Which side effects of opioid analgesics can have therapeutic ...

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Which side effects of opioid analgesics can have therapeutic benefits? (Select all that apply.)
 
  a. Biliary colic
  b. Cough suppression
  c. Suppression of bowel motility
  d. Urinary retention
  e. Vasodilation

Question 2

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm.
 
  On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of:
  a. a mild opioid overdose.
  b. decreased opioid drug levels.
  c. improved ventilation.
  d. worsening hypoxia.

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Answer to Question 1

ANS: B, C, E
Individual effects of morphine may be beneficial, detrimental, or both. Cough suppression is usually beneficial; suppression of bowel motility and vasodilation can be either beneficial or detrimental. Biliary colic and urinary retention are always detrimental side effects.

Answer to Question 2

ANS: D
The classic triad of symptoms of opioid overdose are coma, respiratory depression, and pinpoint pupils. The pupils may dilate as hypoxia worsens, and this symptom, along with continued respiratory depression (fewer than 12 breaths per minute), indicates worsening hypoxia. Fentanyl is a strong opioid, so this is not likely to be a mild overdose, because the patient was wearing two patches. Fentanyl continues to be absorbed even after the patches are removed because of residual drug in the skin, so the drug levels are not likely to be decreasing. The patient does not have improved ventilation, because the respiratory rate is still fewer than 12 breaths per minute.

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