Page 478 - Clinical Application of Mechanical Ventilation

444 Chapter 13

TABLE 13-16 Narcotic Receptor Classifications

Physical Parameter mu kappa sigma

Pain sensation 2 2 0

Body temperature 2 0 1
Pulse rate 2 0 1

Pupils 2 2 1
Respiratory rate 2 2 1

CNS effect Sedation Hypnosis Delirium

0 no effect
1 increased effect
2 reduced effect
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TABLE 13-17 Opioid Drug Classifications

Drugs [Selected Examples] mu kappa sigma

1. Agonist [morphine, meperidine (Demerol), 1 1 0
fentanyl (Sublimaze)]
2. Agonist-antagonist [pentazocine, butorphanol] 2 1 1

3. Antagonist [naloxone (Narcan)] 2 2 2

0 no effect
1 agonist
2 antagonist
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Antagonist drugs such as naloxone (Narcan) are primarily used to reverse overdose
Antagonists block opiate of narcotics. Special care must be exercised with the use of naloxone in a patient
receptors.
being treated for severe pain. It may reverse an untoward adverse effect such as re-
spiratory depression while causing the return of severe pain (Levine, 1994).
Adverse Effects. Opioid analgesics produce many adverse effects. Table 13-18 outlines
the adverse effects that may occur to various systems or body locations of the patient.

Central Nervous System. Opiates cause sedation, respiratory depression, and myoclo-
Sedation, respira- nus (twitching or spasm of muscles) and their effects are dose-dependent (Levine,
tory depression, and shallow
breathing are the primary 1994). Clinically significant respiratory depression is more likely to occur with a
adverse effects of opioid large initial dose or inpatients with underlying pulmonary disease. Respiratory
analgesics on the CNS.
depression (decreased tidal volume and frequency) is mediated by opioid agonist
activity at the mu receptors of the brain stem (Teeple, 1990). Since opiates suppress
deep breathing, they may induce atelectasis, which can be prevented by activating
the automatic sigh mode on the ventilator.

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