Adverse effects of opioids and management
 • Respiratory ...

Adverse effects of opioids and management

 • Respiratory depression – hold opioid, consider low doses of naloxone but CAUTION if on high dose ER opioids.

    o Dilute 0.4 mg naloxone (1 ml) in 9 ml saline, give 1-2 ml q2 min until ↑ RR or mental status improves

    o Half life is shorter than many opioids, watch for recurrence of resp depression

 • Constipation – ALWAYS start standing senna 1-4 tabs qhs or bid and miralax qd when initiating opioids; lactulose, bisacodyl and other laxatives if needed; methylnaltrexone qod if failed laxative therapy (dosed by weight)

 • Myoclonus – reduce dose or rotate opioid, consider gentle IVF; can give ativan 0.5-1 mg PO/IV qid

 • Nausea/vomiting -- prochlorperazine, metoclopramide, haloperidol. Avoid ondansetron (constipating)

 • Pruritus – Nalbuphine 5 mg IV q6h (pruritus mediated by mu receptor unless rash/allergic reaction).

 • Sedation – consider CNS stimulants (dextroamphetamine, methylphenidate)

 • Delirium – reduce dose or rotate opioid; haldol 0.5-1 bid-qid or zyprexa 2.5-5 mg PO qd-bid

 • Allergic reaction – very rare; rotate opioid

#AdverseEffects #SideEffects #opioids #management #pain
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