use to be called nonnarcotic) Opioids (use to be called narcotic) Mu agonists (morphine like agonist) Agonist-antagonists Adjuvants (diverse group of drugs whose analgesic effect is secondary to their primary effect)

Opioid Analgesics
This Just in Time education will spotlight opioid analgesics. Mu agonist opioids are the most commonly used. This group includes:
Morphine Hydromorphone (Dilaudid) Codeine (Tylenol #3) Oxycodone (Percocet/OxyContin/OxyIR ) Hydrocodone ((Vicodin/Lortab) Meperidine (Demerol) Propoxyphene (Darvon/Darvocet N 100)

Opioid Analgesics: Action


Opioid analgesics
Act by depressing pain impulse transmission at the spinal cord level by interacting with opioid receptors. Are used to control moderate to severe pain both before and after surgery.

Opioid Analgesics: Action


Onset of action is
Immediate by IV route Rapid by IM and PO route

Peak action occurs in 15 minutes to 2 hours, depending on drug and route Duration of action is from 2 to 8 hours

Opioid Analgesics: Dosing


Many references exist for dosing information. References available at Passavant Hospital include:
Mosbys 2006 Nursing Drug Reference 2006 Intravenous Medications by Betty I Gahart Micromedex

Opioid Analgesics: Dosing


Precautions in dosing are needed if patient is/has:
Debilitated Under 18 years of age Elderly Renal or hepatic disease Opioid nave (has not been taking opioid drugs regularly)

Contraindicated for use include:


Increased intracranial pressure Decreased ventilation, such as
COPD, cor pulmonale, emphysema, or asthma

History of opiate addiction or allergy

Opioid Analgesics: Side Effects / Adverse Reactions


GI symptoms Nausea, vomiting, anorexia, constipation and cramps Light-headedness Dizziness Sedation Respiratory depression Respiratory arrest Circulatory depression (hypotension) Increased intracranial pressure Remember: Always have Narcan and resuscitation equipment readily available.

Opioid Analgesics: Nursing Considerations


Assess
Need for pain medication; use pain scale I&O ratio; be alert for urinary retention, frequency, dysuria; drug should be discontinued if these occur Respiratory dysfunction, including respiratory depression, rate, rhythm, character, notify physician if respirations are below 12/min. CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction Allergic reactions: rash, urticaria
Taken from 2006 Mosbys Nursing Drug Reference

Opioid Analgesics: Nursing Considerations


Administer:
With antiemetic if nausea or vomiting occurs When pain is beginning to return, determine dosage by response Assistance with ambulation; patient should not be ambulating during drug peak
Therapeutic response, including decrease in pain Follow guidelines in pain management policy 71037
Review this policy on PAH intranet under manuals and referencessee nursing policies

Perform/provide: Evaluate:

Taken from 2006 Mosbys Nursing Drug Reference

Opioid Analgesics: Nursing Considerations

1.

Preventing and Managing Opioid-Induced Side Effects Respiratory Depression*

2.

3. 4.

Nurse monitor sedation level and respiratory status q1-2h during the first 24h in opioid-naive patients treated for moderate to severe pain. *Note: If administering opioid analgesic IV bolus check patient within 10 to 15 minutes of administration. Add or increase nonopioid or nonsedating adjuvants so that the opioid dose can be reduced. Decrease opioid dose by 25% when excessive sedation is detected. If patient is minimally responsive or unresponsive to stimulation, stop opioid administration and consider administering naloxone (Narcan).

Patients who require Narcan usually meet all of the following criteria:
Unresponsive to physical stimuli Shallow respirations or respiratory rate less than 8 breaths/minute Pinpoint pupils

*Taken from McCaffery & Pasero: Pain: Clinical Manual, pp. 262-264, & 2701999, Mosby, Inc

Opioid Analgesics: Nursing Considerations


Teach patient / family
To report any symptoms of CNS changes, allergic reactions, or shortness of breath To avoid alcohol and other CNS depressants For patient on PCA pump, only the patient should self-administer the PCA dose (push the button)
Taken from 2006 Mosbys Nursing Drug Reference

Opioid Analgesics: Documentation


Your documentation should support the following PAH policies, which can be reviewed via the Passavant Intranet under Manual/ResourcesNursing Policies.

Please review the following procedures located on the Passavant Intranet under Manual /ResourcesNursing Procedures
Patient Controlled Anaglesia (PCA Pump) PCA Flow Sheet (Guidelines for)

Charting #6010-060 Verbal/Telephone Physicians Orders (Read Back) #6010-026 Pain Management #710-37 Medication Administration #6010-064 Medication Administration Range Orders #6010-130 Monitoring of Vital Signs #710-72 Patient Controlled Analgesia (PCA) Pump # 6010-071

Summary
This course has provided you with a concise review of opioid analgesics. You have been encouraged to review corresponding policies and procedures related to the administration of opioid analgesics. A more in-depth review of the policies and procedures for pain management will be assigned to you in October.

Thank you for taking the time to read this material. To complete this course you need to complete the post test. Click on the take test button to the left. If you have any questions please contact your nurse manager, supervisor, or clinical director.