• Are different types of opiate receptors in CNS. 
• The Mu and Kappa receptors produce analgesic, sedative and euphoric effects. 
• Delta receptors produce ….
• Analgesia is produced by changing PERCEPTION of pain
• There is no modification of tissue at source of pain

1. CNS– euphoria, sedation, insomnia, agitation, increased intracranial pressure, impairment
2. Respiratory depressions of rate and depth
3. GI – naus/vom, dry mouth, biliary tract spasms; constipation, anorexia
4. CV – facial flushin, tachy/bradycardia, palpitations
5. Genitourinary – urinary retention, hesitancy; spasms of ureters and bladder sphincter
6. Allergic and other – rash, urticaria, sweating

1. Acute asthma, emphysema, airway obstructions, head injury or increased intracranial pressure
2. Convulsive disorders
3. Aucse ulcerative colitis
4. Severe renal/hepatic dysfunction
5. Oxycodone preg cat b and rest are cat c (only if benefits outweigh risks)

1. increases risk ofCNSdepression: alcohol, antihistamines, antidepressants, sedatives, phenothiazines
2. barbiturates – resp depressions, hypotension and sedation

1. Very important to provide a thorough and aggressive bowel program to patients when taking opioids
2. Respiratory depression less common in those who take opioids regularly

                                                               i.      If develops, coach pt to breath; use naloxone only if necessary b/c all pain will come back

3. Encourage deep breathing expercises and intentionally coughing
4. Assist pt at risk for injury with ambulationa and standing up
5. Begin stool softener or laxative for constipation; keep track of BMs; may need enema
6. For imbalanced nutrition (anorexia) assess food intake and weigh and notifyPCP
7. Education pt and family

1.  
1. Preadmin

                                                               i.      Pain assessment

                                                             ii.      Drug hx, allergy hx, past reactions to opioids or if never taken (greater risk of resp depressions)

2. Postadmin

                                                               i.      Take vitals after admin – when depends on route of admin

                                                             ii.      Cathectic persons (generally low health/malnourished), elderly and/or debilitated may require lower dose and/or have greater response

                                                            iii.      PCP if no response

                                                           iv.      NotifyPCP if resp rate less than 10, pulse changes significantly, bp drops

                                                             v.      Monitor for nausea and vomiting

                                                           vi.      If used as antidiarrheal, monitor BM and report if ineffective

                                                          vii.      Miosis (timy pupils) can diminish vision in dim light, could be a risk

                                                        viii.      Constipation common, from opioids as well as limited mobility

• In elderly and in pts who are “opiod naïve” or have not used before, therefore greater risk of resp depression. 
• Wait 4-6 hours after taking if lactating

hydromorphone

oxymorphone

oxycodone

heroin