Opioid and non-opioid analgesics with respiratory depression monitoring, equianalgesic concepts, and pain scale use.
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- What is an equianalgesic dose?
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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?
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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?
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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?
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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?
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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?
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To detect increasing sedation early, since sedation rises before dangerous respiratory depression occurs- What drug class reverses opioid-induced respiratory depression?
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Opioid antagonists (for example, naloxone)- Why is naloxone given in small, titrated doses to an opioid-tolerant patient in respiratory distress?
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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?
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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?
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About 100 times more potent- Why should a transdermal fentanyl patch never be started in an opioid-naive patient?
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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?
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No, it is intended for chronic, stable pain, not acute pain- What toxic metabolite accumulates with repeated meperidine (Demerol) dosing?
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Normeperidine- What serious adverse effect can normeperidine accumulation cause?
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CNS excitation, including tremors and seizures- Why is meperidine avoided for long-term or chronic pain management?
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Its toxic metabolite normeperidine accumulates with repeated doses, raising seizure risk
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