1. Narcotic Analgesics and Anesthesia Drugs Narcotic Analgesics

2. Opioids Actions –Analgesia –Euphoria –Sedation

3. Opioids Primary Use –Moderate Pain –Severe Pain –Acute Pain –Chronic Pain –Breakthrough Pain

4. Opioids Other Uses –Pre-Op Sedation –Adjunct Anesthesia –Anti Anxiety –Diarrhea –Opiate Dependence

5. Opioids Common Opioids –Morphine sulfate –Codeine –meperidine HCl (Demerol) –hydromorphone (Dilaudid) –fentanyl (Duragesic) –oxycodone (OxyContin)

6. Opioids Common Routes –IV –IM –Subcutaneous –Oral –Transdermal –Epidural

7. Opioids Adverse Reactions Euphoria, dysphoria, confusion, sedation Nausea, vomiting, constipation Hypotension, bradycardia or tachycardia Urinary hesitancy, dysuria Respiratory depression, cough depression Allergic reactions, pruritisPain, irritation at injection site

8. Opioids Contraindications Opiate allergies Head injuries, increased intracranial pressure Convulsions Ulcerative colitis Pulmonary diseases (asthma, COPD) Renal or hepatic dysfunction

9. Opioids Not recommended during labor Use caution with elderly Not recommended for biliary surgery Not recommended during lactation Precautions

10. Opioids Opioid Naive ToleranceAddiction Precautions

11. Opioids Precautions Opioids and Acetaminophen Daily acetaminophen intake should NOT EXCEED 4 grams

12. Opioids Interactions CNS Depressants Use caution whenever two or more CNS depressants given

13. Opioids Special Circumstances Opiates of Choice Codeine Persistent Cough Morphine Myocardial Infarct Meperidine Biliary Surgery

14. Opioids Opiate Poisoning miosis Respirations < 10 / min hypoxia

15. Opioids Opiate Antagonist

16. Opioids Patient Controlled Analgesia (PCA)

17. Opioids Epidural

18. Opioids Transdermal