1 F ‘08 P. Andrews, Instructor

2

We’ll talk about  Buprenex  Stadol  Vicodin  Demerol  Morphine sulfate  Fentanyl  Nubain  Trexan  Narcan 3

Buprenex buprenorphine  Class  Opioid analgesic (agonist – antagonist)  Schedule V  Indications  Management of moderate to severe pain 4

 Action  Binds to opiate receptors in CNS (30x morphine and 3x narcan)  Alters perception of and response to pain  Produces generalized CNS depression 5

 Contraindications  Hypersensitivity  Precautions  Increased ICP  Adverse reactions, SE  Nausea/Vomiting  Dizzyness  Headache  Confusion  Dysphoria  Sedation  Sweating 6

 Route & dosage  IV, 0.3 mg q 4-6 h prn  How supplied  0.3 mg/ml in 1 ml preload 7

Stadol butorphanol tartrate  Class  Opioid analgesic (agonist/antagonist)  Indications  Management of moderate to severe pain  Analgesic during labor 8

 Action  Binds to opiate receptors in CNS  Alters perception of response to painful stimuli  Contraindications  Hypersensitivity  Opioid dependency 9

 Precautions  Head trauma  Increased ICP  Adverse reactions, SE  Confusion  Dysphoria  Hallucinations  Sedation  Sweating  Use with extreme precautions in patient on MAO Inhibitors 10

 Route & dosage  1 mg q 3-4 h prn  How supplied  1 mg/ml or 2 mg/ml in 1 ml preloads 11

Vicodin (Anexia) hydrocodone bitartrate w/ acetaminophen  Class  Analgesic  Contains 5 mg narcotic, 500 mg acetaminophen  Schedule III  Indications  Analgesic for moderate to severe pain 12

 Action  Binds to opiate receptors  Acetaminophen produces peripheral and central mechanisms 13

 Contraindications  Hypersensitivity  Precautions  Head injuries  Adverse reactions, SE  Respiratory depression  Sedation  Dizziness  Mental clouding  Acetaminophen overdose may result in potentially fatal hepatic necrosis 14

 Route & dosage  1 – 2 tablets q 4-6 h prn PO  Total 24-hour dose should not exceed 8 tablets 15

Demerol meperidine hydrochloride  Class  Opioid analgesic  Schedule II  Indications  Moderate or severe pain  Action  Binds to opiate receptors in CNS 16

 Contraindications  Hypersensitivity  Precautions  Head injury  Increased ICP  Adverse reactions, SE  Seizures  Confusion, sedation  Hypotension  Constipation  N/V 17

 Route & dose  50 – 100 mg slow IV, SQ, IM  How supplied  10 mg/ml in 5 ml preload,  20 mg/ml, or 50 mg/ml in 5 ml preload 18

MS Contin Morphine Sulfate  Class: Opioid analgesic  Indications  Pulmonary edema  Pain  MI  Action  Acts on opiate receptors to block sensation of pain. Also causes peripheral vasodilation 19

 Contraindications  Head injury  Depressed respiratory drive  Hypotension  Precautions: have intubation equipment and naloxone ready 20

 Adverse reactions, SE  Respiratory depression  Hypotension  Confusion  Sedation  Constipation 21

 Dosage & Route  2-10 mg slow IVP q min. in 2 mg increments, titrated to relief  How supplied  10 mg/ml in 1 ml tubex 22

fentanyl  Class  Opioid analgesic  Schedule II  Indications  Analgesia  Action  Binds to opiate receptors in CNS, altering response to and perception of pain 23

 Contraindications  Hypersensitivity  Precautions  Geriatrics  Diabetes  CNS tumors  alcoholism 24

 Adverse reactions, SE  Apnea  Laryngospasm  Route & dosage  mcg (0.05 – 0.1 mg)  How supplied  0.05 mg/ml in one ml preload or tubex 25

26

Nubain nalbuphine  Class  Opioid analgesic (Agonist/antagonist)  Indication  Moderate to severe pain  Action  Binds to opiate receptors  Alters perception of and response to pain 27

 Contraindications  Hypersensitivity  Opioid dependency  Precautions  Head trauma  Increased ICP 28

 Adverse reactions, SE  Dizziness  Headache  Sedation  Dry mouth  N/V  Clammy feeling, sweating 29

 Route & dosage  10 mg g 3-6 h (not to exceed 20 mg) IV  How supplied  10 mg/ml in 1 and 10 ml vials or  20 mg/ml in 1 and 10 ml vials  1 ml preloads 30

Trexan naltrexone  Class  Opiate receptor agonist  Indications  Alcoholics to decrease compulsive consumption  Detoxified addicts to stay opiate-free 31

 Action  Competes for opiate receptors  Contraindications  None noted  Precautions  None noted  Adverse reactions, SE  Abdominal cramps,  H/A  Depression  irritability 32

 Route & dosage  25 mg tablets, PO; repeat if no withdrawal sx in one hour  Alcohol dependence; 50 mg qd PO 33

Narcan naloxone  Class  Opioid antagonist  Indication  Reversal of CNS depression and respiratory depression 2ndary to opiate overdose 34

 Contraindications  Hypersensitivity  Precautions  Cardiovascular disease  Pregnancy  Adverse reactions, SE  None in emergent setting 35

 Route & dosage  2 mg IV, SQ, IM, ET, SL injection  Repeat prn 36

Nitronox nitrous oxide  Class  Analgesic  Indications  Moderate to severe pain  Action  Alters perception of pain  Decreases hypoxia 37

 Contraindications  Do not administer for abdominal pain  Severe head injury  Precautions  Must be self-administered  N/V 38

 Route & dosage  Inhaled, blended mixture of 50% nitrous oxide and 50% oxygen  Effects dissipate within 2-5 min. after cessation of administ.  Unit consists of oxygen & nitrous oxide cylinders, fed into blender; delivered to modified demand valve 39

40