Chapter 15: Medicines optimization: ensuring quality and safety
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Post‐procedural considerations
Ongoing care
Patients should be monitored for signs of adverse effects from opioids and signs of toxicity. The most common side‐effects are constipation, nausea and vomiting, and drowsiness. All patients who are prescribed an opioid regularly should be prescribed laxatives concurrently to prevent constipation. Nausea and vomiting should subside after a few days but patients should be prescribed antiemetics and given reassurance. Drowsiness due to opioids should also subside after a few days; therefore, if patients experience this symptom, they should be given reassurance that it will pass in time (Regnard and Hockley [296]).
The warning signs of toxicity due to opioids are:
- pinpoint pupils
- confusion
- myoclonus
- hallucinations and nightmares
- respiratory depression.
If patients are showing signs of toxicity, the opioid dose should be reduced or stopped and as‐required opioid pain relief given (Regnard and Hockley [296]). Changing to an alternative opioid can also be considered (Regnard and Hockley [296]).
Naloxone, a specific opioid antagonist, has a high affinity for opioid receptors and reverses the effect of opioid analgesics. It is rarely needed but may be required in the case of opioid‐induced respiratory depression (a respiration rate of eight breaths per minute or below).
Care must be taken not to give naloxone to patients who have non‐life‐threatening opioid‐induced drowsiness, confusion or hallucinations, as this may risk reversing the opioid analgesic effect (Twycross et al. [356]). Naloxone should be used with care, especially in patients with opioid dependence; there have been Patient Safety Alerts whose guidance should be followed (NHS England [229], [231]).
Naloxone should be given in doses of 400 μg every 2 minutes until respiratory function is satisfactory, and doses should be titrated against respiratory function and not the level of consciousness of the patient in order to avoid total reversal of the analgesic effect (Twycross et al. [356]). Registered nurses administering opioids should be aware of local policy, procedures and protocols. Flumazenil is used for reversal of the effects of benzodiazepine toxicity.
