Codeine

 

 

Classification

 

  • Allergy

  • Cold

  • Cough

  • Opioid Analgesic

 

Indications:

 

  • management of mild to moderate pain

  • Antitussive in small doses

  • Off label use = management of diarrhea

 

Action

 

  • binds opiate receptors in the CNS

  • Alters perception and response to pain stimuli

  • general CNS depressant

  • depresses cough reflex

  • Decreases GI motility

 

Contraindications/Cautions:

 

  • Hypersensitivity

  • Head Trauma

  • Increased Intracranial pressure

  • severe renal hepatic or renal pulmonary disease

  • hypothryroidism

  • adrenal insufficiency

  • alcoholism

  • Geri or debilitated: dose reduction, increased susceptibility to CNS depression and constipation

  • Geri: Prostatic Hyperplasia

  • OB: use during labor, respiratory depression may occur in newborn

 

Adverse Rxns/Side Affects

 CNS

  • confusion

  • sedation

  • dysphoria

  • euphoria

  • floating feeling

  • hallucinations

  • headache

  • unusual dreams

EENTeyes, ears, nose and throat

  • blurred vision

  • diplopia

  • miosis (constriction of the pupil of the eye.)

 

Respiratory

  • Respiratory depression

CV

  • hypotension

  • bradycardia

GI

  • constipation

  • nausea

  • vomiting

 GU

  • urinary retention

 Derm

  • Flushing

  • Diaphoresis

 Misc

  • Physical Dependence

  • psychological dependence

  • tolerance

 

Interactions

 

  • MAO inhibitors (reduce initial dose to 25% of usual dose)

 

Additive CNS depression with:

  • alcoholics
  • antidepressants
  • antihistamines

  • sedative/hypnotics

 

Antagonistic effects (partial)

  • buprenorphine

  • butorphanol

  • nalbuphine

  • pentazocine

  • may ppt withdrawal in physically dependent patients

 

Nalbuphine and pentazocine may decrease analgesia

 

Dosage/Route

  • IV

  • IM

  • PO

 

Assessment

 

  • assess BP Pulse, Resp before and during administration

  • If resp is <10/min assess lvl of sedation

  • Initial drowsiness may diminish with subsequent use

  • Assess bowel function: increase fluid intake, bulk and laxatives

  • Simulant laxatives should be administered routinely if opioid use exceeds 2-3 days

 

Pain:

  • assess pain type, location and intensity before and 1hr after administration (peak)

  • increases of 25-50% should be administered until there is either a 50% decrease in numerical pain scale reported or pt reports satisfactory relief

  • An equianalgesic chart should be used when changing from one analgesic to another

 

Antidote: Narcan

 

Patient Teaching:

 

  • may cause drowsiness caution against driving or other activities that require high alertness

  • advise pt to change position slowly to avoid orthstatic hypotension

  • caution pt to turn, cough, breath deeply every 2hr to avoid atelectasis

  • Good oral hygiene, mouth rinse and sugarless gum may decrease fry mouth

Hazard Vallerand, April,  and Hopfer Deglin , Judith. 2007. Davis` Drug Guide for Nurses. 11th ed. F. A Davis Company, USA.

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