Opioid contraindications

Prophylactic, continuous use of antibiotics has no effect on the frequency of exacerbations antibiotics should only be used for treating infectious exacerbations. Antitussives are contraindicated because cough has an important protective role. Opioids may be effective for dyspnea in advanced disease but may have serious adverse effects they may be used to manage symptoms in terminal patients. 

Analgesics are given to reduce abdominal pain. In the past, parenteral meperidine (50 to 100 mg) every 3 to 4 hours was usually used because it causes less spasm of the sphincter of Oddi than other opioids. Meperidine is used less frequently today because it is not as effective as other opioids and is contraindicated in renal failure. Parenteral morphine is sometimes used, but it is thought to cause spasm of the sphincter of Oddi, increases in serum amylase and, rarely, pancreatitis. Hydromorphone may also be... 

Opioids and derivatives (e.g., meperidine, butorphanol, oxycodone, hydromorphone) provide effective relief of intractable migraine but should be reserved for patients with moderate to severe infrequent headaches in whom conventional therapies are contraindicated or as rescue medication after failure to respond to conventional therapies. Opioid therapy should be closely supervised. 

Alternative products to diclofenac include naproxen and mefenamic acid, both of which are non-steroidal anti-inflammatory drugs. Co-codamol is a mixture of the opioid analgesic codeine and paracetamol and it does not possess the anti-inflammatory component. It may be used in pain management either where NSAIDs are contraindicated or in patients who are intolerant to the effects of NSAIDs. 

Loperamide is an opioid analogue that binds to the opiate gut receptors, thereby decreasing intestinal motility and increasing transit time. Loperamide is contraindicated in patients with active ulcerative colitis and children under 4 years. It is used in the treatment of diarrhoea. 

The opioids generally have a high level of safety when used in therapeutic dosages. However, there are several notable exceptions. Morphine and other opioids are contraindicated in patients with hypersensitivity reactions to the opioids. In addition, morphine should not be used in patients with acute bronchial asthma and should... 

Opioids are contraindicated in head trauma because of the risk of a rise in intracranial pressure from vasodilation and increased cerebrospinal fluid volume. In addition, in such patients the onset of miosis following opioid administration can mask the pupillary responses used diagnostically for determination of concussion. 

E. Fentanyl patches have the same effect as fentanyl, only in a time-release manner. Thus, the purpose of the question is delineation of opioid effects—respiratory depression and constipation. The respiratory depression is life-threatening when the patch is used in nonambulatory patients, and it is therefore contraindicated for that purpose. 

Diphenoxylate (marketed in combination with atropine as Lomotil in the United States) is chemically related to both analgesic and anticholinergic compounds. It is as effective in the treatment of diarrhea as the opium derivatives, and at the doses usually employed, it has a low incidence of central opioid actions. Diphenoxylate is rapidly metabolized by ester hydrolysis to the biologically active metabolite difenoxylic acid. Lomotil is recommended as adjunctive therapy in the management of diarrhea. It is contraindicated in children under 2 years old and in patients with obstructive jaundice. Adverse reactions often caused by the atropine in the preparation include anorexia, nausea, pruritus, dizziness, and numbness of the extremities. 

Contraindications CNS disease that affects respirations, hypersensitivity to the preservative benzethonium chloride, physical dependence on other opioid analgesics, preexisting respiratory depression, pulmonary disease... 

Contraindications Acute hepatitis, acute opioid withdrawal, failed naloxone challenge test, hepatic failure, history of hypersensitivity to naltrexone, opioid dependence, positive urine screen for opioids... 

Contraindications Acute alcohol intoxication concurrent use of centrally acting analgesics, hypnotics, opioids, or psychotropic drugs hypersensitivity to opioids... 

Before initiating treatment, careful attention should be paid to the use of any opioid analgesics, since naltrexone may provoke acute withdrawal symptoms. The main contraindications are (1) treatment with opioid analgesics, (2) opioid dependence, (3) acute opioid... 

Direct toxic effects of the opioid analgesics that are extensions of their acute pharmacologic actions include respiratory depression, nausea, vomiting, and constipation (Table 31-4). In addition, tolerance and dependence, diagnosis and treatment of overdosage, and contraindications must be considered. 

Monoamine oxidase inhibitors Relative contraindication to all opioid analgesics because of the high incidence of hyperpyrexic coma hypertension has also been reported. 

Codeine and morphine should also be used with caution in convulsive disorders and if a patient is dependent on opioids, they should not be withdrawn abruptly. (See BNF for further cautions and contraindications.)... 

Loperamide is, therefore, the opioid antidiarrheal of first choice. The prolonged contact time for intestinal contents and mucosa may also improve absorption of fluid. With overdosage, there is a hazard of ileus. The drug is contraindicated in infants below age 2 years. 

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

Respiratory Disorders. Topically applied P-blockers can induce asthma or dyspnea in patients with preexisting chronic obstructive pulmonary disease. Clinicians should inquire about a history of pulmonary disorders before initiating glaucoma treatment with P-blockers. A history of restrictive airway disease also contraindicates the use of opioids for treatment of ocular pain. 

Contraindications fc>r nonsalicylate NSAID therapy are the same as those for aspirin (see Box 7-I).The formation of a gastric ulcer or erosion that may bleed profusely is a serious potential problem with NSAIDs. Consequently, the nonsalicylate NSAIDs should be avoided or used with great caution in patients with active peptic ulcer disease. NSAIDs may increase the risk of GI complications even when used in conjunction with low-dose aspirin for cardioprotection. In addition, because of potential crosssensitivity to other NSAIDs, the nonsalicylate NSAIDs should not be given to patients in whom aspirin or other NSAIDs have caused symptoms of asthma, rhinitis, urticaria, angioedema, hypotension, bronchospasm, or of symptoms of hypersensitivity reactions. Opioids, tramadol, or acetaminophen may be suitable alternatives for patients with known or suspected susceptibility. 

Opioid analgesics are contraindicated in patients with a history of hypersensitivity to narcotics, because there is a... 

Opioids are also contraindicated in patients with acute bronchial asthma and in patients with chronic obstructive... 

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