Codeine

INTRODUCTION

Indications

Management of mild-to-moderate pain. Antitussive (in smaller doses). Unlabeled Use: Management of diarrhea.

Action

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Decreases cough reflex. Decreases GI motility. Therapeutic Effects: Decreased severity of pain. Suppression of the cough reflex. Relief of diarrhea.

Adverse Reactions/Side Effects

CNS: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. Resp: respiratory depression. CV: hypotension, bradycardia. GI: constipation, nausea, vomiting. GU: urinary retention. Derm: flushing, sweating. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria, confusion, hallucinations). Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

• Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fainting, or other symptoms.

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• If used as a cough suppressant, assess cough and lung sounds (See Appendix K) and monitor sputum production. Document whether this drug is effective as a cough suppressant.

• If used as an antidiarrheal, monitor improvements in GI symptoms (decreased diarrhea, cramping, etc.) to help determine if drug therapy is successful.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

• Because of the risk of respiratory depression, bradycardia, and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiratory rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

• Guard against falls ...