Propoxyphene Hydrochloride

INTRODUCTION

Indications

Mild-to-moderate pain.

Action

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression. Therapeutic Effects: Decrease in pain.

Adverse Reactions/Side Effects

CNS: disorientation, dizziness, weakness, dysphoria, euphoria, headache, insomnia, paradoxical excitement, sedation. EENT: blurred vision. CV: hypotension. GI: nausea, abdominal pain, constipation, vomiting. Derm: rash. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria, disorientation, excitement). 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 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.

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 hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart 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 and trauma (hip fractures, head injury). Implement fall-prevention strategies (See Appendix E), especially if patient exhibits sedation, dizziness, or blurred vision.

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Advise patient that opioid analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

• Educate patient about the dangers of opioid overdose; encourage patient to adhere to proper dosing schedule.

• Emphasize that the risk of physical addiction (tolerance and dependence) is usually minimal during short-term treatment of pain. Advise patient that addiction is ...