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Anesthesia > 11. Opiods > Flashcards

11. Opiods Flashcards

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1
Q

What health professional is the largest prescriber of opiods to children <19

A

OMS

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2
Q

Women between the ages of - at at greater risk of dying from a prescription analgesic overdose

A

45-54

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3
Q

Women between the ages of - are at a greater risk of attending an emergency room for perscription analgesics

A

25-45

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4
Q

(Men/women) Are more likely to doctor shop

A

women

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5
Q

What factors have contributed to the current opioid epidemic

A
  • Drastic increase in the number of scripts written
  • Greater social acceptance (doctor gave it to me so it must be ok)
  • Aggressive marketing
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6
Q

What age ranges see the most deaths from opioid overdose

A

20-39

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7
Q

OD deaths are greater in (whites/blacks) and (males/females)

A

White males

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8
Q

T/F OD deaths are about equal in the suburbs and the citiy

A

t- this is not an inner city issue only

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9
Q

T/F most OD deaths are a result of heroin alone

A

f- most are fentanyl related

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10
Q

How often does NYS mandated training need to be done and who needs to do it

A
  • Poeple with DEA numbers
  • Once every 3 years
  • Covers 8 topics
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11
Q

Analgesics (opiod and non-opiod) are used in what three clinical scenarios

A
  • Acute pain- most common
  • Non-cancer chronic pain- most problematic
  • Cancer chronic pain
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12
Q

Define acute pain

A
  • Lasts less than 12 weeks
  • Related to tissue damage
  • Is expected to improve with healing
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13
Q

What information should be obtained regarding a patient’s pain history

A

PQRSTU

  • P= palliative and precipitating factors
  • Q= Quality and Quantity
  • R= Region and radiating
  • S= Severity
  • T= Time and temporal factors
  • U=Understanding
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14
Q

What are the different mechanisms of pain and describe them

A
  • Neuropathic pain= dysfunction with the somatosensoty nervous system
  • Inflammatory
  • Mechanical/ compressive
  • Neuromuscular
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15
Q

T/F The first line of treatment for neuropathic pain is an opiod

A

t- opioid should never be first line treatment regardless of the mechanism of pain

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16
Q

What are the four different approaches to intercepting (managing) pain

A

Initiation

  • Peripheral nerve
  • NSAIDs

Transmission

  • Peripheral Nerve to SC
  • LA

Integration

  • SC to brain
  • Opiods

Modulation

  • Descending pathways that modulate pain pathways
  • TCAs
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17
Q

What are the different non-pharmacologic strategies to treating pain

A
  • Behavior management
  • Psychic therapy (ice, heat, positioning, streatching)
  • Self management
    • Biofeedback
    • Hypnotherapy
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18
Q

Give examples of NSAIDs in the acetic acid family

A

-Diclofenac and etodoloc

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19
Q

Give examples of NSAIDs in the Oxicam family

A

piroxicam and meloxicam

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20
Q

Name NSAIDs in the fenamates family

A

mefanamic acid

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21
Q

Name NSAIDs in the Naphyhylakanones family

A

nabumetone

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22
Q

Describe the expression of COX 1 and 2

Study These Flashcards
A 
1= Always (constituitively)
2= inducible (by inflammatory cells, growth factors and tumor promoters)
23
Q

Role of COX 1

Study These Flashcards
A
  • Hemostasis (platelet funciton)
  • Gi protection
  • Renal function
24
Q

What drugs have a ceiling effect

Study These Flashcards
A

NSAIDs- NOT opioids

25
T/F NSAIDs are effective in treating acute and chronic pain
t
26
What NSAIDs have lower risks of GI bleeding
Ibprofen and naproxen
27
Adverse effects of non-selective NSAIDs
- Gastric irritation - Reversible platelet inhibition - Renal impairment
28
Describe the difference between the terms
Narcotic= legal term Opiate= naturally occuring alkaloid found in the opium poppy Opioid= medicate term describing any substance that binds the opioid receptor and produces psychologic effects
29
Define the following terms | -Abuse
Misuse or over use of a controlled substance
30
Define the following terms | -Addiction
Prolonged uncontrollable need for a habit forming substance that can cause symptoms of withdrawl
31
Define the following terms | -Dependence
Physical and psycological - Physical= results from abrupt discontinuation - Psychological= compulsion to use driven by mental factors "wanting the rush"
32
Define the following terms | -Tolerance
decreased response to a drug
33
Define the following terms | -Withdrawl
Uncomfortable symptoms that develop when a person stops taking a drug for which there is dependence
34
Indications for opiod use
- Moderate to severe pain - Sedation/GA - Cough suppression - Diarrhea treatment - Anxiety - Opioid dependence
35
What are the four types of opiods and give examples
Natural -Codeine, morphine Semi-synthetic -Heroin, oxycodone, and hydrocodone Synthetic -Fentanyl, mederidine, buprenordorphine Endogenous -Endorphins
36
Describe the pharmacologic properties of opioids (effect of opioids on body)
Nmonic MORPHINES - M= Miosis (pin-point pupils) - O=Orthostatic hypotension - R= Respiratory depression - P=Physical dependence - H=Histamine release - I= Increased intracranial pressure - N= Nausea - E= Euphoria - S= Sedation
37
What are the short acting opioids
codeine and hydrocodone
38
What are the extended release opioids
morphine and oxycodone
39
What are the long lasting opioids
Methadone and fentanyl
40
T/F Opiods have a ceiling effect
f
41
Treatment for acute pain _day supply of opioids is sufficient and should never be greater than _ days
3 days... 7 days
42
First line treatment for acute pain is
non-pharmacologic therapy
43
What does PMP stand for
Perscription monitoring program
44
For the test to determine an individuals risk for developing an opioid dependence what are the numbers for mild, moderate, and high risk
Mild= 0-3 Moderate=4-7 High 8+
45
T/F Since the implementation of the PMP there has been a reduction in the number of opioid perscriptions
t
46
T/F Most physicians explain to the patients how to properly dispose of unused opiods
f
47
Chronic pain has persisted for at least how long
3-6 months
48
T/F When behavioral practices and non-opioids have not been effective at reducing the patient's pain opioids should be used
t
49
T/F OPioids have improved function and provided pain relief in non-cancer chronic pain patients
F- insufficient evidence
50
What must be done first before opioids are perscribed
- Screening for dependence risk | - PMP
51
Average number of days of use before dependence is
9 days (only takes one dose for some
52
Drug seeking behaviors are
- Last appointment at end of day - Arrive without an appointment - Allergic to NSAIDs - Only certain drugs are effective - Unusual stories of lost or stolen scripts - Unwilling to give permission to obtain medical history - Request refills sooner than expected - Won't need treatment
53
What are things we can do to prevent addiction
- Talk to patient's about risks of opioids - Prescrib the lowest effective dose and only in quantiity needed - NSAIDs - Use long lasting local (bupivicaine, etidocaine - Avoid combination therapy with alcohol and benzos

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