oxymorphone


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Related to oxymorphone: hydromorphone, Oxymorphone hydrochloride, Opana

analgesic

 [an″al-je´zik]
1. relieving pain.
2. pertaining to analgesia.
3. an agent that relieves pain without causing loss of consciousness.
narcotic analgesic opioid analgesic.
nonsteroidal antiinflammatory analgesic (NSAIA) nonsteroidal antiinflammatory drug.
opiate analgesic (opioid analgesic) any of a class of compounds that bind with a number of closely related specific receptors (opioid receptors) in the central nervous system to block the perception of pain or affect the emotional response to pain; such compounds include opium and its derivatives, as well as a number of synthetic compounds, and are used for moderate to severe pain. Chronic administration or abuse may lead to dependence.

oxymorphone

(ox-i-mor-fone) ,

Opana

(trade name),

Opana ER

(trade name)

Classification

Therapeutic: opioid analgesics
Pharmacologic: opioid agonists
Pregnancy Category: C

Indications

Management of moderate to severe pain. Extended-release tablets should only be used in patients who require continuous, around-the-clock management of chronic pain.Supplement in balanced anesthesia.

Action

Binds to opiate receptors in the CNS.
Alters the perception of and response to painful stimuli, while producing generalized CNS depression.

Therapeutic effects

Decrease in pain.

Pharmacokinetics

Absorption: 10% absorbed following oral administration. Food and alcohol significantly ↑absorption (38%). Well absorbed following IM or subcut administration.
Distribution: Widely distributed; crosses placenta, enters breast milk.
Metabolism and Excretion: Mostly metabolized by the liver; at least 2 metabolites are pharmacologically active, <1% excreted unchanged in urine.
Half-life: 2.6–4 hr.

Time/action profile (analgesic effects)

ROUTEONSETPEAKDURATION
POunknownunknown4–6 hr
PO ERunknownunknown12 hr
IM10–15 min30–90 min3–6 hr
IV5–10 min15–30 min3–6 hr
Subcut10–20 minunknown3–4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Concurrent alcohol;Moderate/severe hepatic impairment;Significant respiratory depression (unless monitoring and resuscitative equipment are readily available);Acute or severe bronchial asthma (extended-release);Acute, mild, intermittent, or postoperative pain (extended-release);Paralytic ileus.
Use Cautiously in: Acute alcoholism or delirium tremens or other toxic psychoses;Mild hepatic impairment;Head injury/↑ intracranial pressure (may obscure neurologic signs and further ↑ pressure);Volume depletion or drugs that may cause hypotension including diuretics and phenothiazines (↑ risk of severe hypotension);Circulatory shock (may ↑ risk of severe hypotension);Adrenocortical insufficiency;Seizure disorders;Hypothyroidism;Prostatic hypertrophy or ureteral stricture;Severe pulmonary or renal impairment;Biliary tract disease or pancreatitis; Obstetric: Use only in pregnancy if maternal benefit outweighs fetal risk; Lactation: Lactation; Geriatric: Blood levels are ↑; dose accordingly.
Exercise Extreme Caution in: Conditions association with hypoxia, hypercapnea, ↓ respiratory reserve (including asthma, COPD, cor pulmonale, morbid obesity, sleep apnea, myxedema, kyphoscoliosis, CNS depression and coma).

Adverse Reactions/Side Effects

Central nervous system

  • confusion (most frequent)
  • sedation (most frequent)
  • dizziness
  • dysphoria
  • euphoria
  • floating feeling
  • hallucinations
  • headache
  • unusual dreams

Ear, Eye, Nose, Throat

  • blurred vision
  • diplopia
  • miosis

Respiratory

  • respiratory depression (life-threatening)

Cardiovascular

  • orthostatic hypotension

Gastrointestinal

  • constipation (most frequent)
  • dry mouth
  • nausea
  • vomiting

Genitourinary

  • urinary retention

Dermatologic

  • flushing
  • sweating

Miscellaneous

  • physical dependence
  • psychological dependence
  • tolerance

Interactions

Drug-Drug interaction

Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—↓ initial dose of oxymorphone to 25% of usual dose).↑ risk of CNS depression, hypotension and respiratory depression with alcohol, other opioids or CNS depressants including sedatives, hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, or sedating antihistamines ; may initiate therapy with 1/3 to 1/2 usual starting dose.Drugs that may cause volume depletion or hypotension including diuretics, phenothiazines may ↑ risk of severe hypotension.Administration of partial-antagonist opioid analgesics may precipitate withdrawal in physically dependent patients.Nalbuphine, buprenorphine, or pentazocine ↓ analgesia.Concomitant use of kava-kava, valerian, or chamomile can ↑ CNS depression.

Route/Dosage

Larger doses may be required during chronic therapy
Oral (Adults) Opioid-naive patients—10–20 mg every 4–6 hr, some patients may require initial dose of 5 mg, not to exceed 20 mg. Once optimal analgesia is obtained, chronic pain patients may be converted to an equivalent 24-hr dose given as extended release tablets every 12 hr.
Subcutaneous Intramuscular (Adults) 1–1.5 mg q 3–6 hr as needed. Analgesia during labor—0.5–1 mg.
Intravenous (Adults) 0.5 mg q 3–6 hr as needed; ↑ as needed.

Availability (generic available)

Tablets (Opana): 5 mg, 10 mg
Extended-release tablets (Opana ER): 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg
Solution for injection: 1 mg/mL

Nursing implications

Nursing assessment

  • Assess type, location, and intensity of pain prior to and 1 hr following IM and 15–30 min (peak) following IV administration. When titrating opioid doses, increases of 25–50% should be administered until there is either a 50% reduction in the patient’s pain rating on a numerical or visual analogue scale or the patient reports satisfactory pain relief. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal.
  • Patients taking controlled-release tablets should also be given supplemental short-acting opioid doses for breakthrough pain.
  • An equianalgesic chart (see ) should be used when changing routes or when changing from one opioid to another.
  • Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25–50%. Initial drowsiness will diminish with continued use.
  • Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive oxymorphone for pain do not develop psychological dependence. Progressively higher doses may be required to relieve pain with long-term therapy.
  • Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives. Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated.
  • Lab Test Considerations: May ↑ plasma amylase and lipase levels.
  • If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain.

Potential Nursing Diagnoses

Acute pain (Indications)
Chronic pain (Indications)
Risk for injury (Side Effects)

Implementation

  • high alert: Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, and infusion pump settings.
  • Explain therapeutic value of medication prior to administration to enhance the analgesic effect.
    • Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe.
    • Coadministration with nonopioid analgesics may have additive analgesic effects and may permit lower doses.
    • Medication should be discontinued gradually after long-term use to prevent withdrawal symptoms.
  • Oral: Administer at least 1 hr prior to or 2 hr after eating.
  • Extended Release: Swallow controlled-release tablets whole; do not break, crush, or chew. Titrate to mild to no pain with regular use of no more than 2 doses of supplemental analgesia (rescue) per 24 hr. Dose should be based on 24-hr opioid requirement determined with short-acting opioids then converted to controlled-release form.
    • If patient is opioid-naive, start with 5 mg every 12 hr, then titrate in increments of 5–10 mg every 12 hr every 3–7 days to a level that provides adequate analgesia with minimal side effects.
    • If converting from Opana to Opana ER, administer half the patient's total daily dose of Opana as Opana ER every 12 hr.
    • If converting from parenteral oxymorphone, administer 10 times the patient's total daily parenteral oxymorphone dose as Opana ER in two equally divided doses every 12 hr.
    • If converting from other opioids, 10 mg of oral oxymorphone is equianalgesic to hydrocodone 20 mg, oxycodone 20 mg, methadone 20 mg, and morphine 30 mg orally.
  • Intravenous Administration
  • Administer undiluted. Concentration: 1 mg/mL.
  • Rate: Give over 2–3 min

Patient/Family Teaching

  • Instruct patient on how and when to ask for pain medication.
  • Instruct patient to take oxymorphone as directed and not to adjust dose without consulting health care professional. Take missed doses as soon as possible if on chronic therapy. If almost time for next dose, skip dose and return to regular schedule. Do not double doses unless advised by health care professional. Do not stop taking oxymorphone abruptly, may cause withdrawal symptoms. Discontinue gradually under supervision of health care professional. Caution patient to keep medication out of reach of children and pets.
  • Advise patient that oxymorphone is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed.
  • Caution patient not to share this medication; may cause harm or death and is against the law.
  • Medication may cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise patient to make position changes slowly to minimize orthostatic hypotension.
  • Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.
  • Inform patients taking Opana ER tablets that soft mass resembling tablets may appear in stool; active medication was already absorbed.
  • Advise patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status.

oxymorphone

/oxy·mor·phone/ (-mor´fōn) an opioid analgesic, used as the hydrochloride salt as an analgesic and anesthesia adjunct.
References in periodicals archive ?
In addition, oxymorphone was excreted mainly as a conjugate and noroxycodone was excreted mostly in an unconjugated form.
patent litigation with regard to the production and sale of its Oxymorphone Hydrochloride Extended-Release Tablets approved by the U.
Accidental Ingestion Accidental ingestion of even one dose of OPANA ER, especially by children, can result in a fatal overdose of oxymorphone.
Its TPM/oxymorphone patch product in a 2013 clinical trial was able to deliver therapeutic levels of oxymorphone into the bloodstream, a world first.
Noroxymorphone is a secondary metabolite of oxycodone formed mainly after O-demethylation of noroxycodone (mainly catalyzed by CYP2D6) and at a lower rate after N-demethylation of oxymorphone (mainly catalyzed by CYP3A4 and 2D6).
The following were obtained from Radian Corporation: (a) codeine, morphine, hydrocodone, hydromorphone, and oxycodone, which were used to prepare calibrators; (b) deuterated codeine, morphine, hydrocodone, and hydromorphone, which were used as internal standards; and (c) oxymorphone and norcodeine, which were used for interference studies.
Schedule II opioid substances which include hydromorphone, morphine, oxycodone, fentanyl, oxymorphone and methadone have the highest potential for abuse and risk of fatal overdose due to respiratory depression.
Dymek, 22, of 7 Pioneer Valley Drive, Spencer, charged with possession of oxymorphone and oxycodone with intent to distribute, possession of oxymorphone, and possession of oxycodone, continued to Jan.
Schedule II opioid substances, which include morphine, oxycodone, hydromorphone, oxymorphone, and methadone, have the highest potential for abuse and risk of fatal overdose due to respiratory depression.
2), (3) The primary drugs used for the treatment of pain are the opioids oxycodone, hydrocodone, and oxymorphone.
The opioid drugs on the FDA's list are mostly transdermal or extended-release oral formulations, and include brandname products fentanyl (Duragesic extended-release transdermal system), methadone (Dolophine tablets), oxycodone (OxyContin extended-release tablets), oxymorphone (Opana extended-release tablets), and several extended-release oral morphine products.
Detection and quantitation by GC/MS of opiates such as the keto-opiates hydrocodone, hydromorphone, oxycodone, and oxymorphone are desirable not only because of their potential interference with the measurement of codeine and morphine but also because of their potential for abuse.