Opioid and non-opioid analgesics with respiratory depression monitoring, equianalgesic concepts, and pain scale use.
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- What is an equianalgesic dose?
- The dose of one analgesic (or route) that produces pain relief equivalent to a given dose of another analgesic (or route)
- In equianalgesic dosing, 30 mg of oral morphine is approximately equal to how much IV morphine?
- 10 mg IV morphine (about a 3:1 oral to IV ratio)
- When switching a patient from one opioid to another using equianalgesic tables, why is the calculated dose of the new opioid often reduced?
- To account for incomplete cross-tolerance between different opioids, lowering the risk of overdose
- What is the most sensitive early indicator of opioid-induced respiratory depression?
- Increasing sedation level (drowsiness), which precedes a drop in respiratory rate
- What respiratory rate in an adult receiving opioids should prompt the nurse to withhold the dose and notify the provider?
- A respiratory rate below 12 breaths per minute
- What is the purpose of a sedation scale, such as the Pasero Opioid-Induced Sedation Scale (POSS), in a patient on opioids?
- To detect increasing sedation early, since sedation rises before dangerous respiratory depression occurs
- What drug class reverses opioid-induced respiratory depression?
- Opioid antagonists (for example, naloxone)
- Why is naloxone given in small, titrated doses to an opioid-tolerant patient in respiratory distress?
- To reverse respiratory depression while minimizing abrupt, severe withdrawal symptoms and return of severe pain
- After giving naloxone, why must the nurse continue to monitor the patient closely for renarcotization?
- Naloxone's duration of action is shorter than that of most opioids, so respiratory depression can return once it wears off
- How much more potent is fentanyl compared to morphine?
- About 100 times more potent
- Why should a transdermal fentanyl patch never be started in an opioid-naive patient?
- It can cause life-threatening respiratory depression because the patient has no established opioid tolerance
- Is a fentanyl transdermal patch appropriate for acute, short-term pain?
- No, it is intended for chronic, stable pain, not acute pain
- What toxic metabolite accumulates with repeated meperidine (Demerol) dosing?
- Normeperidine
- What serious adverse effect can normeperidine accumulation cause?
- CNS excitation, including tremors and seizures
- Why is meperidine avoided for long-term or chronic pain management?
- Its toxic metabolite normeperidine accumulates with repeated doses, raising seizure risk