Opioids / Narcotics Mechanism of Action Opioids bind to specific opiate receptors where they act as agonists in the CNS

to produce analgesia, euphoria, and sedation which results to alteration to the perception of and response to pain. Adverse Effects CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness,, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflexes. CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope. Dermatologic: Pruritis, urticaria, laryngospasm, bronchospasm, edema GI: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Local: Tissue irritation and indurations (subcutaneous injection) Major hazards: respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Sweating, physical tolerance and dependence, psychological dependence. Nursing Interventions Advise patient not to chew or crush controlled-release preparations Dilute and administer IV slowly to diminish possibility of adverse effects Ask patient to lie down before and during IV administration Keep opioid antagonists and equipment for assisted or controlled respiration readily available during IV administration Caution patient when injecting IM or subcutaneously into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Observe injection sites for irritation or any extravasations Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex Monitor bowel movement and arrange for anthraquinone laxatives for severe constipation If CNS vision arises, settle safety precautions like raising the side rails or assisting the patient in walking Provide frequent small meals if GI upset occur Manage environment if sweating, visual difficulties develop Render back rubs, position, and other no drug methods to ease pain Reassure patient about addiction liability; most patients who receive opioids

for medical reasons do not develop dependence syndromes Teaching Points Take these drugs exactly as prescribed. Avoid alcohols, antihistamines, sedatives, tranquilizers, and over-thecounter- drugs Do not take any leftover medication for other disorders, and do not let anyone else take your prescription You may experience these side effects: nausea, loss of apetite (take drug with food and lie quietly); constipation (notify your health care provider if this is severe; a laxative may help); dizziness, sedation, drowsiness, impaired visual acuity 9avoid driving or performing other tasks requiring alertness, visual acuity) Report severe nauseam vomiting, constipation, shortness of breath or difficulty breathing, skin rash. Representative Drugs Codeine Fentanyl Hydrocodone Hydromorphone Levomethadyl Levorphanol Meperidine Methadone Morphine sulphate Opium Oxycodone Oxymorphone Propoxyphene Remifentanil Sufentanil Tramadol