Wk 9. Opiods & Analgesics

Question 1

1. Define opioid.

Answer 1

Any drug that has actions similar to those of morphine.

Question 2

2. Define opiate.

Answer 2

Applies only to compounds present in opium.

Question 3

3. Explain the WHO three-step analgesic ladder.

Answer 3

Start with a nonopioid. If no pain relief, give an opioid for mild-moderate pain. If severe pain, give an opioid for moderate-severe pain. May use nonopioids and adjuvants with opioids to provide more pain relief.

Question 4

4. An equianalgesic dose of a pain medication is equivalent to how much morphine IM?

Answer 4

10 mg morphine IM

Question 5

5. Which receptors are stimulated by opioid analgesics?

Answer 5

Mu and kappa

Question 6

6. Stimulation of which receptors can result in severe respiratory depression and physical dependence?

Answer 6

Mu receptors

Question 7

7. Morphine works best for what type of pain?

Answer 7

Constant, dull pain

Question 8

8. Morphine binds to receptors which are located where?

Answer 8

Brain and spinal cord

Question 9

9. What is the toxic metabolite of meperidine (Demerol)? What effects may it have?

Answer 9

Normeperidine. Agitation, irritability, tremors, seizures.

Question 10

10. Meperidine (Demerol) may interact with a variety of antidepressants because it increases what neurotransmitter?

Answer 10

Serotonin

Question 11

11. Most mixed agonists/antagonists are agonists at what receptor? Antagonists at what receptor?

Answer 11

Agonist – Kappa

Antagonist – Mu

Question 12

12. Administering a mixed agonist/antagonist with an opioid may lead to what?

Answer 12

Pain or withdrawal

Question 13

13. Name a commonly-used opioid antagonist.

Answer 13

Naloxone (Narcan)

Question 14

14. To which side effects of opioids do patients NOT develop a tolerance? What interventions are warranted?

Answer 14

Constipation, miosis (pinpoint pupils). Stress safe environment and nightlights, as well as the use of laxatives and stool softeners.

Question 15

15. Cross tolerance exists between morphine and what other drugs?

Answer 15

Other opioids

Question 16

16. Define physical dependence.

Answer 16

Physical dependence is an abstinence syndrome which will occur if the drug is stopped abruptly.

Question 17

17. Define addiction.

Answer 17

A behavioral pattern characterized by using a psychoactive substance despite physical, psychological, or social harm.

Question 18

18. What is a common cause of death from opioids? Opioids should be withheld if the respiratory rate drops to ___ or below.

Answer 18

Respiratory depression. 12.

Question 19

19. What 6 interventions can be used to prevent constipation with opioid use?

Answer 19

Exercise, fiber, fluid, stool softener, stimulant laxative, methylnaltrexone

Question 20

20. Sedation commonly occurs with opioid administration. What can be expected with prolonged administration?

Answer 20

Decreasing sedation

Question 21

21. Nausea and vomiting may be avoided with opioid use by what two interventions?

Answer 21

Pretreatment with an antiemetic, lying still

Question 22

22. What three interventions should a nurse teach a patient about the risk of orthostatic hypotension from opioids?

Answer 22

Lie down or sit if dizzy or lightheaded, change positions slowly, use ambulatory assistance

Question 23

23. Itching from opioids is mediated by what chemical?

Answer 23

Histamine

Question 24

24. How do opioids affect vision?

Answer 24

Causes miosis which impairs vision.

Question 25

25. How can opioids increase intracranial pressure (ICP)?

Answer 25

Opioids can decrease respirations which increase the amount of CO2 in the bloodstream. Elevated CO2 causes vasodilation which increases ICP.

Question 26

26. How do opioids affect the mother and fetus/neonate?

Answer 26

Opioids may suppress uterine contractions and cause respiratory depression of the neonate. The fetus may develop a physical dependence with prolonged use by the mother.

Question 27

27. Why is the administration of opioids done with precaution in inflammatory bowel disease?

Answer 27

Opioids can cause toxic mega colon or a paralytic ileus.

Question 28

28. What are the three symptoms in the classic triad of opioid toxicity?

Answer 28

Coma, respiratory depression, miosis (pinpoint pupils)

Question 29

29. What fraction of the total daily dose of opioids is usually given as a supplemental dose for breakthrough pain?

Answer 29

1/6 of the total daily dose

Question 30

30. Which route is preferred for the administration of opioids? How will the dose compare to an intravenous dose?

Answer 30

Oral, oral doses are higher