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Codeine

Codeine
Classification: Narcotic (opiate agonist) analgesic, antitussive
Dosages:
Tablet-15, 30, 60 mg
Oral-15 mg/5 mL
Injectable- 30 & 60 mg
Uses:
1) Symptomatic relief of mild to moderately severe pain
2) To suppress hyperactive or nonproductive cough
Contraindications:
1) Hypersensitivity to codeine or other morphine derivatives
2) Acute asthma, COPD, increased intracranial pressure, head injury, acute asthma
Nursing Implications:
record relief of pain, evaluate effectiveness when used as a cough suppressant, supervise ambulation, monitor for nausea, report nausea accompanied by vomiting avoid driving and avoid alcohol

Fentanyl

Fentanyl; Actiq Oralet, Duragesic, Fentora, Ionsys, Onsolis, Sublimaze
Classification: Analgesic; Narcotic (opiate agonist)
Dosages:
Tablet-100,200,300,400, 600,800 mcg
Lozenge- 100.200.300.400 mcg
Lozenge (stick)-200,400,600,800,1200,1600 mcg
Injectables-0.05 mg/mL
Patch- 12,25,50,75,100 mcg/h
Buccal Film-0.2,0.4,0.6,0.8,1.2 mg
Uses: Short acting analgesic during operative and perioperative periods, used in open heart surgery
Contraindications: Pt who have received MAO inhibitors, substance abuse, myasthenia gravis, L&D, pregnancy
Nursing Implications:
Monitor vital signs,observe for skelatal and thoracic muscle rigidity and weakness. Respiratory depression

Hydromorphone

Dilaudid
Classification: Narcotic, analgesic, antitussive
Dosages:
Tablet-2,4,6,8 mg
Oral Solution- 5mg/5mL
Injectables- 1 mg/mL 10 mg/mL
Uses- relief of moderate to severe pain and control of persistent nonproductive cough
Contraindications: Intolerance to opiate agonist, acute bronchial asthma, COPD, upper airway obstruction, severe respiratory depressions, pregnancy
Nursing Implications: Note baseline RR, rate, depth, rhythm, size of pupils. 12 RR/min or less sign of toxicity. withhold drug contact AP. Monitor VS at regular intervals, assess effectiveness 30 mins after dose. Monitor bowel habits as may cause constipation.

Hydrocodone

Hycodane, Robidone A, Vicodin (with acetaminophen)
Classification: Narcotic (opiate agonist) analgesic, antitussive
Dosages:
Tablets- 5mg with 500 mg or more acetaminophen
Use: relief of hyperactive or nonproductive cough and relief of mild to moderate pain
Contraindications: hypersensitivity to hydrocodone, acute or severe asthmatic bronchitis, COPD, children < 2
Nursing Implications: monitor for effectiveness, nausea, vomiting, respiratory status and bowel elimination. No driving, drink adequate fluids, no alcohol.

Levorphanol

Levo-Dromoran
Classification:Analgesic, Narcotic (opiate Agonist)
Dosages:
Tablet- 2 mg
Injectables- 2 mg/mL
Uses: relieve moderate to severe pain and preoperatively to allay apprehension
Contraindications: Hypersensitivity to levorphanol, L&D, pregnancy, lactation
Nursing Implications: assess pain, monitor bowel function, ambulation, no driving, alcohol, increase fluid and fiber uptake

Meperidine

Demerol
Classification: Analgesic, Narcotic (Opiate Agonist)
Dosages:
Tablet: 50 & 100 mg
Syrup: 50mg/5mL
Injectable: 10,25,50,75,100 mg/mL
Actions: Relief of moderate to severe pain, preoperative medication of support of anesthesia, and for obstetric analgesia.
Contraindications: hypersensitivity to meperidine, convulsive disorders, abdominal conditions prior to dx, MAOI therapy, pregnancy
Nursing Implications: give in the smallest effective dose, note RR, depth, and rhythm and size of pupils. If RR is 12/min or below and pupils are constricted or dilated or breathing is shallow consult a physician. Monitor vital signs closely, may cause severe hypotension in postoperative pts. Exercise caution with ambulation, be aware of nausea, vomiting, dizziness. Do not drive or take other CNS depressants.

Methadone

Dolophine, Methadose
Classification: Narcotic, Analgesic (Opiate Agonist)
Dosages:
Tablet: 5,10,40 mg
Oral: 1,2,10 mg/mL
Injectables: 10mg/mL
Uses: To relieve sever pain, for detox,
Contraindications: Severe pulmonary disease, COPD, lactation.
Nursing Implications: Monitor weight, be alert for paradoxical increase in depression/agitation.

Morphine

Avinza, Depodur, Embeda
Classification: Analgesic, Narcotic (Opiate agonist)
Dosages:
Tablet: 10, 15, 30, mg
Controlled release tablets: 10,15,20,30,50,60,90,100,120,200, mg
Oral: 10mg/2.5mL, 10mg/ 5mL, 20mg/mL, 20 mg/5mL, 30mg/1.5mL,100mg/5mL
Injectables: 0.5,1,2,4,5,8,10,15,25,50 mg/mL
XR lysosomal injection: 10mg/mL
Suppositories: 5,10,20,30 mg
Actions: relief of severe acute and chronic pain after non analgesics have failed. Relieve dyspnea of acute left ventricular failure and pulmonary edema and pain of MI
Contraindications: hypersensitivity to opiate agonists, increased intracranial pressure, convulsive disorders, acute bronchial asthma, respiratory depression, hypovolemia,
Nursing Implications: obtain baseline RR, depth, rhythm, and size of pupils before admin of drug. RR of 12/min or lower and miosis are signs of toxicity. Withhold drug and call physician. Continue monitoring respiratory depression for 24 hours. Assess vitals at regular intervals.

Oxycodone

Oxycontin, Percolone, Endocodone, OxyFAST, Roxicodone
Classification: Narcotic, Analgesic (Opiate agonist)
Dosages:
Tablets: 5,15,30 mg
Tablets (OxyContin): 10,20,40,80,160 sustained release tablets
Oral: 5mg/mL 20mg/mL
Actions: relief of moderate to severe pain
Contraindications: Hypersensitivity to oxycodone and principal drugs with which it is combined, bronchial asthma, pregnancy, lactation, and children under six.
Nursing Implications: monitor pts response closely, check hepatic function and hematologic status periodically with pts on a high dose. No driving, no drinking.

Oxymorphone

Numorphan, Opana, Opana ER
Classification: Narcotic, Analgesic ( Opiate agonist)
Doses:
Tablets: 10 mg
XR tablets: 10 mg
Injectables: 1, 1.5 mg/mL
Suppositories: 5 mg
Actions: relief of moderate to severe pain, preoperative medication, obstetric analgesia, support of anesthesia and relief of anxiety in pts with dyspnea associated with acute ventricular failure and pulmonary edema.
Contraindications: Alcoholics, biliary tract disease, bladder obstruction, severe pulmonary disease, respiratory insufficiency, COPD, depression, older adults, pregnancy.
Nursing Implications: Monitor RR, withhold if 12 rr/min or less. Supervise ambulation

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