Analgesics, Narcotic

Drug that counteract the effects of the narcotic analgesics are the narcotic antagonists. These drugp compete with the narcotics at the receptor sites and are used to reverse the depressant effects of the narcotic analgesics. Both types of drug are discussed in this chapter. 

Opioid analgesics are the narcotic analgesics obtained from the opium plant. More than 20 different alkaloids are obtained from the unripe seed of the opium poppy 

Morphine, when extracted from raw opium and treated chemically, yields the semisynthetic narcotics hydromorphone, oxymorphone, oxycodone, and heroin. Heroin is an illegal narcotic in the United States and is not used in medicine. Synthetic narcotics are those man-made analgesics with properties and actions similar to the natural opioids. Examples of synthetic narcotic analgesics are methadone, levorphanol, remifen-tanil, and meperidine Additional narcotics are listed in the Summary Drug Table Narcotic Analgesics. 

GENERIC NAME TRADE NAM E USES ADVERSE REACTIONS DOSAGE RANGES 

SUM MARY DRUG TABLE NARCOTIC ANALGESICS (Continued) 

Camphorated tin dure of opium, Paregoric OxyCtontin, OxylR, Roxicodone 

Analgesic, anesthesia before, during, and after surgery 

Fentanyl Oralet only as anesthetic premedication Actiq only as management of breakthrough cancer pain Chronic pain 

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Incorporation of the benzylic carbon of phenylacetic acid into a cyclohexane ring affords an agent whose activity is closely related to that of the narcotic analgesics. This activity is particularly noteworthy for the fact that this structure repre-... 

It is generally accepted that the narcotic analgesics do not in fact interfere with the pain as such rather, these compounds change the perception of the pain. In other words, the patient may come to regard pain with detachment. This very mechanism may be responsible for one of the major drawbacks of the narcotic 286... 

In an extension of this work, Schnider and his colleagues condensed the salt (36) with the Grignard reagent from p-methoxy-benzyi chloride. The product (40), on reduction (41) and cycliza tion, affords the methoxylated morphinan (41). Removal of the methyl ether affords the narcotic analgesic racemorphan (43)... 

A not uncommon side effect observed with morphine and some of the other narcotic analgesics is constipation due to decreased motility of the gastrointestinal tract. It proved possible to so modify pethidine as to retain the side effect at the expense of analgesic activity. Relief of diarrhea, it will be realized, is a far from trivial indication. Alkylation of the anion from diphenylacetonitrile (95) with ethylene dibromide gives the intermediate, 96. Alkylation of normeperidine (81) with that halide... 

Narcotic analgesic. A drug that alleviates pain by interacting with the morphine receptor. 

Ms. dimes, an 80-year-old woman, is receiving a lower dose of Demerol, a narcotic analgesic, postoperatively for pain. Her family questions the use of a lower dose Determine what information you would give her family when they voice concerns that the dosage will not adequately relieve their mother s pain. Analyze what... 

The next three chapters deal with dragp used in the management of pain the nonnarcotic analgesics (salicylates, nonsalicylates [acetaminophen], and the nonsteroidal anti-inflammatory dragp) and the narcotic analgesics. 

SUM MARY DRUG TABLE NON NARCOTIC ANALGESICS SALICYLATES AND NON SALICYLATES... 

Discuss the uses, general drug action, general adverse reactions, contraindications, precautions, and interactions of the narcotic analgesics. 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking the narcotic analgesics. 

List some nursing diagnoses particular to a patient taking a narcotic analgesic. 

Discuss ways to promote optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of narcotic analgesics. 

The adverse reactions of the narcotic analgesics are discussed extensively in the chapter. Some of the reactions may be less severe or intense than others. 

Classification of the narcotic analgesics is based on their activity at the opioid receptor sites. Although five categories of opioid receptors have been identified, only three of these receptors affect the action of the narcotic... 

DISPLAY 19-1 Secondary Pharmacological Effects of the Narcotic Analgesics... 

The major use of the narcotic analgesic is to relieve or manage moderate to severe acute and chronic pain. The ability of a narcotic analgesic to relieve pain depends on several factors, such as the drug, the dose, the route of administration, the type of pain, the patient, and the length of time the drug has been administered. Morphine is the most widely used opioid and an effective drug for... 

In addition to the relief or management of moderate to severe acute and chronic pain, the narcotic analgesics may be used for the following reasons ... 

The adverse reactions differ according to whetiier die narcotic analgesic acts as an agonist or as an agonist-antagonist. 

One of the major hazards of narcotic administration is respiratory depression, widi a decrease in the respiratory rate and depth. The most common adverse reactions include light-headedness, dizziness, sedation, constipation, anorexia, nausea, vomiting, and sweating. When diese effects occur, die primary healdi care provider may lower die dose in an effort to eliminate or decrease die intensity of die adverse reaction. Otiier adverse reactions tiiat may be seen witii die administration of an agonist narcotic analgesic include ... 

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