1-60

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1-60. NARCOTICS

a. The active principles of opium are alkaloids, of which there are about twenty. Two opium alkaloids widely used in the practice of medicine are morphine and codeine. Opium alkaloids and synthetic narcotics such as meperidine (Demerol^®) are narcotic agonist that have an affinity for certain receptor sites and depress brain cells involved in pain perception.

b. Morphine and codeine act mainly on the central nervous system (CNS) where they produce a combination of depressing and stimulating effects. Papaverine has little effect on the nervous system, but produces

relaxation of certain smooth muscles. The analgesic effect of morphine is indicated for the treatment of

severe pain. Morphine may be administered orally, intramuscularly, intravenously, subcutaneously, epidurally, and rectally.

c. Frequently seen side effects of opioid use include vertigo, faintness, and lightheadedness, occurring most often in ambulatory patients. Less frequently seen side effects include dry mouth, headache, anorexia, abdominal cramping, nervousness, increased anxiety, mental confusion, urinary retention or painful urination,

visual disturbances, and nightmares. Among the more serious adverse reactions are seizures, tinnitus, jaundice, breathing difficulties, and respiratory depression.

d. Nursing care implications consist of properly accounting for narcotics, observing the patient's response to the analgesic, and recording the degree and duration of pain relief and any adverse effects that may occur. Naloxone hydrochloride (Narcan^®) is an opioid antagonist; that is, it can reverse opioid-induced respiratory depression and sedation by displacing the opioids at the receptor site. Naloxone should be available on nursing units where opioid medications are used.