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7586 Week 2/3 Extra Notes from Handout (Dunn)

Terms in this set (18)

a onetime dose used to quickly achieve pain control
loading dose (bolus)
this is the amount of opioid that is constantly being infused (mg or
mcg/hr)
continuous infusion (basal rate)
a dose that the patient can self-administer when needed
PCA (demand dose)
determines how often the patient can receive a PCA dose and is the period during which the patient cannot obtain additional medication (usually in minutes)
delay or lockout period
an additional amount of medication the nurse can administer if needed
nursing bolus
the total amount of opioid a patient can receive in 1 hour
hourly limit
management of opioid-related constipation
- be proactive
- anyone on an opioid should have a bowel regimen which includes a stimulant laxative and stool softener (unless they are having overt diarrhea)
- no tolerance develops to constipation
management of opioid-related sedation
- assess over-sedation versus pain relief
- monitor BP, respirations, ability to arouse, etc.
- may consider methylphenidate
management of opioid-related respiratory depression
- monitor!!
- naloxone
naloxone dosing
0.4-2 mg IV

- half-life is very short and will need repeated doses/continuous infusion
- large doses can precipitate opioid withdrawal
- when reversing opiate side effects in patients needing analgesia, dilute and titrate (0.1-0.2 mg q2-3 minutes)
management of opioid-related nausea/vomiting
- not an allergic reaction
- should get better with repeated dosing
- may give anti-emetics
management of opioid-related intoxication
- s/sx: euphoria, dysphoria, apathy, lethargy, somnolence, etc.
- tramadol = seizures
- methadone = QT prolongation
- may require naloxone
management of opioid-related itching
- not an allergic reaction
- can pre-medicate with antihistamines
management of opioid-related intolerance vs. allergy
Intolerance:
- related to histamine release
- most commonly due to codeine, morphine, and meperidine
- switch to non-opioid; treat with antihistamines or reduce dose

Allergy:
- severe hypotension, rash, difficulty breathing, etc.
- use a non-opioid or an opioid in a different chemical class
morphine-like agonists
- morphine
- hydromorphone
- oxymorphone
- codeine
- hydrocodone
- oxycodone
- levorphanol
meperidine-like agonists
- meperidine
- fentanyl
methadone-like agonist
- methadone
centrally-acting analgesics
- tramadol
- tapentadol
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