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ANALGESICS

F ‘08P. Andrews, Instructor

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OPIATES & OPIATE BLOCKERS

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We’ll talk about

Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl

Nubain Trexan Narcan

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Buprenexbuprenorphine Class

Opioid analgesic (agonist – antagonist) Schedule V

Indications Management of moderate to severe pain

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Action Binds to opiate receptors in CNS (30x

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

pain Produces generalized CNS depression

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Contraindications Hypersensitivity

Precautions Increased ICP

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

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

How supplied 0.3 mg/ml in 1 ml

preload

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Stadol butorphanol tartrate

Class Opioid analgesic (agonist/antagonist)

Indications Management of moderate to severe pain Analgesic during labor

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Action Binds to opiate receptors

in CNS Alters perception of

response to painful stimuli

Contraindications Hypersensitivity Opioid dependency

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Precautions Head trauma Increased ICP

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

precautions in patient on MAO Inhibitors

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Route & dosage 1 mg q 3-4 h prn

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

preloads

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Vicodin (Anexia)hydrocodone bitartrate w/ acetaminophen Class

Analgesic Contains 5 mg narcotic, 500 mg

acetaminophen Schedule III

Indications Analgesic for moderate to severe pain

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Action Binds to opiate receptors Acetaminophen produces

peripheral and central mechanisms

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Contraindications Hypersensitivity

Precautions Head injuries

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

result in potentially fatal hepatic necrosis

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Route & dosage 1 – 2 tablets q 4-6 h

prn PO Total 24-hour dose

should not exceed 8 tablets

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Demerol meperidine hydrochloride

Class Opioid analgesic Schedule II

Indications Moderate or severe pain

Action Binds to opiate receptors in CNS

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Contraindications Hypersensitivity

Precautions Head injury Increased ICP

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

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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

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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

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Contraindications Head injury Depressed respiratory drive Hypotension

Precautions: have intubation equipment and naloxone ready

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Adverse reactions, SE

Respiratory depression

Hypotension

Confusion

Sedation

Constipation

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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

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fentanyl

Class Opioid analgesic Schedule II

Indications Analgesia

Action Binds to opiate receptors in CNS, altering

response to and perception of pain

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Contraindications Hypersensitivity

Precautions Geriatrics Diabetes CNS tumors alcoholism

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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

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Nubainnalbuphine

Class Opioid analgesic (Agonist/antagonist)

Indication Moderate to severe pain

Action Binds to opiate receptors Alters perception of and response to

pain

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Contraindications Hypersensitivity Opioid dependency

Precautions Head trauma Increased ICP

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

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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

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Trexannaltrexone

Class Opiate receptor agonist

Indications Alcoholics to decrease compulsive

consumption Detoxified addicts to stay opiate-free

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Action Competes for opiate receptors

Contraindications None noted

Precautions None noted

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

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Route & dosage 25 mg tablets, PO; repeat

if no withdrawal sx in one hour

Alcohol dependence; 50 mg qd PO

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Narcannaloxone

Class Opioid antagonist

Indication Reversal of CNS depression and

respiratory depression 2ndary to opiate overdose

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Contraindications Hypersensitivity

Precautions Cardiovascular disease Pregnancy

Adverse reactions, SE None in emergent setting

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Route & dosage

2 mg IV, SQ, IM, ET,

SL injection

Repeat prn

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Nitronoxnitrous oxide

Class Analgesic

Indications Moderate to severe pain

Action Alters perception of pain Decreases hypoxia

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Contraindications Do not administer for

abdominal pain Severe head injury

Precautions Must be self-administered N/V

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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

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