opiates

Question 1

what is the gold standard opioid analgesic

Answer 1

morphine

note: In addition to relief of pain, morphine also confers a state of euphoria and mental detachment

Question 2

what is the opioid of choice for severe pain in palliative care

Answer 2

morphine

Question 3

which opioids may cause withdrawal symptoms, including pain, in patients dependent on other opioids.

Answer 3

buprenorphine, Pentazocine

note: this is because they have both agonist and antagonist properties

Question 4

which opioid has a longer duration of action than morphine

Answer 4

buprenorphine

Question 5

which opioid, has its effects only partially reversed by naloxone hydrochloride

Answer 5

buprenorphine

Question 6

which opioid is equivalent to heroin

Answer 6

diamorphine

Question 7

why can diamorphine be injected in smaller volumes

Answer 7

because it has a greater solubility than other opioids. this is important in emaciated (abnormally thin or weak) patients

Question 8

why should methadone not be administered more often than twice daily

Answer 8

to avoid the risk of accumulation and opioid overdosage

Question 9

what is the alternative for patients who experience excitation (or exacerbation of pain) with morphine

Answer 9

methadone

Question 10

which opioid is commonly used as a second-line drug if morphine is not tolerated or does not control the pain

Answer 10

oxycodone

Question 11

which opioid should be avoided after myocardial infarction

Answer 11

Pentazocine

this is because it may increase pulmonary and aortic blood pressure as well as cardiac work

Question 12

what are the benefits associated with tramadol

Answer 12

It has fewer of the typical opioid side-effects (notably, less respiratory depression, less constipation and less addiction potential);

Question 13

name some examples of weak opioids

Answer 13

codeine phosphate, dihydrocodeine, Meptazinol

Question 14

which opioids are used during labour

Answer 14

• Pethidine

- morphine or diamorphine hydrochloride (often preferred)

Question 15

what is the advantage of Tapentadol

Answer 15

Nausea, vomiting, and constipation are less likely to occur with tapentadol than with other strong opioid analgesics

Question 16

why must you avoid co-prescribing all opioids with benzodiazepines

Answer 16

because prescribing both of them together increases the risk of sedation, respiratory depression, coma, and death

note: if there are no alternatives + you must prescribe both together, the lowest possible doses should be given for the shortest duration

Question 17

what are the contra-indications for all opioids

Answer 17

• acute respiratory depression
• head injury
• raised intracranial pressure
• risk of paralytic ileus (when the muscle contractions that move food through your intestines are temporarily paralyzed)

note: opioids are contraindicated in head injury + raised intracranial pressure because opioid analgesics interfere with pupillary responses vital for neurological assessment

Question 18

what are the common side effects of opioids

Answer 18

• arrhythmias
• dry mouth
• constipation
• nausea + vomiting
• euphoric mood
• hallucinations
• urinary retention
• skin reactions

Question 19

how do you treat respiratory depression caused by opioids

Answer 19

it may be treated by artificial ventilation or be reversed by naloxone

Question 20

what can happen if opioids are given during pregnancy

Answer 20

Respiratory depression and withdrawal symptoms can occur in the neonate