Mu vs Kappa
Which has less sedation, respiratory depression, constipation, and no abuse potential?
Kappa
which three drugs that we are studying are pure opioid agonists (agonize both Mu and Kappa)
morphine, codeine, fentanyl
What is the opioid antagonist we are studying?
naloxone
Which is the kappa agonist/mu antagonist we are studying?
butorphanol
When giving an opioid, what is the main vital sign needing to be monitored closely?
respiratory rate/O2 stat
analgesia, antipyretic, vasodilation
pain relief
sedation
decreased bowel motility
cough suppression (specifically codeine)
how can you give naloxone?
IV, IM, SubQ
Which is the mu agonist/kappa antagonist we are studying?
buprenorphine
What is the toxicity triad for pure opioids?
pinpoint pupils
respiratory depression
sedation
Augmenting Mu receptors results in...
analgesia, sedation, respiratory depression, decreased motility of GI tract, physical dependence, decreased sympathetic tone (hypotension, bradycardia)
Why might a patient receiving morphine need a catheter?
treat urinary retention
or
are too sedated to get up to use the bathroom
What is the MoA for naloxone and what is the intended action?
blocks Mu and Kappa
reverses effects of opioids by competing for opioid receptors
What is butorphanol and buprenorphine used for?
butorphanol - manage mild/moderate pain; labor pain
buprenorphine - treat opioid dependence
How should you push IV opioids?
slowly over 4-5 minutes
Which does morphine, codeine, and fentanyl agonize?
both Mu and Kappa
What are some adverse effects of pure opioid agonists?
constipation
orthostatic hypotension
urinary retention
biliary colic
N/V
what are some adverse effects to naloxone?
constipation
tachycardia/tachypnea
abstinence syndrome
what are some expected actions for agonist/antagonist opioids?
less or no euphoria
high doses may cause dysphoria
decreased bowel motility
cough suppression
your patient just had their gallbladder removed. would you question an order for morphine?
yes - don't use pure opioids after biliary surgery
What is the main monitoring point when giving mu or kappa agonists?
respiratory depression
What is considered the toxicity triad for opioid agonists?
pinpoint pupils
respiratory depression
sedation
Why does one need to be closely monitored in the hours after given naloxone?
Naloxone has a relatively short half-life
opioid effects may return and you may need to give another dose (monitor respiratory state)
what are adverse effects for agonist/antagonist opioids?
orthostatic hypotension
abstinence syndrome
sedation/respiratory depression (hold if less than 12) (have naloxone available)
True or False: patients on opioids need to be put on fall risk
true