Opioids for Pain Management - Summary Table

(October 24, 2023)

Abbreviations

Note: the references that were not cited within the text of the various sections were used to support the content of the table itself.


Full description, comments and references coming soon

Mechanism of action

Comments

Cautions of opioids

Summary of opioids adverse effects:

Opioids are inherently associated with critical adverse effects that have an increased risk of frequency and severity in the emergency department setting.


Black Box Warnings

All 4 listed opioids have a black box warning with universal grounds, but there are singularities in the black box of fentanyl, methadone and meperidine that are described afterwards.

Transversal black box warning that apply to fentanyl, morphine, methadone and meperidine (10, 11, 12, 13):

“WARNING: ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; NEONATAL OPIOID WITHDRAWAL SYNDROME; AND RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS”

Opioids hypoventilation - reversal with opioid antagonists

Opioid administration may lead to apnea or respiratory arrest. Any patient receiving opioids should be closely monitored. In case of respiratory depression, the primary management must include supportive ventilation measures such as bag-mask ventilation and oxygen, along with considering airway protection based on the individual case. Administration of an opioid antagonist, such as naloxone, should also be considered. (6, 14).

Naloxone (6, 14)


Naloxone infusion preparation:
2 mg in 500 ml of NaCl 0.9% or DW5 (concentration of 0.004 mg/ml).
Calculate initiation based on ⅔ of the wake-up dose per hour.


Naloxone pharmacology

US-FDA approved indications

Related drugs

References

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