Opioid constipation with

When using opioids, prevent constipation with a Gl stirmJant. 

Answer B. Docusate is a stool-softening laxative that facilitates mixing of oil and water via its surfactant properties. Drugs that have muscarinic blocking effects, like scopolamine and the antihistamines diphenhydramine and promethazine, tend to cause constipation by decreasing GI motility. Loperamide is an opioid derivative, with no analgesic activity, used in the treatment of diarrheal states. 

Like other opioid agonists, codeine s major sites of action are localized to and mediated by supraspinal and spinal opioid receptors. Codeine has a low affinity for mu and kappa opioid receptors and its major effects are due to its conversion to morphine. Morphine binds mu opioid receptors with higher affinity, producing dose-dependent analgesia, as well as negative effects typical of mu receptor agonists such as respiratory depression, constipation, and nausea. Codeine also provides clinically useful central antitus-sive effects through a central mechanism that is not completely understood [1]. 

The adverse effects of extended-release hydromorphone are similar to other opioid medications with constipation, nausea, vomiting, pruritus, and urticaria being common. Other possible side effects include confusion, somnolence, euphoria, and respiratory depression. Respiratory depression is the most dangerous side effect of hydromorphone as it may result in hypoxia, coma, and death. Hydromophone should be used with caution in patients taking other CNS depressant medications. High doses of hydromorphone can result in the accumulation of neuroexcita-tory metabolites which may cause seizures and myoclonus. One advantage over morphine is that hepatic metabolites of hydromorphone have minimal analgesic or respiratory depressant activity. 

Side effects are similar to those observed with opioids constipation nausea central nervous system depression seizures (in conditions with lower seizure threshold)... 

Patients who are acutely intoxicated with an opioid usually present with miosis, euphoria, slow breathing and slow heart rate, low blood pressure, and constipation. Seizures may occur with certain agents such as meperidine (Demerol ). It is critically important to monitor patients carefully to avoid cardiac/ respiratory depression and death from an excessive dose of opioids. One strategy is to reverse the intoxication by utilizing naloxone (Narcan ) 0.4 to 2 mg IV every 2 to 3 minutes up to 10 mg. Alternatively, the IM/SC route may be used if IV access is not available. Because naloxone is shorter-acting than most abused opioids, it may need to be readministered at periodic intervals otherwise the patient could lapse into cardiopulmonary arrest after a symptom-free interval of reversed... 

The best management of opioid-induced constipation is prevention. Patients should be counseled on proper intake of fluids and fiber, and a laxative should be added with chronic opioid use. 

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. 

These differences in the behavioural properties of the opioid receptor sub-types are of considerable interest because the clinical use of currently marketed opioid analgesic drugs is limited by their undesirable side-effects, which include respiratory depression, constipation and an abuse or dependence liability. These side-effects have been associated with mu receptor ac-... 

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. 

Tolerance. With repeated administration of opioids, their CNS effects can lose intensity (increased tolerance). In the course of therapy, progressively larger doses are needed to achieve the same degree of pain relief Development of tolerance does not involve the peripheral effects, so that persistent constipation during prolonged use may force a discontinuation of analgesic therapy however urgently needed. 

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... 

The use of opium dates to 4,000 b.c. At that time it was used for medicinal and recreational purposes mainly via inhalation. Today few opium-containing preparations are used, since the activity of opium is largely attributed to its morphine content. The preparations in use today are those that have constipative effects useful for the treatment of diarrhea. Preparations include pantopon, an injectable hydrochloride of opium alkaloids, and paregoric, a camphorated tincture of opium. Paregoric can be used to treat infants with opioid withdrawal signs following in utero exposure to opioids. 

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