Drug Generic: Naloxone Hydrochlori de Brand: Narcan Pharmacologic Class: Opioid antagonist

Dosage/Ro ute/Timing Adults: 0.1 to 0.2 mg I.V. q 2 to 3 minutes, p.r.n. Children: 0.005 to 0.01 mg/kg dose I.V. Repeat q 2 to 3 minutes, p.r.n.

Mechanism of action Chemical effect: Unknown; may displace opioid analgesics from their receptors (competitive antagonism). Has no pharmacologi c activity. Therapeutic effect: Reverses opioid effects

Indications Postoperativ e opioid depression Known or suspected opioidinduced respiratory depression, including that caused by pentazocine and propoxyphe ne. Naloxone challenge for diagnosing opiate dependence .

Contraindication s Contraindicated in patients hypertensive to the drug or any of its components. Use cautiously in patients with cardiac irritability and opioid addiction. Abrupt reversal of opioidinduced CNS depression may cause nausea, vomiting, diaphoresis, tachycardia, CNS excitement, and increased blood pressure. In pregnant women, use cautiously. In breastfeeding women, safety and effectiveness havent been established.

Adverse Effects CNS : tremors, seizures CV: Tachycard ia and hypertensi on with high doses, ventricula r fibrillation GI: Nausea and vomiting with high doses Respirator y: Pulmonary edema Other: Withdrawa l symptoms in opioiddependen

Nursing Responsibilitie s Assessment: Assess patients opioid use before starting therapy, and reassess regularly to monitor the drugs effectiveness. Duration of opioid may exceed that of naloxone, causing nrelapse into respiratory depression. Monitor patients respiratory depth and rate. Patients who receive naloxone to reverse opioidinduced respiratory depression

t patients with higherthanrecommen ded doses.

may develop tachypnea. If patient has an adverse GI reaction, monitor his hydration. Assess patients and familys knowledge of drug therapy. Planning and implementati on: Provide oxygen, ventilation, and other resuscitation measures to patient with severe respiratory depression from acute opioid overdose. Instruct patient and family to report adverse reaction.

Drug Generic: Morphine Sulfate Brand: Avinza, Morphine H.P. Pharmacologic class: Opioid

Dosage/Ro ute/Timing Adults: 5 to 20 mg/70 kg S.C. or I.M. q 4 hours, p.r.n. Children: 0.1 to 0.2 mg/kg S.C. q 4 hours.

Mechanism of action Chemical effect: Binds with opioid receptors in CNS, altering both perception of and emotional response to pain through unknown mechanism. Therapeutic effect: Relieves pain.

Indications For severe pain Severe pain associated with terminal cancer Pain following major surgery

Contraindication s Contraindicated in patients hypertensive to the drug or any of its components and I those with conditions that preclude I.VV. administration of opioids (acute bronchial asthma or upper airway obstruction. Use cautiously in debilitated patients and in patients with head injury, increased intracranial pressure, seizures, chronic pulmonary disease, prostatic hyperplasia, severe hepatic or renal disease,

Adverse Effects CNS: Sedation, somnolen ce, clouded sensorium , euphoria, seizures (with large doses), dizziness, nightmare s (with long acting oral form). CV: Hypotensi on, flushing, bradycardi a, shock, cardiac arrest. GI: Nausea, vomiting, constipati on, ileus.

Nursing Responsibilitie s Assessment: Assess patients pain before therapy and regularly thereafter to monitor the drugs effectiveness. Drug may worsen or mask gallbladder pain. Monitor patient with respiratory depression after administration. When given epidurally, monitor patient for up to 24 hours after injection. Check respiratory rate and depth

acute abdominal conditions, hypothyroidism, Addisons disease or urethral stricture. In pregnant women, use cautiously. In breastfeeding women, wait 2 -3 hours after last dose before breastfeeding to avoid sedation in infant. In elderly patients, use cautiously.

GU: Urine retention Hematolo gic: Thromboc ytopenia Respirator y: Respirator y depressio n, respirator y arrest. Skin: Pruritus and flushing with epidural administra tion. Other: Physical dependen ce.

every 30 to 60 minutes for 24 hours. Frequently assess for constipation; adjust GI drugs as needed when increasing morphine dose. Be alert for adverse reactions and drug interactions. Assess patients and familys knowledge of drug therapy. Planning and implementati on: Double check the orders written against the strength you are giving carefully. Serious events

and fatalities may occur from dispensing and using wrong concentrations . Dont crush or break extended- or sustainedrelease tablets. Keep opioid antagonist and resuscitation equipment available. Warn patient about getting out of bed or walking without assistance. Warn outpatient not to drive or perform other hazardous activities until the drugs CNS effects are known.

Instruct patient not to use alcohol during therapy.