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SCCT Quiz 2 - Coggle Diagram
SCCT Quiz 2
morphine ER (MS Contin,
Avinza, Kadian)
common ADRs: constipation, N/V, hypotension, dizziness, sedation, diaphoresis, HA, depression, xerostomia
rare ADRs: cardiac arrest, physical dependence, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones
interactions: barbiturates/BZDs/centrally acting muscle relaxants/opioids/phenothiazines (additive CNS depression), buprenorphine/opioid agonists/antagonists (precipitation of withdrawal symptoms), MAOIs (additive respiratory depression), SSRIs/SNRIs/TCAs/triptans (increased risk of serotonin syndrome)
efficacy: relief of pain
indications: chronic pain (moderate to severe)
toxicity: excessive drowsiness, decreased breathing, severe constipation, chest pain, dizziness, vital signs
class: opioid analgesic (C-II)
counseling: use stimulant laxative for preventing opioid-induced constipation; may cause drowsiness, avoid driving or other tasks requiring motor coordination; avoid EtOH and other CNS depressants; ER products must not be crushed or chewed, crushing or chewing will release total dose of morphine at once and increase risk of respiratory depression; ER capsule can be opened and sprinkled on soft food, but must be swallowed whole and not chewed
tramatol (Ultram)
common ADRs: constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, HA, flushing
rare ADRs: cardiac arrest, physical dependence, tolerance, seizures, pancreatitis, suicidal ideation, anemia, serotonin syndrome, adrenal insufficiency, decreased sex hormones
counseling: use laxative for preventing constipation if used chronically; may cause drowsiness; avoid driving or other tasks requiring motor coordination; avoid EtOH and other CNS depressants; ER products much not be crushed or chewed but may be taken with or without food, and always the same way to avoid variability in absorption
drug interactions: barbiturates/BZDs/centrally acting muscle relaxants/opioids/phenothiazines (additive CNS depression), buprenorphine/opioid agonists/antagonists/opioid antagonists (precipitation of withdrawal symptoms), CYP3A4/5 inducers/inhibitors, CYP2D6 inhibitors, MAOIs (additive respiratory depression, risk of serotonin syndrome), SSRIs/SNRIs/TCAs/triptans (increased risk of SS)
efficacy: relief of pain
indications: chronic moderate to moderately severe pain
toxicity: excessive drowsiness, decreased breathing, severe constipation, chest pain, dizziness, signs of tolerance, monitor vitals
class: opioid analgesic (C-IV)
fentanyl transdermal
(Duragesic, Ionsys)
rare ADRs: SJS, physical dependence, tolerance
efficacy: relief of pain
common ADRs: application site reactions, sweating, constipation, GI distress, confusion, HA, anxiety, urinary retention, fatigue
toxicity: severe skin rash, excessive drowsiness, decreased breathing, severe constipation, chest pain, inability to urinate, constipation
interactions: barbiturates/BZDs/centrally acting muscle relaxants/opioids/phenothiazines (additive CNS depression). BBs and CCBs (additive hypotension with combined with fentanyl anesthesia), buprenorphine/opioid agonists/antagonists (precipitation of withdrawal symptoms), CYP3A4/5 inducers, CYP3A4/5 strong/moderate inhibitors, MAOIs (additive respiratory depression), SSRIs/SNRIs/TCAs/triptans (increased risk of serotonin syndrome)
counseling: use laxative for preventing constipation; may cause drowsiness, avoid driving or other tasks requiring motor coordination; avoid EtOH and other CNS depressants; apply to clean, dry skin; skin breaks may increase absorptions; remove old patch when new patch applied; febrile patients may have increased absorption; monitor carefully
indications: chronic pain (moderate to severe)
class: opioid analgesic (C-II)
hydrocodone (Norco, Lorcet,
Vicodin, Zohydro ER, Hysingla ER)
common ADRs: constipation, GI distress, somnolence
rare ADRs: SJS, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormone
interactions: barbiturates/BZDs/centrally acting muscle relaxants/opioids/phenothiazines (additive CNS depression), buprenorphine/opioid agonists/antagonists (precipitation of withdrawal symptoms), CYP3A4/5 inducers/inhibitors, CYP2D6 inhibitors, MAOIs (additive respiratory depression), SSRIs/SNRIs/TCAs/triptans (increased risk of serotonin syndrome)
efficacy: relief of pain
indications: pain, severe enough to require daily around the clock opioid
toxicity: seek medical attention if severe skin rash, excessive drowsiness, decreased breathing, severe constipation, black tarry stools, or yellowing of eyes or skin
counseling: use a stool softener and/or laxative for preventing constipation with chronic use; may cause drowsiness, avoid driving or other tasks requiring motor coordination; avoid EtOH and other CNS depressants
class: opioid analgesic (C-II)
oxycodone (OxyContin)
rare ADRs: cardiac arrest, respiratory depression, physical dependence, tolerance, severe hypersensitivity, serotonin syndrome, adrenal insufficiency, decreased sex hormones
efficacy: relief of pain
common ADRs: constipation, GI distress, sedation, sweating, pruritus
interactions: barbiturates/BZDs/centrally acting muscle relaxants/opioids/phenothiazines (additive CNS depression), buprenorphine/opioid agonists/antagonists (precipitation of withdrawal symptoms), CYP3A4/5 inducers/inhibitors
toxicity: excessive drowsiness, severe skin rash, decreased breathing, severe constipation, chest pain, dizziness; monitor vital signs, specifically RR and BP
indications: chronic pain (moderate to severe)
counseling: use laxative for preventing constipation; may cause drowsiness, avoid driving or other tasks requiring motor coordination; avoid EtOH and other CNS depressants
class: opioid analgesic (C-II)