Opioid Analgesics (Narcotics)

Mechanism of Action

• Binds to opioid pain receptors in the brain.
• Causes analgesic response.
• Response is receptor-specific, depending on the narcotic used.

Therapeutic Effects

• Decreases pain.
• Has antitussive effects (suppresses cough).

Indications

• Moderate to severe pain.
• Cough suppression.
• Adjunct to anesthesia (supplementary to primary anesthesia).

Precautions and Contraindications

• Sedation and Hypotension: Be aware of these effects.
• Respiratory Insufficiency: Can cause respiratory depression; monitor respiratory rate closely.
• Slow GI Motility: Leads to constipation, often seen in elderly patients.

Side Effects

• Sedation and Hypotension.
• Respiratory depression (critical to monitor).
• Nausea and vomiting (GI upset).
• Constipation (due to decreased GI motility).

Nursing Actions

• Assess therapeutic and side effects regularly.
• Patients at risk for injury due to mood, behavior, and mentation changes.
  • Use safety measures: raise side rails, ensure call light is within reach.
  • Instruct patients not to get out of bed without assistance.
• Monitor drug amounts and potential side effects, especially with combination drugs.
• Use of opioid antagonist (Naloxone/Narcan) in case of overdose.

Examples of Drugs in this Class

• Codeine, Mepyridine, Hydromorphone
• Fentanyl
  • Trade names vary based on route:
    • Actiq: Transmucosal route (fentanyl lollipop).
    • Duragesic: Topical patch, often changed every 24-48 hours.
    • Sublimaze: IV route.
• Tramadol (Ultram): Synthetic, centrally acting analgesic now classified as opioid.
• Morphine
  • Various administration routes: IV, IM, SubQ, epidural, oral solution.
  • MS Contin: Time-release tablets.
  • MSIR: Immediate release tablets.
  • RMS: Rectal morphine sulfate (suppository).
• Norco: Combination of Hydrocodone (opioid) and Acetaminophen.
• Oxycodone
  • Trade names: Oxycontin, Percocet, Perkadan.
  • Percocet: Combination of Oxycodone and Acetaminophen, with varying dosages.