They have no ceiling effect for increasing doses. The home care nurse is actively involved in managing the side effects from opioid analgesics. A stool softener should also be prescribed. Antiemetics and sedative or antianxiety agents may assist in alleviating this concern. Most patients develop tolerance to the sedative effects within 1 to 2 days after initiation or dosage increases.
Sedation always precedes depression.
Narcan should always be available to be titrated and given slowly. Drug levels should be monitored closely. Side effects can be significant. Valium for instance is helpful for muscle spasms but can potentiate CNS depression when used with opioids. Because the nurse has close association with the patient, ethical conflicts may arise over pain management issues such as balancing the cost and clinical presentation of the pain.