opioid analgesics or narcotics right narcotic analgesics this is also in chapter 10. mechanism of action binds to pain receptors binds to opioid pain receptors in the brain and so what we'll get here is this will cause an analgesic response agents receptor specific so it just depends on which narcotic we're giving so that particular agent is very receptor specific as to how that works therapeutic effects we want to decrease pain and then any narcotic basically every narcotic has an anti-test of effect where it will decrease cough okay it can suppress cough so that's why you'll see some oral uh antitussive medications given to a patient that has a narcotic component to it that is why because it all narcotics have an anti-testive effect so for indications we have moderate to severe pain again you see cough suppression there adjunct to anesthesia so remember an adjunct is a thing that's basically added to something else as supplementary rather than an essential part of it right so it's an adjunct to anesthesia so the main component would be the anesthesia but then the provider may add a narcotic to that to help with pain precautions and contraindications uh so really important to remember these sedation and hypotension is definitely something that you want to be aware of um the big one in here too is respiratory insufficiency so narcotics can cause respiratory depression so you really want to make sure as a nurse that you are assessing the respiratory rate with any narcotic given and then slow gi motility that's another big one you're gonna see this uh oh probably pretty often now you think about our elderly population right they are on a multiple amounts of medications and then typically you're gonna see some type of analgesic whether it be a non-opioid or an opioid but especially with opioids you're going to see them complain pretty often about constipation because it slows gi motility so for side effects we have sedation and hypotension there again respiratory depression again very big to remember nausea and vomiting narcotics can cause gi upset so that's that's possible that your patient can become nauseous or start vomiting and then big again to remember is constipation because it does decrease that gi motility so for nursing actions we want to make sure that we're assessing the therapeutic and side effects they are at risk for injury remember this is a narcotic it's an opioid right and this does affect their mood and behavior and it can affect their mentation so you really want to closely watch your patients when you're giving an opioid not only for the possible respiratory depression that can occur not only for the decreased vital signs like the hypotension but also because of their mentation that can change so you want to make sure you put the side rails of the bed up you put the call light in reach and that you are assessing them and saying hey do not get out of bed unless you put the call light on and i will come assist you okay because it can make them a little bit confused lightheaded and dizzy everyone reacts a little bit differently to it some more than others but you want to make sure that you are keeping your patients safe at all times assess drug amounts side effects with use of combination drugs so remember we um for the non-opioid your prototype was acetaminophen right and then you could see in there um how acetaminophen could be in a combination drug with an opioid and opioid is what we're talking about now so you want to just make sure that we're looking at um if especially if they're on several other types of medications that there's not any possible side effects that could happen with those may need to treat side effects or provide an antidote an opioid antagonist that we would give if a patient overdosed on an opioid is naloxone that is your prototype that you need to remember for testing purposes narcan is the trade name naloxone is a reversal agent and we just want to make sure that we're super closely assessing our patients respiratory rate again but this is what you will see them pull out if the patient has an opioid overdose this is your reversal agent to remember all right so for the examples of drugs in class um your prototypes here you have starred is codeine mepyridine and hydromorphone uh letter e fentanyl fentanyl is the generic name but it can be given in varied routes okay so underneath there one two and three you see actiq duragesic and sublimaze these are actually trade names i know they're starred for you to remember but the reason why is the trade name is specific to the route okay so if the patient was getting actique that is the trade name for fentanyl but that is specific for the transmucosal route so that is actually literally a fentanyl lollipop it's a lollipop the patient just sucks on it and they're able to receive the fentanyl dosage through the lollipop okay but actiq is the trade name for that specific route duragesic is a topical patch and so quite often you might see patients on a topical topical patch that is maybe a delayed release and they change it out every 24 to 48 hours depending on how it's ordered um i had a patient quite a few years ago who had their duragesic patch on and then they were laying on a heating pad so it completely changed the rate of absorption for that drug so she came in with a slew of crazy side effects that i've never seen before but it just had to do with the fact that she was laying on my heating pad with that georgesic patch on and again it changed the the rate of absorption for her so another big thing to remember for these patches and any patch for any medication that you give is before you put a new patch on you want to make sure you kind of investigate the body and see if there's not any other patches on their body you want to remove those wipe the skin and then place the new patch okay so that way they're not walking around with 10 patches on their body that no one realized they had on and they're getting um multiple doses of their medication and then sublimate sublimazes the iv route of fentanyl all right so uh tramadol or or ultram that you see there that's not a starred prototype that you have to remember but this used to be listed on the outline for non-opioid analgesics in your textbook it may still be listed as a non-opioid analgesic but this is a synthetic centrally acting analgesic and the fda updated its classification to an opioid so if it is still listed as a non-opioid in the text it just has not been updated yet so remember this is actually considered an opioid medication if you were to see this in the clinical setting or if you see your patient is prescribed this medication all right and then we have uh morphine here morphine um can be given several different ways okay it can be given parenteral which would be the iv im or subq routes ms content is those are time release tablets the patient can take and then you see duramorph and astromorph so this can be given either the epidural or intrathecal injection route that would be you know be given via the spinal canal it's going to reach that csf fluid and it's super useful in spinal anesthesia and then msir these are immediate release tablets so msir stands for morphine sulfate immediate release okay rms that's a suppository rms stands for rectal morphine sulfate and then oral solution you might typically see a liquid form of morphine that is an oral solution that can be given sublingual so under the tongue and this is super typical for hospice patients so they may have an order for a couple drops underneath the tongue every so often for pain and we have norco we mentioned this before with the non-opioid analgesics just so you could see the combination of an opioid and non-opioid so norco is combination drug of hydrocodone that's the opiate component and acetaminophen and typically you'll see this dose just 5 325 so that's 5 milligrams of hydrocodone and 325 gram milligrams sorry of acetaminophen within that combination pill that medication vicodin hydrocodone acetaminophen you see that listed again norco is the same thing as vicodin the difference is is that in norco the acetaminophen dosage is smaller in vicodin this used to be dosed as 5 500 so this would be 5 milligrams of hydrocodone and 500 milligrams of acetaminophen but because of the liver impairment issues that they were seeing with acetaminophen they have reduced the amount to 325 and now it has the name norco i will tell you i know this is start as a prototype but you really won't see this as much anymore vicodin has been taken out of a lot of the hospitals and facilities because of the high dosage of acetaminophen and we're kind of cutting back on that because of the risk for liver issues so you'll more typically see norco and then we have oxycodone that's the generic name and then if you look here there is oxycontin percocet and perkadan percocet is the uh that's the trade name of the generic you would need to know so you would need to know it as oxycodone acetaminophen okay but you'll see it commonly referred to as the trade name which is percocet so oxycodone acetaminophen this can either be dosed in 5 325s or 10 325s so we have the oxycodone component to either be 5 or 10 milligrams and the acetaminophen component to be 325 milligrams