Hydrocodone

INTRODUCTION

Indications

Used mainly in combination with nonopioid analgesics (acetaminophen/aspirin/ibuprofen) in the management of moderate-to-severe pain. Antitussive (usually in combination products with decongestants).

Action

Bind to opiate receptors in the CNS. Alter the perception of and response to painful stimuli while producing generalized CNS depression: Suppress the cough reflex via a direct central action. Therapeutic Effects: Decrease in severity of moderate pain. Suppression of the cough reflex.

Adverse Reactions/Side Effects

Noted for hydrocodone only; see acetaminophen/aspirin/ibuprofen monographs for specific information on individual components

CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. Resp: respiratory depression. CV: hypotension, bradycardia. GI: constipation, dyspepsia, nausea, vomiting. GU: urinary retention. Derm: 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, 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.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• 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.

Interventions

• Implement appropriate manual therapy techniques, physical agents, ...