Benzodiazepines and Opioids: Uses, Effects, and Safety

Advantages and Disadvantages of Short-Acting and Long-Acting Benzodiazepines

Short-acting benzodiazepines present a lower risk of causing excessive sleepiness but cause more problems with insomnia and anxiety when discontinued. Long-acting benzodiazepines increase the risk of sedation because they accumulate in the body but cause fewer withdrawal symptoms when discontinued.

Respiratory Monitoring in Patients Treated with Benzodiazepines

You should always monitor SpO2 continuously, as well as the risk of aspiration. It is necessary to have a suction unit ready.

Preventive Technique for Pain Control

It is based on maintaining constant therapeutic levels of analgesics or anti-inflammatory drugs. Medication should be administered at the scheduled interval, even if the person has no pain.

Pharmacokinetics of Morphine Hydrochloride

Morphine hydrochloride is readily absorbed by most routes of administration. The onset of action is faster via the intravenous route. Subcutaneous absorption of water-soluble opioids is faster than that of fat-soluble opioids. It has good oral tolerance.

Kidney Failure in Morphine Hydrochloride Poisoning

The elimination of morphine and its metabolites occurs renally. Therefore, people with kidney failure may experience an accumulation of these molecules, leading to a prolonged effect.

Half-Life of Morphine in Healthy Adults

The half-life of morphine in a normal adult is 2-3 hours.

Effects of Morphine on the Body

• Miosis
• Analgesia
• Respiratory depression: a dose-dependent effect.
• Inhibition of gastrointestinal peristalsis
• Nausea/vomiting
• Sedation
• Feeling of well-being (euphoria)
• Tolerance

Complications from Morphine Hydrochloride Use and Monitoring

• Respiratory depression: especially with parenteral use and high doses. People at risk include the elderly, children, and those with kidney failure, liver failure, or respiratory diseases (e.g., COPD).
  Monitoring:

  • Monitor respiratory rate and depth.
  • Monitor oxygen saturation (SpO2).
  • Assess level of consciousness.

• Constipation
  Monitoring:

  • Monitor bowel movements.
  • Assess for abdominal distension.
  • Encourage fluid and fiber intake.

• Excessive sedation/coma
  Monitoring:

  • Assess level of consciousness.
  • Monitor vital signs.
  • Monitor for signs of respiratory depression.

• Nausea and vomiting
  Monitoring:

  • Assess for nausea and vomiting.
  • Administer antiemetics as needed.
  • Monitor hydration status.

• Tolerance: usually with chronic use.
  Monitoring:

  • Assess pain levels regularly.
  • Monitor for increasing dose requirements.
  • Consider alternative pain management strategies.

• Ineffectiveness of the dose: persistence of pain or inadequate relief.
  Monitoring:

  • Assess pain levels regularly using a pain scale.
  • Evaluate the effectiveness of the current dose.
  • Adjust the dose or consider alternative analgesics as needed.

Effects of Codeine on the Body

• Cough suppressant
• Antidiarrheal
• Mild analgesic, usually in combination with NSAIDs (e.g., acetaminophen)

Its analgesic effect is not due to codeine's affinity for opioid receptors. Instead, a small fraction (10%) is converted to morphine during metabolism. A therapeutic dose does not usually produce sedation. It is less likely to cause constipation than morphine.

Pethidine (Meperidine) in Patients with Cirrhosis or Hepatic Impairment

In persons with cirrhosis or hepatic impairment, pethidine (meperidine) administration may increase drug bioavailability by 80%, leading to increased adverse effects such as respiratory depression.

Pharmacokinetics of Pethidine (Meperidine)

Absorption: Pethidine is well absorbed by most routes, but injectable administration is preferred. It is metabolized in the liver and eliminated by the kidneys.

Effects of Pethidine (Meperidine) on the Body

• Analgesia
• Sedation
• Respiratory depression
• Euphoria (similar to morphine)
• Increased heart rate
• Does not produce miosis
• Lower rate of constipation compared to morphine
• Further delay in gastric emptying, hindering the absorption of oral drugs
• Nausea and vomiting