Opioids

Opioids

Drug monograph · NCLEX study reference
Therapeutic class	Opioid analgesic
Pharmacologic class	Opioid agonists (morphine, hydromorphone, fentanyl, oxycodone, codeine, meperidine); tramadol and tapentadol are atypical opioids; buprenorphine is a partial agonist (controlled, most C-II)
Onset / peak / duration	IV minutes; oral 30 to 60 minutes; transdermal fentanyl over hours with long duration; ER products extended.
Half-life / level	Varies; no routine level; fentanyl very potent (micrograms).
Routes	PO (oral), IV, IM, SubQ, Transdermal, Rectal, Buccal
High-alert (ISMP)	Yes
Black box warning	Yes (see Safety)
Antidote / reversal	Naloxone.
Pregnancy / lactation	Use cautiously; risk of neonatal withdrawal.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Opioids — Opioid analgesic; Opioid agonists (morphine, hydromorphone, fentanyl, oxycodone, codeine, meperidine); tramadol and tapentadol are atypical opioids; buprenorphine is a partial agonist (controlled, most C-II).

Identification

• Therapeutic class: Opioid analgesic.
• Pharmacologic class: Opioid agonists (morphine, hydromorphone, fentanyl, oxycodone, codeine, meperidine); tramadol and tapentadol are atypical opioids; buprenorphine is a partial agonist (controlled, most C-II).

Pharmacology

• Mechanism of action: Bind mu opioid receptors to reduce pain perception and transmission.
• Onset / peak / duration: IV minutes; oral 30 to 60 minutes; transdermal fentanyl over hours with long duration; ER products extended.
• Half-life / therapeutic level: Varies; no routine level; fentanyl very potent (micrograms).

Clinical use

• Indications: Moderate to severe pain; fentanyl also anesthesia; codeine also cough; specific agents for chronic pain.
• Usual dose, route, frequency: Titrated to pain by route; morphine PO, IV, IM, SubQ, rectal; fentanyl IV, transdermal, buccal.
• Maximum dose / adjustments: No fixed ceiling for pure agonists but titrate carefully; reduce in renal and hepatic impairment and the elderly; avoid meperidine in renal impairment and for chronic or repeated use (toxic metabolite causes seizures); transdermal fentanyl only for opioid-tolerant patients.

Safety

• Contraindications: Severe respiratory depression, paralytic ileus, acute asthma; meperidine with MAO inhibitors; codeine and tramadol in children and breastfeeding (ultrarapid metabolizers).
• Black box warning: Addiction, abuse, and misuse; life-threatening respiratory depression; accidental exposure (especially transdermal and pediatric); neonatal opioid withdrawal syndrome; and fatal interaction with benzodiazepines and other central nervous system depressants and alcohol.
• Interactions: Benzodiazepines and CNS depressants and alcohol (respiratory depression), serotonergic drugs (serotonin syndrome with tramadol, tapentadol, meperidine, fentanyl), MAO inhibitors (meperidine), CYP3A4 interactions (fentanyl, oxycodone).
• Pregnancy / lactation: Use cautiously; risk of neonatal withdrawal.
• High-alert: Yes.

Adverse effects

• Common side effects: Constipation (does not improve over time), sedation, nausea, pruritus, urinary retention, miosis.
• Serious effects to report: Respiratory depression (rate below 12), oversedation, hypotension, serotonin syndrome, withdrawal if stopped abruptly.
• Antidote / reversal: Naloxone.

Nursing process

• Assessment before administration: Pain score, respiratory rate and sedation level, blood pressure, bowel pattern, opioid tolerance.
• Interventions during therapy: Assess respirations and sedation before and after dosing; hold and notify for slow breathing or deep sedation; start a bowel regimen; have naloxone available; independent double-check per policy.
• Monitor: Respiratory rate, sedation scale, pain relief, bowel function, blood pressure.
• Evaluation / expected outcome: Adequate pain control with safe respirations.

Patient teaching

• Patient teaching: Take a stool softener and laxative; do not combine with alcohol or sedatives; do not drive until stable; store securely.
• Notify provider if: Slow or shallow breathing, extreme drowsiness, confusion, no bowel movement for several days.
• Administration tips: IV push slowly; verify fentanyl patch dose and opioid tolerance; never cut ER tablets.