Opioids on the NCLEX
Opioid class for NCLEX: full agonists, partial agonists, antagonists, naloxone, respiratory depression.
Opioids are high-alert meds on every floor. The NCLEX tests respiratory depression, naloxone, and the difference between agonists, partial agonists, and antagonists.
Full agonists
Morphine, hydromorphone, fentanyl, oxycodone, hydrocodone, methadone, meperidine (avoid, metabolite neurotoxicity).
Partial agonists / mixed
Buprenorphine (Suboxone), nalbuphine, butorphanol. Ceiling effect on respiratory depression.
Antagonist
Naloxone (Narcan), pure antagonist. Reverses respiratory depression. Short half-life, may need repeat dosing. Naltrexone, long-acting, used for opioid use disorder.
Side effects
Respiratory depression (the killer). Sedation. Constipation (prophylactic stool softener/stimulant). Itching (histamine release). Hypotension. Urinary retention.
Tolerance and withdrawal
Tolerance develops to sedation/respiratory effects faster than analgesia. Withdrawal is unpleasant but not fatal (unlike benzos/alcohol).
Frequently asked
Respiratory rate to hold?
Generally hold for RR <12 in adult. Reassess.
PCA pump and family pushing the button?
Never. PCA-by-proxy is a sentinel event. Counsel family explicitly.
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