Narcotics and Antimigraine Agents (AE, Drug-Drug Interactions)

NARCOTICS, NARCOTIC
ANTAGONISTS, AND
ANTIMIGRAINE AGENTS (AE,
DRUG-DRUG INTERACTIONS
June V. Sams
NARCOTICS AND ANTIMIGRAINE AGENTS
I. Narcotic Agonists
✓ codeine (generic)
✓ fentanyl (Actiq, Duragesic)
✓ hydrocodone (Hysingla ER, Zohydro ER)
✓ hydromorphone (Dilaudid)
✓ levorphanol (generic)
✓ meperidine (Demerol)
✓ methadone (Dolophine)
✓ opium (Paregoric)
✓ oxycodone (OxyContin, Oxecta)
✓ oxymorphone (Numorphan)
✓ remifentanil (Ultiva)
✓ sufentanil (Sufental)
✓ tapentadol (Nucyta)
✓ tramadol (Ultram)
II. Narcotic Agonist-Antagonist
✓ buprenorphine (Buprenex)
✓ butorphanol (generic)
✓ nalbuphine (generic)
✓ pentazocine (Talwin)
III. Narcotic Antagonist
✓ naloxone (Evzio)
✓ naltrexone (ReVia)
IV. Antimigraine agents
✓ Ergot Derivatives
o dihydroergotamine (Migranal, D.H.E. 45)
o ergotamine (Ergomar)
✓ Triptans
o almotriptan (Axert)
o eletriptan (Relpax)
o trovatriptan (Frova)
o narariptan (Amerge)
o rizatriptan (Maxalt, Maxalt-MLT)
o sumatriptan (Imitrex)
o zolmitriptan (Zomig, Zomig-ZMT)
I. NARCOTIC AGONIST
• These are drugs that react with the opioid receptors throughout the body to
cause analgesia, sedation, or euphoria
• These are classified as controlled substances due to its potential in the
development of physical dependence while taking drugs.
ADVERSE EFFECTS
o GI tract: nausea, vomiting, constipation, and biliary spasm
o Respiratory Tract: respiratory depression with apnea, cardiac arrest,
and shock
o Neurological: light-headedness, dizziness, psychoses, anxiety, fear,
hallucinations, pupil constriction, and impaired mental processes
o GU: ureteral spasm, urinary retention, hesitancy and loss of libido
o CV: orthostatic hypotension
o Others: sweating and dependence, both physical and psychological
o Narcotic Agonists + Barbiturate general anesthetic, or phenothiazines
and monoamine oxidase inhibitors (MOA) = increased risk of
respiratory depression, hypotension, and sedation or coma
o Tapentadol + Selective Serotonin re-uptake inhibitors (SSRIs),
MAOIs, tricyclic antidepressants (TCAs), and St. John’s Wort =
increased risk of potentially life-threatening serotonin syndrome
(AVOID!)
II. NARCOTIC AGONIST-ANTAGONIST

• These drugs stimulate certain opioid receptors but block other such receptors.
• Have less abuse potential
ADVERSE EFFECTS
o Respiratory: Respiratory depression with apnea and suppression of
the cough reflex
o GI tract: nausea, vomiting, biliary spasm
o CNS: Light-headedness, dizziness, psychoses, anxiety, fear,
hallucination, and impaired mental processes.
o GU: ureteral spasm, urinary retention, hesitancy, and loss of libido
o Others: sweating and dependence, both physical and psychological
o Narcotic Agonist-Antagonist + Barbiturate general anesthetic =
increased risk of respiratory depression, hypotension, and
sedation or coma
o Use of narcotic agonist-antagonist in patients who have previously
received any narcotic puts these patients at risk for increased AE,
including respiratory depression.
o Pentazocine + Tripelennamine (T’s and Blues) = hallucinogenic,
euphoric effects, with potentially fatal complications
NURSING RESPONSIBILITIES
o Assess for contraindications and cautions
o Assess for orientation, affect, reflexes, and pupil size to evaluate any
CNS effects
o Monitor liver and renal function lab test results
o Perform baseline and periodic pain assessments with the patient
o Monitor injection sites for irritation and extravasation
o Use extreme caution when injecting these drugs into any body area
that is chilled or has poor perfusion or shock.
o Use additional measures to relieve pain
o Reassure patients that the risk of addiction is minimal.
o Monitor for AE (CNS Changes, GI depression, respiratory depression,
arrhythmias, hypertension)
III. NARCOTIC ANTAGONISTS

• They bind strongly to opioid receptors but do not activate them.
• They block opioid receptors and reverse the effects of opioids, including
respiratory depression, sedation, psychomimetic effects, and hypotension.
ADVERSE EFFECTS
o Most common AE: acute narcotic abstinence syndrome (characterized
by nausea, vomiting, sweating, tachycardia, hypertension,
tremulousness, and feeling of anxiety)
o CNS: CNS excitement and reversal of analgesia are esp. common after
surgery.
o CV: tachycardia, BP changes, dysrhythmias, and pulmonary edema.
o Larger doses of Narcotic Antagonists = reversed effects of
buprenorphine, butorphanol, nalbuphine, or pentazocine
NURSING RESPONSIBILITIES
o Assess for contraindications or cautions
o Perform a physical assessment to establish baseline data
o Assess for orientation, affect, reflexes, and pupil size to evaluate any
CNS effects
o Obtain an ECG as appropriate
o Administer naloxone challenge before giving naltrexone
o Ensure that patients receiving naltrexone have been narcotic free for
7-10 days. Check urine opioid levels
o Monitor for AE (CV changes, arrhythmias, hypertension)

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NARCOTICS, NARCOTIC

II. NARCOTIC AGONIST-ANTAGONIST

III. NARCOTIC ANTAGONISTS

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