Copyright 2017 Wolters Kluwer All Rights Reserved Narcotic Agonists cont

Copyright © 2017 Wolters Kluwer • All Rights Reserved Narcotic Agonists (cont.) Narcotic Agonists (cont.) • Cautions – Respiratory dysfunction – GI or GU surgery – Acute abdomen or ulcerative colitis • Adverse Reactions – Respiratory depression with apnea – Cardiac arrest – Shock – Orthostatic hypotension – Nausea, vomiting, constipation – Biliary spasm – Dizziness, psychoses, anxiety, fear, hallucinations • Drug-to-Drug Interactions – Barbiturate general anesthetics, phenothiazines, and MAOIs

Copyright © 2017 Wolters Kluwer • All Rights Reserved Question Question Identify a reason a narcotic agonist may be prescribed? A. Relief of minor pain B. Analgesia during anesthesia C. Analgesia during sleep D. Relief of moderate acute pain

Copyright © 2017 Wolters Kluwer • All Rights Reserved Answer Answer b. Analgesia during anesthesia Rationale: Indications: – Relief of severe acute or chronic pain – Analgesia during anesthesia – Cross placenta

Copyright © 2017 Wolters Kluwer • All Rights Reserved Narcotic Agonists–Antagonists Narcotic Agonists–Antagonists • Pentazocine ( Talwin ) – Preferred drug for patients switched from parenteral to oral forms after surgery or labor • Buprenorphine ( Buprenex ) – Treats mild to moderate pain • Butorphanol ( Stadol, Stadol NS ) – Preoperative medication – Relieves moderate to severe pain • Nalbuphine ( Nubain ) – Treats moderate to severe pain – Adjunct for general anesthesia – Relieves pain during labor and delivery

Copyright © 2017 Wolters Kluwer • All Rights Reserved Narcotic Agonists–Antagonists (cont.) Narcotic Agonists–Antagonists (cont.) • Actions – Act at a specific opioid receptor sites in the CNS to produce analgesia, sedation, euphoria, and hallucinations • Indications – Moderate to severe pain – Adjunct to general anesthesia – Relief of pain during labor and delivery

Copyright © 2017 Wolters Kluwer • All Rights Reserved Narcotic Agonists–Antagonists (cont.) Narcotic Agonists–Antagonists (cont.) • Pharmacokinetics – Readily absorbed IM and reach peak levels when given IV – Metabolized in the liver excreted in urine or feces – Cross placenta • Contraindications – Known allergy – Pregnancy and lactation • Cautions – Physical dependence on a narcotic – COPD and disease of the respiratory tract – Acute MI or documented CAD • Adverse Reactions – Respiratory depression – Nausea, vomiting, constipation, and biliary spasm

Copyright © 2017 Wolters Kluwer • All Rights Reserved Narcotic Agonists–Antagonists (cont.) Narcotic Agonists–Antagonists (cont.) • Adverse Reactions – Headache – Dizziness – Psychoses – Anxiety – Hallucinations – Ureteral spasm, urinary retention • Drug-to-Drug Interactions – Barbiturate general anesthetics