NARCOTICS (OPIATES)
INTRODUCTION
Pain is an unpleasant sensation disturbing patient’s comfort, thought sleep or normal daily activity and is symptomatic of an underlying disease process
Fifth Vital Sign
Precipitating factor, quality, radiating, severity, and time of pain
Endorphans
MECHANISM OF ACTION
ENDORPHAN RECEPTOR
- BLOCKS PERCEPTION OF PAIN
THERAPEUTIC USES
ANALGESIA
- ANTITUSSIVE - blocks cough reflex
PHARMACOLOGY - CNS
ANALGESIA WITHOUT LOSS OF CONSCIOUSNESS
DROWSINESS - sleepiness
BEHAVIORAL CHANGES - euphoria and dysphoria
DEPRESS COUGH REFLEX
NAUSEANT AND EMETIC
PHARMACOLOGY CNS
TOXIC EFFECTS
respiratory depression
miosis (pupil constriction)
HEAD INJURY
decreases respiratory drive
PHARMACOLOGY CARDIOVASCULAR
ORTHOSTATIC HYPOTENSION
intravenous administration decreased cardiac workload during myocardial infarction
PHARMACOLOGY GASTROINTESTINAL
DECREASES PERISTALSIS - stomach and intestines
- INCREASES BILIARY PRESSURE
PHARMACOLOGY MISCELLANEOUS
UTERUS - prolongs labor
NARCOTIC ANALGESICS
MORPHINE - intermediate action, but can be given sustained release. Decreases cardiac work load
MEPERIDINE - short acting
FENTANYL - extremely potent
NARCOTIC ANTAGONIST
BLOCKS OPIATE RECEPTOR
reverses opiate toxic effects
DISPLACES OPIATES ON RECEPTORS
SHORT ACTING
PRECIPITATES WITHDRAWAL
NARCOTIC AGONIST/ANTAGONIST
STIMULATES OR BLOCKS RECEPTORS
NOT EFFECTIVE IN SEVERE PAIN
ADVANTAGES
decreases abuse potential
decreases addictive potential
ANTIDIARRHEAL
EFFECTIVE IN NON-INFECTIOUS DIARRHEA
DECREASES GI MOTILITY TO DECREASE DIARRHEA - but will retain toxins and bacteria
ANTITUSSIVE
DECREASES COUGH REFLEX
DECREASES STERNAL PAIN TO ENCOURAGE DEEP BREATHING
PAIN CONTROL CONCEPTS
PATIENT CONTROLLED ANALGESIA
leads to less use
CHRONIC TERMINAL PAIN
addiction is not a concern
POST-OPERATIVE USE
not adequately utilized to promote healing