Methadone HCl Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Methadone hydrochloride

Brand Name: Dolophine, Methadone HCl Diskets, Methadone HCl Intensol, Methadose

Pregnancy Category C, C-II controlled substance

Drug class: Narcotic agonist analgesic

Therapeutic actions

Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins); when used in approved methadone maintenance programs, can substitute for heroin, other illicit narcotics in patients who want to terminate a drug use.

Indications

· Relief of severe pain

· Detoxification and temporary maintenance treatment of narcotic addiction (ineffective for relief of general anxiety)

Contraindications:

· Contraindicated with hypersensitivity to narcotics, diarrhea caused by poisoning (before toxins are eliminated), bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial pressure.

· Use cautiously with acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, convulsive disorders, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, pregnancy prior to labor (crosses placenta; neonatal withdrawal observed in infants born to drug-using mothers; safety for use in pregnancy before labor not established), labor or delivery (administration of narcotics to mother can cause respiratory depression of neonate--risk greatest for prematures), renal or hepatic dysfunction, lactation.

Adverse effects

Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions, miosis, visual disturbances, suppression of cough reflex

Facial flushing, peripheral circulatory collapse, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope

Pruritus, urticaria, laryngospasm, bronchospasm, edema, hemorrhagic urticaria (rare)

Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis

Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

Tissue irritation and induration (SC injection)

Drug Interactions:

· Potentiation of effects of methadone with barbiturate anesthetics–decrease dose of meperidine when coadministering

· Decreased effectiveness of methadone with hydantoins, rifampin, urinary acidifiers (ammonium chloride, potassium acid phosphate, sodium acid phosphate)

· Increased effects and toxicity of methadone with cimetidine, ranitidine

Nursing considerations

· Give to nursing women 4–6 hr before the next feeding to minimize the amount in milk.

· Provide narcotic antagonist, equipment for assisted or controlled respiration on standby during parenteral administration.

· Use caution when injecting SC into chilled areas of the body or in patients with hypotension or in shock--impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.