1 F ‘08 P. Andrews, Instructor. 2 We’ll talk about Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl Nubain Trexan Narcan 3.

1

ANALGESICS

F ‘08P. Andrews, Instructor

2

OPIATES & OPIATE BLOCKERS

3

We’ll talk about

Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl

Nubain Trexan Narcan

4

Buprenexbuprenorphine Class

Opioid analgesic (agonist – antagonist) Schedule V

Indications Management of moderate to severe pain

5

Action Binds to opiate receptors in CNS (30x

morphine and 3x narcan) Alters perception of and response to

pain Produces generalized CNS depression

6

Contraindications Hypersensitivity

Precautions Increased ICP

Adverse reactions, SE Nausea/Vomiting Dizzyness Headache Confusion Dysphoria Sedation Sweating

7

Route & dosage IV, 0.3 mg q 4-6 h prn

How supplied 0.3 mg/ml in 1 ml

preload

8

Stadol butorphanol tartrate

Class Opioid analgesic (agonist/antagonist)

Indications Management of moderate to severe pain Analgesic during labor

9

Action Binds to opiate receptors

in CNS Alters perception of

response to painful stimuli

Contraindications Hypersensitivity Opioid dependency

10

Precautions Head trauma Increased ICP

Adverse reactions, SE Confusion Dysphoria Hallucinations Sedation Sweating Use with extreme

precautions in patient on MAO Inhibitors

11

Route & dosage 1 mg q 3-4 h prn

How supplied 1 mg/ml or 2 mg/ml in 1 ml

preloads

12

Vicodin (Anexia)hydrocodone bitartrate w/ acetaminophen Class

Analgesic Contains 5 mg narcotic, 500 mg

acetaminophen Schedule III

Indications Analgesic for moderate to severe pain

13

Action Binds to opiate receptors Acetaminophen produces

peripheral and central mechanisms

14

Contraindications Hypersensitivity

Precautions Head injuries

Adverse reactions, SE Respiratory depression Sedation Dizziness Mental clouding Acetaminophen overdose may

result in potentially fatal hepatic necrosis

15

Route & dosage 1 – 2 tablets q 4-6 h

prn PO Total 24-hour dose

should not exceed 8 tablets

16

Demerol meperidine hydrochloride

Class Opioid analgesic Schedule II

Indications Moderate or severe pain

Action Binds to opiate receptors in CNS

17

Contraindications Hypersensitivity

Precautions Head injury Increased ICP

Adverse reactions, SE Seizures Confusion, sedation Hypotension Constipation N/V

18

Route & dose 50 – 100 mg slow IV, SQ,

IM How supplied

10 mg/ml in 5 ml preload, 20 mg/ml, or 50 mg/ml in

5 ml preload

19

MS ContinMorphine Sulfate

Class: Opioid analgesic Indications

Pulmonary edema Pain MI

Action Acts on opiate receptors to block sensation

of pain. Also causes peripheral vasodilation

20

Contraindications Head injury Depressed respiratory drive Hypotension

Precautions: have intubation equipment and naloxone ready

21

Adverse reactions, SE

Respiratory depression

Hypotension

Confusion

Sedation

Constipation

22

Dosage & Route

2-10 mg slow IVP q 3 - 5 min.

in 2 mg increments, titrated to

relief

How supplied

10 mg/ml in 1 ml tubex

23

fentanyl

Class Opioid analgesic Schedule II

Indications Analgesia

Action Binds to opiate receptors in CNS, altering

response to and perception of pain

24

Contraindications Hypersensitivity

Precautions Geriatrics Diabetes CNS tumors alcoholism

25

Adverse reactions, SE Apnea

Laryngospasm

Route & dosage 50-100 mcg (0.05 – 0.1 mg)

How supplied 0.05 mg/ml in one ml preload

or tubex

26

27

Nubainnalbuphine

Class Opioid analgesic (Agonist/antagonist)

Indication Moderate to severe pain

Action Binds to opiate receptors Alters perception of and response to

pain

28

Contraindications Hypersensitivity Opioid dependency

Precautions Head trauma Increased ICP

29

Adverse reactions, SE Dizziness Headache Sedation Dry mouth N/V Clammy feeling, sweating

30

Route & dosage 10 mg g 3-6 h (not to

exceed 20 mg) IV How supplied

10 mg/ml in 1 and 10 ml vials or

20 mg/ml in 1 and 10 ml vials

1 ml preloads

31

Trexannaltrexone

Class Opiate receptor agonist

Indications Alcoholics to decrease compulsive

consumption Detoxified addicts to stay opiate-free

32

Action Competes for opiate receptors

Contraindications None noted

Precautions None noted

Adverse reactions, SE Abdominal cramps, H/A Depression irritability

33

Route & dosage 25 mg tablets, PO; repeat

if no withdrawal sx in one hour

Alcohol dependence; 50 mg qd PO

34

Narcannaloxone

Class Opioid antagonist

Indication Reversal of CNS depression and

respiratory depression 2ndary to opiate overdose

35

Contraindications Hypersensitivity

Precautions Cardiovascular disease Pregnancy

Adverse reactions, SE None in emergent setting

36

Route & dosage

2 mg IV, SQ, IM, ET,

SL injection

Repeat prn

37

Nitronoxnitrous oxide

Class Analgesic

Indications Moderate to severe pain

Action Alters perception of pain Decreases hypoxia

38

Contraindications Do not administer for

abdominal pain Severe head injury

Precautions Must be self-administered N/V

39

Route & dosage Inhaled, blended mixture

of 50% nitrous oxide and 50% oxygen

Effects dissipate within 2-5 min. after cessation of administ.

Unit consists of oxygen & nitrous oxide cylinders, fed into blender; delivered to modified demand valve

40