Opioid Analgesics

1
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

2
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.

3
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)

4
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)

5
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.

6
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

7
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

8
Opioid Analgesics Dosing

• Precautions in dosing are needed if patient
  is/has
• Debilitated
• Under 18 years of age
• Elderly
• Renal or hepatic disease
• Opioid naïve (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

9
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.

10
Opioid Analgesics Nursing Considerations

• Assess
• Need for pain medication use pain scale
• IO 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
11
Opioid Analgesics Nursing Considerations

• Administer
• With antiemetic if nausea or vomiting occurs
• When pain is beginning to return, determine
  dosage by response
• Perform/provide
• Assistance with ambulation patient should not be
  ambulating during drug peak
• Evaluate
• Therapeutic response, including decrease in pain
• Follow guidelines in pain management policy
  710-37
• Review this policy on PAH intranet under manuals
  and referencessee nursing policies

Taken from 2006 Mosbys Nursing Drug Reference
12
Opioid Analgesics Nursing Considerations

• Preventing and Managing Opioid-Induced Side
  Effects
• Respiratory Depression
• 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
13
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
14
Opioid Analgesics Documentation

• Your documentation should support the following
  PAH policies, which can be reviewed via the
  Passavant Intranet under Manual/ResourcesNursing
  Policies.
• 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
• Please review the following procedures located on
  the Passavant Intranet under Manual
  /ResourcesNursing Procedures
• Patient Controlled Anaglesia (PCA Pump)
• PCA Flow Sheet (Guidelines for)

15
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.

16

• 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.