Antagonist narcotic

Modifications of the morphine skeleton have produced butorphanol [42408-82-2] (35) and drotebanol [3176-03-2] (36), which in animal models have demonstrated antitussive activity much greater than that of codeine (51,52). Butorphanol is also a potent analgetic of the narcotic antagonist type (51). Both compounds possess a unique 14-hydroxyl group. 

Naltrexone hydrochloride dihydrate (l-7V-cyclopropylmethyl-7,8-dihydro-14-hydroxy-morphinan-6-one hydrochloride) [16676-29-2] M 413.9, m 274-276°, [a] -173° (c 1, H2O), pKEst(i) 6 (N-cyclopropylmethyl), pKEst(i) (phenolic OH). This narcotic antagonist has been purified by recrystn from MeOH and dried air. The free base has m 168-170° after recrystn from Me2CO. [Cone et al. J Pharm Sci 64 618 7975 Gold et al. Med Res Rev 2 211 7952.]... 

Demethylation of the acetyl derivative (47) of levorphanol affords desmethyl compound, 48. Hydrolytic removal of the acetate (49) followed by alkylation with allyl bromide affords the narcotic antagonist levallorphan (50), an agent with properties... 

Narcotic antagonist. A drug that selectively blocks the actions of morphine-like compounds. 

Another agent of this general type is nalmefene (47) Despite their useful characteristics, opiates display tolerance, addiction, abuse, and some toxic side effects Antagonists combat some of these effects, most notably respiratory depression and addiction Nalmefene reputedly has significant oral activity as a narcotic antagonist The synthesis of nalmefine concludes by Wittig olefination of naltrexone (46) to nalmefene (47) This molecular transformation resulted in a significant increase in oral potency as well (141... 

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. 

Nursing care includes close monitoring of the patient immediately after insertion of the epidural catheter and throughout therapy for respiratory depression. Vital signs are taken every 30 minutes, apnea monitors are used, and a narcotic antagonist, such as naloxone, is readily available... 

Fhtients receiving long-term opioid therapy rarely have problems with respiratory depression. In instances where respiratory depression occurs, administration of a narcotic antagonist (see Chap. 20) may be ordered by die primary health care provider if die respiratory rate continues to fall. 

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

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

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

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 antagonists. 

Naloxone is contraindicated in those with a hypersensitivity to the narcotic antagonists. Naloxone is used cautiously in those with a narcotic addiction. Naloxone... 

Naltrexone is contraindicated in those with a hypersensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C). Naltrexone is used cautiously in those with a narcotic addiction in patients with cardiovascular disease, acute hepatitis, liver failure, or depression and in patients who are suicidal. Naltrexone is used cautiously during lactation. 

The Patient Receiving a Narcotic Antagonist for Respiratory Depression... 

The effects of some narcotics may last longer than the effects of naloxone. A repeat dose of naloxone may be ordered by the primary health care provider if results obtained from the initial dose are unsatisfactory. The duration of close patient observation depends on the patient s response to the administration of the narcotic antagonist. 

Which narcotic antagonist would most likely be prescribed for treatment of a patient who is experiencing an overdose of a narcotic ... 

National Research Council Clinical evaluation of naltrexone treatment of opiate-dependent individuals report of the National Research Council Committee on Clinical Evaluation of Narcotic Antagonists. Arch Gen Psychiatry 35 335—340, 1978... 

---