McKenna's Pharmacology for Nursing, 2e

C H A P T E R 2 6 Opioids, opioid antagonists and antimigraine agents 409

Care considerations for people receiving opioid antagonists

■■ 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. ■ ■ 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). ■ ■ 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. ■ ■ Monitor for adverse effects (CV changes, arrhythmias, hypertension). KEY POINTS

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.