Opioids
PREGNANCY CATEGORY B OR C
CONTROLLED SUBSTANCE C-II
Therapeutic Actions
Opioids act as agonists at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).
Indications
Relief of moderate to severe acute and chronic pain
Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage
Analgesic adjunct during anesthesia
Intraspinal use with microinfusion devices for the relief of intractable pain
Unlabeled use: Relief of dyspnea associated with acute left ventricular failure and pulmonary edema
Contraindications and Cautions
Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning until toxins are eliminated, during labor or delivery of a preterm infant (may cross immature blood–brain barrier more readily), after biliary tract surgery or following surgical anastomosis, pregnancy, or labor (can cause respiratory depression of neonate; may prolong labor).
Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (may be safer to wait 4–6 hr after administration to nurse the baby); acute abdominal conditions; CV disease, supraventricular tachycardias; myxedema; seizure disorders; acute alcoholism, delirium tremens; cerebral arteriosclerosis; ulcerative colitis; fever; kyphoscoliosis; Addison’s disease; prostatic hypertrophy, urethral stricture; recent GI or GU surgery; toxic psychosis; renal or hepatic impairment.
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 reflex
CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope
Dermatologic: Pruritus, urticaria, laryngospasm, bronchospasm, edema
GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis
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