Pediatrics : Side effects of Opioids

      • Side effects of Opioids
        • General
          • Constipation (possibly severe)
          • Respiratory depression
          • Sedation
          • Nausea and vomiting
          • Agitation, euphoria
          • Mental clouding
          • Hallucinations
          • Orthostatic hypotension
          • Pruritus
          • Urticaria
          • Sweating
          • Miosis (may be sign of toxicity)
          • Anaphylaxis (rare)
        • Signs of Tolerance
          • Decreasing pain relief
          • Decreasing duration of pain relief
        • Signs of Withdrawal Syndrome in Patients With Physical Dependence
          • Initial Signs of Withdrawal
            • Lacrimation
            • Rhinorrhea
            • Yawning
            • Sweating
          • Later Signs of Withdrawal
            • Restlessness
            • Irritability
            • Tremors
            • Anorexia
            • Dilated pupils
            • Gooseflesh
            • Nausea, vomiting
        • Managing Opioid-Induced Respiratory Depression
          • If Respirations Are Depressed
            • Assess sedation level.
            • Reduce Infusion by 25% When Possible.
            • Stimulate patient (shake shoulder gently, call by name, ask to breathe).
            • Administer oxygen.
          • If Patient Cannot Be Aroused or Is Apneic
            • Initiate resuscitation efforts as appropriate.
            • Administer naloxone (Narcan):
              • For children weighing less than 40 kg (88 lbs), dilute 0.1 mg naloxone in 10 mL sterile saline to make 10 mcg/mL solution, and give 0.5 mcg/kg.
              • For children weighing more than 40 kg (88 lbs), dilute 0.4-mg ampule in 10 mL sterile saline and give 0.5 mL.
            • Administer bolus by slow intravenous (IV) push every 2 minutes until effect is obtained.
            • Closely monitor patient. Naloxone’s duration of antagonist action may be shorter than that of the opioid, requiring repeated doses of naloxone.
      • Fear of Opioid Addiction
        • One of the reasons for the unfounded but prevalent fear of addiction from opioids used to relieve pain is a misunderstanding of the differences between physical dependence, tolerance, and addiction.
          • Physical dependence 
            • Is a physiologic state in which abrupt cessation of the opioid, or administration of an opioid antagonist, results in a withdrawal syndrome. 
            • Physical dependence on opioids is an expected occurrence in all individuals who continuously use opioids for therapeutic or nontherapeutic purposes. It does not, in and of itself, imply addiction.
          • Tolerance 
            • Is a form of neuroadaptation to the effects of chronically administered opioids (or other medications) that is indicated by the need for increasing or more frequent doses of the medication to achieve the initial effects of the drug. 
            • A person may develop tolerance both to the analgesic effects of opioids and to some of the unwanted side effects, such as respiratory depression, sedation, or nausea. Tolerance is variable in occurrence, but it does not, in and of itself, imply addiction.
          • Addiction 
            • Is characterized by a persistent pattern of dysfunctional opioid use that may involve any or all of the following:
              • Adverse consequences associated with the use of opioids
              • Loss of control over the use of opioids
              • Preoccupation with obtaining opioids, despite the presence of adequate analgesia

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