Mosby's 2014 Nursing Drug Reference (305 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
HIGH ALERToxyCODONE (Rx)
(ox-i-koe′done)
ETH-Oxydose, Oxecta, Oxyfast, Oxy-CONTIN, Roxicodone, Supeudol
Endodan, Percodan
Endocet, Magnacet, Percocet, Primalev, Roxicet, Tylox, Xolox
Func. class.:
Opiate analgesic
Chem. class.:
Semisynthetic derivative
Do not confuse:
Percodan
/Decadron
Roxicet
/Roxanol
Tylox
/Xanax/Trimox/Wymox
OxyCODONE
/HYDROcodone
OxyCODONE
/OxyCONTIN
Roxicodone
/roxanol
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception
Moderate to severe pain
Unlabeled uses:
Postherpetic neuralgic (cont rel)
Hypersensitivity, addiction (opiate), asthma, ileus
Black Box Warning:
Respiratory depression
Precautions:
Pregnancy (B), breastfeeding, child <18 yr, addictive person
ality, increased intracranial pressure, MI (acute), severe heart disease, renal/hepatic disease, bowel impaction
Black Box Warning:
Opioid-naive patients, substance abuse, accidental exposure, potential for overdose/poisoning, status asthmaticus
Calculator
• Adult:
PO
10-30 mg q4hr (5-15 mg q4-6hr for opiate-naive patients)
Conc sol is extremely concentrated; do not use interchangeably; CONT REL
10 mg q12hr for opiate-naive patients
Available forms:
OxyCODONE:
cont rel tabs (OxyCONTIN) 10, 15, 20, 30, 40, 80, 160 mg; immediate rel tabs 5, 7.5, 10, 15, 20, 30 mg; immediate rel caps 5 mg; oral sol 5 mg/5 ml, 20 mg/ml;
oxyCODONE with acetaminophen:
tabs 2.5 mg/300 mg, 2.5 mg/325 mg, 5 mg/300 mg, 5 mg/325 mg, 7.5 mg/325 mg, 7.5 mg/500 mg, 10 mg/325 mg, 10 mg/400 mg, 10 mg/650 mg; caps 5 mg/500 mg; oral sol 5 mg/325 mg/5 ml;
oxyCODONE with aspirin:
4.88/325 mg;
oxyCODONE with ibuprofen:
5 mg/400 mg
•
OxyCODONE should be titrated from the initial recommended dosage to the dosage required to relieve pain
•
There is no maximum dosage of oxyCODONE; however, careful titration is required until tolerance develops to some of the side effects (drowsiness, respiratory depression)
•
May be administered with food or milk to minimize GI irritation
•
Oxecta brand tablets:
Swallow whole; do not crush or dissolve; owing to nature of this formulation, do not presoak, lick, or otherwise wet tablet before administering dose; administer 1 tablet at a time; allow patient to swallow each tablet separately with sufficient liquid to ensure prompt and complete transit through the esophagus; do not use this brand for administration via nasogastric, gastric, or other feeding tubes because it can obstruct feeding tubes
•
Administer whole; do not crush, chew, or break in half; taking chewed, broken, or crushed controlled-release tablets could lead to the rapid release and absorption of a potentially toxic dose of oxyCODONE
•
OxyCONTIN brand tablets:
Owing to hydro-gelling nature of the 2010 reformulation do not presoak, lick, or otherwise wet tablet before administering dose; administer 1 tablet at a time; allow patient to swallow each tablet separately with sufficient liquid to ensure prompt and complete transit through the esophagus
•
OxyCODONE controlled-release (OxyCONTIN)
60 mg and 80 mg tablets are for use only in opioid-tolerant patients
•
May be administered without food
•
OxyFAST
is a highly concentrated solution (20 mg oxyCODONE/ml), and care should be taken in dispensing and administering this medication; for ease of administration, the solution may be added to 30 ml of a liquid or semisolid food; if the medication is placed in liquid or food, the patient needs to consume it immediately; do not store diluted oxyCODONE for future use
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria
, fatigue, abnormal dreams/thoughts, hallucinations
CV:
Palpitations, bradycardia, change in B/P
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea, vomiting, anorexia, constipation, cramps
, gastritis, dyspepsia, biliary spasms
GU:
Increased urinary output, dysuria, urinary retention
INTEG:
Rash
, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression
PO:
Onset 15-30 min, peak 1 hr, duration reg rel 2-6 hr, cont rel 12 hr, metabolized by liver, excreted in urine, crosses placenta, excreted in breast milk, half-life 3-5 hr, protein binding 45%
Increase:
effects with other CNS depressants—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Increase:
oxyCODONE level: CYP3A4 inhibitors
Increase:
toxicity—cimetidine, MAOIs
Increase:
sedative effect—kava, St. John’s wort, valerian
Increase:
amylase, lipase
•
Pain:
intensity, location, type, characteristics; need for pain medication by pain/sedation scoring; physical dependence
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
CNS changes:
dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions:
rash, urticaria
Black Box Warning:
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min; B/P, pulse
•
Bowel status:
constipation; stimulant laxative may be needed with fluids, fiber
Black Box Warning:
Substance abuse:
assess for substance abuse in patient/family/friends before prescribing: monitor for abuse
Black Box Warning:
Accidental exposure:
dispose of properly away from pets, children
•
Storage in light-resistant area at room temp
•
Assistance with ambulation
•
Safety measures: nightlight, call bell within easy reach
•
Therapeutic response: decrease in pain without dependence
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from extended use
•
That withdrawal symptoms may occur after long-term use: nausea, vomiting, cramps, fever, faintness, anorexia
•
To avoid CNS depressants, alcohol
•
To avoid driving, operating machinery if drowsiness occurs
Naloxone (Narcan) 0.2-0.8 mg IV, O
2
, IV fluids, vasopressors, caution with patients physically dependent on opioids
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERToxymorphone (Rx)
(ox-i-mor′fone)
Opana, Opana ER
Func. class.:
Opiate analgesic
Chem. class.:
Semisynthetic phenanthrene derivative