Narcotic Analgesic Medications Narcotic Analgesics

Narcotic AnalgesicMedications

Narcotic Analgesics

Opioids

Actions–Analgesia

– Euphoria

– Sedation

Opioids

Primary Use–Moderate Pain

– Severe Pain

–Acute Pain

–Chronic Pain

– Breakthrough Pain

Opioids

Other Uses

– Pre-Op Sedation

–Adjunct Anesthesia

–Anti Anxiety

–Diarrhea

–Opiate Dependence

Opioids

Common Opioids

– Morphine sulfate– Codeine– meperidine HCl (Demerol)– hydromorphone (Dilaudid)– fentanyl (Duragesic)– oxycodone (OxyContin)

Opioids

Common Routes

– IV– IM– Subcutaneous– Oral– Transdermal– Epidural

Opioids

Adverse Reactions

Euphoria, dysphoria, confusion, sedation

Nausea, vomiting, constipation

Hypotension, bradycardia or tachycardia

Urinary hesitancy, dysuria

Respiratory depression, cough depression

Allergic reactions, pruritis Pain, irritation at injection site

Opioids

Contraindications

Opiate allergies

Head injuries, increased intracranial pressure

Convulsions

Ulcerative colitis

Pulmonary diseases (asthma, COPD)

Renal or hepatic dysfunction

Opioids

Not recommended during labor

Use caution with elderly

Not recommended for biliary surgery

Not recommended during lactation

Precautions

Opioids

Opioid Naive

Tolerance Addiction

Precautions

Opioids

Precautions

Opioids and Acetaminophen

Daily acetaminophen intake should NOT EXCEED 4 grams

Opioids

Interactions

CNS Depressants

Use caution whenever two or more CNS depressants given

Opioids

Special Circumstances

Opiates of Choice

CodeinePersistent Cough

MorphineMyocardial Infarct

MeperidineBiliary Surgery

Opioids

Opiate Poisoning

miosis

Respirations < 10 / min

hypoxia

Opioids

Opiate Antagonist

Opioids

Patient Controlled Analgesia (PCA)

Opioids

Epidural

Opioids

Transdermal

Narcotic AnalgesicsNursing Process

• Assessment

– Pain assessment– Precipitating factors– Nonpharmacological medications– Time last medicated– Response to last pain medication– Allergies– Bowel history


• Planning

– Adverse reactions– Expected pain relief– Route of administration


• Suggested Nursing Diagnoses

– Pain, acute– Pain, chronic– Constipation r/t adverse drug effects


• Implementation

– Identify patient– Observe 6 Rights


• Evaluation

– Response to medication– Evidence of adverse reactions– Evidence of tolerance, addiction

Narcotic AnalgesicsKey Points

• Side Effects– Lethargy, Confusion– Constipation

• Adverse Reactions– Respiratory Depression (Opiate Naïve)– Opiate Poisoning

• Combination Drugs– Be mindful of acetaminophen toxicity


• Addiction– Not likely to happen when purpose of drug is to

relieve pain

• Tolerance– Likely to occur, especially with morphine

• PCA’s– PCA’s are PATIENT controlled, not nurse

controlled


• Opioids are drugs of choice for SOME pains

• Not ALL pain should be managed with Opioids

• Review: Thumbs Up? Thumbs Down?


• Pain associated with Myocardial Infarction– Morphine is the drug of choice


• Pain associated with Ulcerative Colitis– Opioids should be avoided


• Pain associated with Gall Bladder surgery– Avoid morphine– Meperidine is drug of choice


• Pain associated with Labor– May prolong labor– May cause respiratory depression in the

newborn


• Pain associated head injury– Opioids may increase intracranial pressure

(ICP)


• Pain in patients with COPD– Opioids cause respiratory depression


• Pain in patients with seizure disorders– Opioids may precipitate seizures

Anesthestic Medications

Anesthetic Medications

• Topical

– Application to body surface– Cream, lotion, spray, gel, etc.– May be given prior to an

injection


• Local Infiltration

– Injection of anesthetic into tissue– Example: Novacaine


• Regional Anesthesia

– Spinal

Subarachnoid space

– Conduction

Near a nerve


• Regional Anesthesia - Spinal

– Injected into subarachnoid space of spinal cord– Most commonly 2nd lumbar vertebra– Loss of feeling and movement• Lower abdomen

• Perineum

• Lower extremities


• Regional Anesthesia – Conduction Blocks

– Epidural block– Caudal block

– Brachial plexus block


• Preparing the patient for local or regional anesthetics– Positioning– Teaching– Emotional Support


• Providing care after local or regional anesthesia– Safety r/t lack of sensation– Loss of body functions– Hemorrhage– Infection


• Preanesthesia Medications

– Opioids to decrease anxiety / apprehension• Fentanyl (Sublimaze)

• Meperidine (Demerol)

• Morphine



– Barbiturates to decrease anxiety / apprehension• Pentobarbital (Nembutal)

• Secobarbital (Seconal)



– Benzodiazepines to decrease anxiety / apprehension• Chlordiazepoxide (Librium)

• Diazepam (Valium)

• Midazolam (Versed)

• Lorazepam (Ativan)


• Antiemetic Medications

– Decrease nausea / vomiting and side effect of drowsiness / antianxiety• Hydroxizine (Vistaril)

• Promethazine (Phenergan)


• Antiemetic Medications

– Cholinergic blocking agents to decrease respiratory secretions and mucous production• Atropine sulfate

• Robinul

• Scopolamine


• General Anesthesia

– Cause loss of consciousness– Except for very short procedures, patient must

be intubated– Profound analgesia


• Types of General Anesthesia

– Barbiturates• Methotrexital (Brevital)

• Propofol (Diprivan)



– Benzodiazepines• Midazolam (Versed)



– Ketamine (Ketalar)

• Street Drug

Special K



– Gases and Volatile Liquids• Nitrous oxide



– Opioids• Fentanyl (Sublimaze)

• Given as adjunct to other medications to produce reduced motor activity and profound analgesia



– Skeletal Muscle Relaxants• Deep abdominal or chest surgery

• Facilitate endotracheal insertion

• Succinylcholine (Anectine)


• 4 Stages of Anesthesia

– Stage 1 – Analgesia– Medication given to induce anesthesia– Lasts 5 – 10 seconds



– Stage 2 – Delerium– Delerium– Keep room quiet



– Stage 3 – Surgical Analgesia– Deep coma– Surgery takes place



– Stage 4 – Respiratory Paralysis– ABNORMAL – Severe Complication– Respiratory and Cardiac Arrest


• Nursing Responsibilities

– Preanesthesia• Check Allergies

• Administer Pre-op medications observing 5 rights

• Provide safety after medications given



– Post Anesthesia: PACU• Check airway for patency

• Observe for hypoxia, especially if nitrous oxide administered

• Position patient to prevent aspiration

• Check patient every 5 – 10 minutes, suctioning as needed



– Post Anesthesia: PACU (cont.)• Exercise caution in administering opioids

• Record all medications given



– Post Anesthesia: Post-op• Continue to exercise caution with opioid medications

• Refrain from barbiturates and benzodiazepines during first 24 hours

• Administer supplemental oxygen as needed

Anesthesia MedicationsKey Points

• Anesthesia can be– Local– Regional– General


• Many different kinds of medications can induce anesthesia– Barbiturates (Nembutal, Seconal)– Benzodiazepines (Versed)– Ketamine– Nitrous oxide– Opioids (Inapsine)– Skeletal muscle relaxants (Anectine)


• Many different kinds of medications can induce anesthesia– Barbiturates (Nembutal, Seconal)– Benzodiazepines (Versed)– Ketamine– Nitrous oxide– Opioids (Inapsine)– Skeletal muscle relaxants (Anectine)


• Nursing Responsibilities are dependent upon type of anesthesia given, but always focus on– Airway (respiratory depression, aspiration)– Safety (confusion, lethargy)– Comfort (without reentering anesthesia state)

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Narcotic Analgesic Medications Narcotic Analgesics