Constipation, opioid causing

Opioids cause side effects that limits their use. They include respiratory depression, nausea, vomiting, constipation, a heightened level of blood pressure, urine retention, perspiration, and itching of course, the most dangerous of these is respiratory depression. Opioids cause dependency and addiction. 

Constipation and sedation occur with therapeutic doses constipation should be managed with stool softeners. In overdose, opioids cause a triad of pinpoint pupils, coma, and respiratory depression. 

Morphine sulfate and other opioids cause a reduction in intestinal movement resulting in constipation that might make the patient uncomfortable. Knowing this, the nurse might instruct the patient about foods and fluids that might increase intestinal motility such as bran and increased water intake. 

When prescribing strong opioids as analgesics for severe pain, it is even recommended to combine the treatment with prophylactic use of laxatives to avoid constipation. The effect of opioids on the bowel is to cause almost no movement at all in the bowels and therefore it is unavoidable to use stimulating laxatives sometimes combined with bulk forming preparations. 

Digestive system g agonists decrease secretion of stomach acid, reduce gastric motility, and prolong gastric emptying. Pancreatic, biliary, and intestinal secretions are reduced. Intestinal transit is also slowed. Peristaltic movements are reduced, but tone is increased, sometimes causing spasm. As a result, constipation is a frequent problem with opioid use. Bile duct pressure is also increased by opioids. 

Consequently the opioid drugs (e.g. codeine, morphine), which are normally used to control pain, can cause constipation. 

Tramadol is an opioid analgesic, which acts by exerting an opioid effect and through the stimulation of adrenergic and serotonin pathways. Compared with the other opioids, tramadol is less likely to cause the typical opioid side-effects, such as respiratory depression, and constipation. It is also less likely to cause addiction. 

Dextromethorphan is an opioid antitussive similar in action to codeine and pholcodine. Codeine and pholcodine are considered to be more potent than dextromethorphan. Dextromethorphan tends to cause less constipation and dependence than codeine. Cough suppressants are not usually recommended in children under 2 years. 

Pharmacology Diphenoxylate, a constipating meperidine congener, lacks analgesic activity. High doses cause opioid activity. 

Diphenoxylate + Atropine (Lomotil, Lonox) [C V] [Opioid Antidiarrheal] Uses D Action Constipating m CTidine congener, X GI motihty Dose Adults. Initial, 5 mg PO tid—qid until controlled, then 2.5-5 mg PO bid 20 mg/d max Peds >2 y. 0.3-0.4 mg/kg/24 h (of diphenoxylate) bid-qid, 10 mg/d max Caution [C, +] Contra Obstructive jaundice, D d/t bacterial Infxn children <2 y Disp Tabs, Liq SE Drowsiness, dizziness, xCTostomia, blurred vision, urinary retention, constipation Interactions T Effects W/ CNS depressants, opioids, EtOH, T risk HTN crisis W7 MAOIs EMS Monitor for Sxs of electrolyte disturbances and hypovolemia d/t D OD May cause Szs, hypotension, and anticholinergic effects (xerostomia [dry mouth], urine retention, flushed skin) activated charcoal may be effective for OD... 

Slows intestinal motihty Dose Adul. Initial 4 mg PO, then 2 mg aftCT each loose stool, up to 16 mg/d Feds. 2—5 y, 13—20 kg 1 mg PO tid 6-8 y, 20—30 kg 2 mg PO bid 8-12 y, >30 kg 2 mg PO tid Caution [B, +] Not for acute D caused by Salmonella sp, Shigella sp, or C. difficile Contra Pseudomembranous colitis, bloody D Disp Caps, tabs, Liq SE Constipation, sedation, dizziness Interactions t Effects W/ antihistamines, CNS depressants, phenothiazines, TCAs, EtOH EMS Use caution w/ narcotics, may T risk of constipation related to opioids OD May cause constipation and CNS depression activated charcoal may be effective, naloxone (Narcan) may be effective... 

Uses Obesity Action Blocks uptake of norepinephrine, serotonin, dopamine Dose 10 mg/d PO, may to 5 mg after 4 wk Caution [C, -] w/ SSRIs, Li, dextromethorphan, opioids Contra MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp Caps SE HA, insomnia, xerostomia, constipation, rhinitis, tach, HTN Interactions T Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tryptophan, zolmitriptan, St. John s wort effects W/ cimetidine, erythromycin, ketoconazole T CNS depression W/ EtOH EMS Use fentanyl w/ caution, may T risk of serotonin synd concurrent EtOH use can T CNS depression OD May cause tach, HTN, diaphoresis, HA, fever, agitation, muscle tremors, and Szs symptomatic and supportive... 

The adverse reactions include slowing of gastrointestinal propulsion with the ensuing risk of constipation, which can be prevented with lactulose or lactitol. Opioid treatment can also cause nausea and sometimes vomiting. There is also a dependence problem and a risk of respiratory depression. The latter may be a practical problem in anaesthetic practice or in overdose, but rarely in the case of treatment with slowly increased oral doses. The nausea is... 

Behavioral effects of opioids include euphoria, sedation and mental clouding. Physiological effects include respiratory depression, decreased heart rate, contraction of the pupil, constipation, nausea, and vomiting. Opioids can also release histamine from body stores, causing severe itching, hypotension, sweating, and flushing. 

Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death. 

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