C H A P T E R 2 6
Opioids, opioid antagonists and antimigraine agents
409
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Opioid agonists react with opioid receptor sites to
stimulate their activity.
■■
Opioid agonists–antagonists react with some opioid
receptor sites to stimulate activity and block other
opioid receptor sites.
■■
Opioid antagonists are used to treat opioid overdose
or to reverse unacceptable adverse effects.
MIGRAINE HEADACHES
The term
migraine headache
is used to describe several
different syndromes, all of which include severe, throb-
bing headaches on one side of the head. This pain can
be so severe that it can cause widespread disturbances,
affecting GI and CNS function, including mood and
personality changes.
Migraine headaches should be distinguished from
cluster headaches and tension headaches (Box 26.4).
Cluster headaches usually begin during sleep and involve
sharp, steady eye pain that lasts 15 to 90 minutes, with
sweating, flushing, tearing and nasal congestion. Tension
headaches, which usually occur at times of stress, feel
like a dull band of pain around the entire head and last
from 30 minutes to 1 week. They are accompanied by
anorexia, fatigue and a mild intolerance to light or sound.
KEY POINTS
Care considerations for
people receiving opioid antagonists
Assessment: History and examination
■
■
Assess for contraindications or cautions:
any known allergies to these drugs
to avoid
hypersensitivity reactions
; history of opioid
addition,
which may lead to opioid abstinence
syndrome
; history of MI or CAD,
which may be
exacerbated by the reversal of opioid depression
;
and current status of pregnancy and breastfeeding,
which require cautious use of these drugs
.
■
■
Perform a physical assessment to establish
baseline
status before beginning therapy and for any
potential adverse effects.
■
■
Assess the person’s neurological status, including
level of orientation, affect, reflexes and pupil size,
to evaluate CNS effects
; monitor respiratory rate
and auscultate lungs for adventitious sounds
to
evaluate respiratory status
.
■
■
Monitor vital signs, including pulse and blood
pressure,
to identify changes and risks to the CV
system.
■
■
Obtain an ECG as appropriate
to evaluate for
cardiac effects
.
Implementation with rationale
■
■
Maintain open airway and provide artificial
ventilation and cardiac massage as needed
to
support the person.
Administer vasopressors as
needed
to manage opioid overdose.
■
■
Administer naloxone challenge before giving
naltrexone
because of the serious risk of acute
withdrawal.
■
■
Provide continuous monitoring,
adjusting the dose
as needed, during treatment of acute overdose.
■
■
Provide comfort and safety measures
to help the
person cope with the withdrawal syndrome.
■
■
Ensure that people receiving naltrexone have been
opioid free for 7 to 10 days
to prevent severe
withdrawal syndrome.
Check urine opioid levels if
there is any question.
■
■
If the person is receiving naltrexone as part of
a comprehensive opioid or alcohol withdrawal
program, advise the individual to wear or carry a
MedicAlert warning
so that healthcare personnel
know how to treat the person in an emergency.
■
■
Institute comfort and safety measures, such as
side rails and assistance with ambulation,
to
ensure safety;
institute bowel program as needed
for treatment of constipation
; use environmental
controls
to decrease stimulation
; and provide,
small frequent meals
to relieve GI irritation if GI
upset is severe.
■
■
Offer support and encouragement
to help the
person cope with the effects of drug regimen.
■
■
Provide thorough teaching, including drug name
and prescribed dosage; measures to avoid adverse
effects; warning signs to report immediately that
may indicate possible problems; safety measures
such as avoiding driving, avoiding making
important decisions and having a responsible
person available for assistance; and the importance
of continued monitoring and evaluation
to enhance
knowledge about drug therapy and to promote
compliance.
Evaluation
■
■
Monitor response to the drug (reversal of opioid
effects, treatment of alcohol dependence).
■
■
Monitor for adverse effects (CV changes,
arrhythmias, hypertension).
■
■
Evaluate the effectiveness of the teaching plan
(person can give the drug name and dosage and
describe possible adverse effects to watch for,
specific measures to prevent them and warning
signs to report).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
