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drug adverse effects of opiates

Adverse effects: 1) sedation, drowsiness a) level of arousal dose-dependent b) tolerance develops within a few days 2) supression of the hypothalamic-pituitary axis - decreased secretion of gonadotropins (LH, FSH) - hypogonadism (both genders), erectile dysfunction [2] - central origin; down regulation of GnRH [8] - decreased secretion of ACTH [2] - suboptimal morning cortisol in as many as 10% 3) nausea/vomiting (tolerance develops within a few days) 4) constipation a) tolerance does NOT develop to constipating effects [3] b) stimulant laxative (senna) all patients [8] c) stool softener (dosusate) as needed d) bulk laxative such as fiber usually insufficient [3] e) methylnaltrexone may help relieve constipation in palliative care patients without negating analagesic effect of opioid [8,10] 5) urinary retention [3] 6) respiratory depression 7) higher risk for invasive pneumococcal infection [11] 8) hypotension 9) hypothermia 10) hyporeflexia 11) pruritus, hives, flushing due to release of histamine from mast cells [1] - no evidence that itching improves with continued use (no reference provided) 12) miosis (usually) 13) true allergy uncommon, generally adverse effect [1] 14) cognitive slowing, hyperreflexia, myoclonus & hyperalgesia may result from long-term opioid use [8] 16) increased risk of major depression & anxiety & stress-related disorders [12] 17) xerostomia (tolerance develops within a few days) Overdose: 1) supportive measures a) maintenance of airway b) ventilatory support' c) avoid gastric lavage d) limit whole body irrigation to 'body packers' 1] body packers rarely require surgery, except with intestinal obstruction 2] avoid endoscopic attempts at removal (danger of rupture) 2) antidotes a) use judiciously, so as not to precipitate pain crisis b) naloxone c) nalmefene

Properties

DRUGS: opioid agonist FORM: drug adverse effects opioid receptor agonist

References

  1. Prescriber's Letter 13(2): 2006 Opioid Intolerance Decision Algorithm Detail-Document#: 220201
  2. Prescriber's Letter 19(2): 2012 Hormonal Effects of Opioids Detail-Document#: 280205 (subscription needed) http://www.prescribersletter.com
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996 pg 535
  6. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 682-683
  7. VA Greater Los Angeles Healthcare System
  8. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
  9. Bliesener N, Albrecht S, Schwager A et al Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005 Jan;90(1):203-6 PMID: 15483091
  10. Thomas J et al, Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 2008, 358:2332 PMID: 18509120
  11. Wiese AD, Griffin MR, Schaffner W et al Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case - Control Study. Ann Intern Med. 2018. Feb 13 PMID: 29435555 http://annals.org/aim/article-abstract/2672601/opioid-analgesic-use-risk-invasive-pneumococcal-diseases-nested-case-control - Dublin S, Von Korff M. Prescription Opioids and Infection Risk: Research and Caution Needed. Ann Intern Med. 2018. Feb 13 PMID: 29435579 http://annals.org/aim/article-abstract/2672606/prescription-opioids-infection-risk-research-caution-needed
  12. Brooks M New Risks of Prescription Opioids Discovered. Medscape - Nov 17, 2020. https://www.medscape.com/viewarticle/941170 - Rosoff DB, Smith GD, Lohoff FW Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders, A Multivariable Mendelian Randomization Analysis. JAMA Psychiatry. Published online November 11, 2020 PMID: 33175090 PMCID: PMC7658804 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772881