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A-CNS Pharma > Opioids > Flashcards

Opioids Flashcards

1
Q

بسم الله الرحمن الرحيم وبه نستعين

What are opioids ?

A

Drugs with morphine like actions

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2
Q

Anaglesiscs?

A

Drugs relive pain due to multiple causes.
Opiods : Morphine + synthetics
Non opioids : NSAIDS + Paracetamol

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3
Q

Mild pain
mODERATE Pain uncontrolled
Moderate to severe pain
Comfortable pain free

A

Non opidods + adjuvants
Weak opioids + non opioids + adjuvantts
Stron opioids + non opioid + adjunatn
Invaseive

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4
Q

Non opioids ?
Adjuvants ?

A

NSAIDS + Acetamnipohen
Antidepressants + AntiConvulsants

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4
Q

Non opioids ?
Adjuvants ?

A

NSAIDS + Acetamnipohen
Antidepressants + AntiConvulsants

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5
Q

Weak opioids ?

A

Termadol + codiene

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6
Q

StRONG OPIOIDS

A

MOHAB FANTA
Morphine
Oxycodiene
Hydromorphone
Bubronephrine
Fentanayl

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7
Q

Opioids analgesices used in ?

A

Moderate to severe pain
named dueOPium poppy= Opium ——-10% is morphine

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8
Q

Opioids analgesices used in ?

A

Moderate to severe pain
named dueOPium poppy= Opium ——-10% is morphine
Codiene also dervied from opium

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9
Q

Opiates and opioids ?

A

Opiates are derivatves of the alkaloids of opium poppy
Opioids : The class of drugs inculding : Opiate , Opiopepetins , Synthetic and semsyntheic drugs work as Opiates

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Narcotic ? why ? opioids

A

Because of
Stupor +Analgesisa
Stupor = Drowisness and impairment without loss of Consiousness

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10
Q

Mention sourcrs of opioids

A

S2EP
Plant : Morphine - Codiene
Endogenous : endorphins enkephalins and dynorphins
Synthetic: FTM ( Fentanyl+ tramadol+ Methadone )
Semisynthetic : Heroin + Oxycodiene

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11
Q

Classifiacation of opioids at Function

A

3As:
-Analgesics + Antitissuves+Antidiarrheal
1-Analgesics وقسمناهم
2-Antitussives CD Codeine - Dextromethorphan
3-Antidiarrheal : LD
Lopramide + Diphenoxylate

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11
Q

Natural opiodis ?

A

Morphine + codiene agnoists

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12
Q

Semisynthetic :
opioids?

A

HO HO H !
Hydrocodone
Oxycodone
Hydromprohone
OxyMorphone
Heroin

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13
Q

Classificaion of Synthetics Opioids?>

A

FT2M2 agonists
Fentaynyl
Tramadlo
Tepentatdol
Mehadone
Mepridine

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14
Q

Partial agonists of opioids ?

A

Bubrenorp.hin.e
Pentazocine
Nalubuphine

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15
Q

Antagonists of Opioids
عشان نزع السمية

A

1- Nalxone
2- Nalterxone

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16
Q

Opioids receptors ?

A

Mu- Delta - kuppa Receptors

Mu most imp resp fort Analgeisa + sedation + respirtaory deprssion !

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17
Q

General explanation of Opioid receptors work

A

Gi decreasing CAMP Presynaptic
Closing Ca channels
Preventing Glutamate release
Opeining K channels postsynaptic Hyperpolarization and Prevents AP

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18
Q

Opioids receptor activaed ?

A

Supraspinal : Brainstem + thalamus+cerberal Cortex
Spinal
Pehriphey ? afferent nerves conducting pain
Increasing Dopamine in Nucleus Accumbenes casuing Euphoria and prevent the emotional feel of pain

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19
Q

Ascending pain pathway is ?
Descending pain pathway?

A

spinothalmic tract
Descending start from periaqudrcta grey area desending to spinal cord releasing Enkephalins + NE + 5HT
repressing spinothalamic Tract of pain
So how opiodes relieve pain ?
Increasing the Opiopepetins : Enkeplains
Working on its Receptors on spinothalmic tract inhibiting pain pahtyway

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20
Q

Termadol

A

Inhibit reuptake of
Serotonin and NE increaing their inhibitory effect on spinothalamic Tract
And it is Non opioid activity on side to its opioid activity

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21
Q

Classify Opioids Analgesics at its efficay?

A

Strong :
Agnoists as PFHM
Pethidine
Fentanyl
Heroin
Methadone - Morphine
Partial agonists as Bubrenorphine
______________________
Moderate Codiene and oxycodeine
+ NSAIDS + Antussive activity
_______________________
Weak : Propoxyphene
Analgesics + NSAIDS PARACETAMOL

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22
Q

Main )))))Actions of opioids mention
and classify it to indications and contraindications

A

Anaglesia+ Sedation + euphoris
1-Analgeisa
I: post operative : acute trauma - MI
CI : Undiagnosed acute abdomen
2-Sedation
I: anaethesia preoperateve preanathrsia medications
CI: casuing Sedation and Narcosis
in dangerous cases
3-Euphroia not indication it is cause of contra indication as casuing dependence

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23
Q

Indication of Opoiids mention

A

Anglesisc post operative acte reuama cancer MI
Sedation in anathesia and Sugery

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24
Q

Contraindication of Opioids /

A

Analgesic in Undiagnosed Acute abdomen
Sedation and Narcosis in some situations
Casuing euphoria

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25
Q

How opioids casuing euphoraa?

A

Inhibite release of Glutamte which inhibit dopamine release casuing
Increased Dopamine in Nucleus accumbnes and Ventral Tegmental Area
Casuing euphoria

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26
Q

Maiinly casue of Death in Case of opioids?

A

Repiratoy center inhibition by toxicity

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27
Q

Inhbitory effects of Opioids works on?

A

4 centers + Uterine
Respiratory Center
Cough Center
VMC
thermoregulatory center

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28
Q

Opioids and cough center?

A

They are antitussive
Codeine + Dextromethorphan
كان بيعمل إدمان
تلاقيهم بيشتروا ازارة ويشربوها مرة واحدة !

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29
Q

Opioids and Respiratory Center

A

Most common cause of death
due to opioids cuz of respiratory depression .
Make body insensitive to CO2 and Inadqeuate Respiration
Also in Case of Ceaserain section In addicted woman Casuse Asphyxia Neonatorum .
Increasing Co2 casuing Cerberal VD icreasing ICP contraindicatd in head injury

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30
Q

Make body insensitive to CO2 and Inadqeuate Respiration

A

opioids

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31
Q

in Case of Ceaserain section In addicted woman opioids are CI why ?

A

Casuse Asphyxia Neonatorum .

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32
Q

Opioids are contraindicatd in head injury why ?

A

Make respiratorty centers insensitive to Co2 Increasing Co2 casuing Cerberal VD icreasing ICP contraindicatd in head injury

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33
Q

Why Opioids are CI in Labour?

A

Decrasing Uterine tone +
Ceaseine section casue Ashpyxia Neonatorum

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34
Q

Acute pulmonary edema is indication of Opioids ?

A

Yes , becasue opioids Repress VMC
Causing Venulodilator and Arteriolodilator effects Causuing decreas in PreLoad and AfterLoad of Heart Decreasing Respiratory distress + Anxiety
But in normal p casues Hypotension

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35
Q

Hypothermia and opioids

A

Opioids depress the Thermoregulatory centers Causing Hypothermia

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36
Q

Describe inhibitory effects of opioids ?

A

-Depress the COUGH center so
I: Antitussive Codeine+ Dextrometh
-Depress respiratory center so
CI: Respiratory depression + Asphyxia nenoatrum in CS
-Depress VMC so
I: Acute pulmonary edema
CI : Hypotension
-Depress uterine tone
CI: labour
Depress Thermoregulatory center :
AE CI : Hypothermia

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37
Q

Inhibitory indications of Opioids ?

A
  • Antitussive inhibiting cough cent
    -Acute pulmonart edema inhibiting VMC
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38
Q

Inhibitory Contraindications of Opioids ?

A

-Respiratory depression
-Asphyxia Neonatorum
-Labour delay
-Hypotension
-Hypothermia

39
Q

المدمن بيتعرف من؟

A

Miosis
Constipation

40
Q

Opioids and pupil

A

Stuimulate occluomotor nucleus or
The parasympathtic nuclerus of third 3rd cranial nerve casuing pin point pupil or called Miosis adverse effect and distingusih addicts

41
Q

Opioids and Vomiting ?

A

Stimulating The CTZ
Chemoreceptor Trigger zone

42
Q

Opioids and diarrhea?

A

Its antidiarrheal (indications) as it is spsamogenic
Causing closure of Sphincters of anal and urinary of bladder
Stool and urine retention
constioation

43
Q

Opioids and gall bladder ?

A

In case of Biliary colic is spamogenic closing the sphincter of oddi and increasing inflammation may casue rupture and peritonins and septic shock

44
Q

Opioids and Asthma and Hypotension

A

Opioids release Histamine cassuing bronchoconstriction so CI in Athma
And hypotension VMC - HISTAMINE

45
Q

Hypotension in opioids is due to ?

A

Histamine release
vmc depression

46
Q

Stimulatory indication of opioids ?

A

Antidiarrheal

47
Q

Stimulatory Advers effe and CI of opioids

A

+Occlumotor nucleus Miosis
+CTZ Nausea and Vomiting
Spasmogenic = constpiaton
Spasmogeinc = CI in biliary colic
Histamine releas = CI in Asthma + Hypotension

47
Q

Stimulatory Advers effe and CI of opioids

A

+Occlumotor nucleus Miosis
+CTZ Nausea and Vomiting
Spasmogenic = constpiaton
Spasmogeinc = CI in biliary colic
Histamine releas = CI in Asthma + Hypotension

47
Q

Stimulatory Advers effe and CI of opioids

A

+Occlumotor nucleus Miosis
+CTZ Nausea and Vomiting
Spasmogenic = constpiaton
Spasmogeinc = CI in biliary colic
Histamine releas = CI in Asthma + Hypotension

47
Q

Tolerance occurs with all effect except ?

A

Miosis + Constipation

48
Q

Stimularoy action of Opioids mention

A

+Occulmotor nucleus
+CTZ
+Spasmogenic
+Histamine relase

49
Q

Contraindications of Morphine inspite of Severe pain ?

A

1-Undiagnosed acute abdomen
2-Labour
3-biliary colic
4-Head Injury

50
Q

Other side effect of opioids ?

A

Seizures decreasing threshold of epilepsy in high doses

51
Q

Othe CI of Opioids
?

A

Extreme age
Hypothyroidism
Liver dysfunctions

52
Q

Morphine is given

A

Parenteral
IV IM SC Epidurally

53
Q

Morphine is not perefered ?

A

Orally due to extensive first pass metabolism 20-40 %

54
Q

Duration of action of Morphine ?

A

4-6 hOURES

55
Q

Pehthidine Mepridine

A

IM + oral

56
Q

Pethidine in potency and efficacy ?

A

Potency less than Morphine
Efficacy Equal to Morphine

57
Q

What is used instead of Morphine in Biliary colic + Labour + why?

A

Pethidine or Mepridine
in Biliary colic:- less spasmogenic
in Labour :- less repiratory depression not casuing Asphyxia neonatorum
Less Utrein relaxation not delaying labor

58
Q

Why Pethdine casue less constipation ?

A

Short action 2-3h
meanwhile Morphine 4-6 h

59
Q

Blurred Vision and Dry moth appear with ? why?

A

Pethidine as it has atropine like actions parasympathatic antagonist
May casue mydriasis

60
Q

Pethdine Increase risk of convulsion especially in / ?

A

1-Renal failure
2->48 h of acute pain
so its used only in acute not chronic
_____________________
Due to of accumulation of (Normeperidine)

61
Q

Indications of Pethidine ?

A

Postopertative pain
Biliary colic +Labour

62
Q

Advantage of pethidine over morpine are ‘
;

A

-Less repiratory depression so
less asphyxia neonatrum and death
-less spamogenic less constipation due to low duration and used in biliary colic and labour not causing delay or uterine relaxation

63
Q

disadvantage of Mepridine pethidine against Morphine are?

A

Atropine like action
Blurred vision + dry mouth + Mydriasis
Risk of Convulsants due to accumulation of normeperdiine in RF or after 48

64
Q

هل في تراجع في استخدام البثيدين ؟

A

اه عشان طلع بيتحول في الكبد ل
Norpethidine toxic metabolite
وده سام للطفل اللي الكبد مش هيقدر يعمل فيه
conjugation + excretion
فهيعمل
Asphyxia Neonatorum \

65
Q

Desrive Fenatnyl Potency and oneset
and duration

A

Potency 100 fold than morphine
onset rapid due to lipophilicity 1-5m
Short duration .5 -2 hours

66
Q

Functions of fentanyel mention

A

1-Epidural anasthesia + analgesisa:
Posteperatively + during labor
2-Transmucosal + Transdermal patches in chronic pain as cancer

67
Q

مشاكل Fentanyel ايه ؟

A

الجرعة العالية بتعمل تخشب في عضلات جدار الصدر فيقلل اتساعية الصدر و يقلل القدرة علي التنفس
decrasing thoracic complicamce+ Ventilation

68
Q

Indications of Fentanyl
Mention

A

1-Analgesic :
pre post operative + labor
2-Anasthesia :
Pre-anesthetic medication
3-Conscious sedation + Neuroleptanalgesia+ Neuroleptanethesia

69
Q

Conscoius sedation mean ?

A

Amensia+ Analgesia + sedation
without loss of Conscousness

70
Q

Consous sedation imp ?

A

In minor and diagnostic procedures as Endoscopy

71
Q

Conscious sedation is done by ?

A

Benzodiazpines+Opoid analgesics
MidaZolam+ Fenatnyl

72
Q

Conscious sedation drug toxiciy can be reversed by ?

A

Flumazenil + Naloxone
advantage

73
Q

Neuroleptanalgesisa mean ?

A

Neurolept = antipsychotic drug + anaglesic
Dorperidol +Fentanyel

74
Q

Neuroleptanalgesisa mean ?

A

Neurolept = antipsychotic drug + anaglesic
Dorperidol +Fentanyel
Neuroleptanasthesia is done by adding 65% N2O In O2 to Neuroleptanalgesic patient

75
Q

Neuroleptanasthesia is done by ?

A

Neuroleptanasthesia is done by adding 65% N2O In O2 to Neuroleptanalgesic patient

76
Q

Subgroups or Congenres of Fentanyl
mention 2

A

1-Sufentanil : more potent
2-Remifentanil : ريمي ريمي ريمي
ultrashot as metabolized in blood and tisse esterases casuing less venilation depression

77
Q

Remifentanil : ريمي ريمي ريمي
duration and give reasion

A

ultrashot as IV INFUSION
metabolized in blood and tisse esterases casuing less venilation depression

78
Q

Heroin is ?

A

DiacetylMorphine
Diacetyls Increase Lipid Solubility and Crossing BBB 3 times than morphine make it more liable to Euphoria and Addiction due to rapid onset short duration
Is converted in brain into Morphine

79
Q

How addcits use herioin ?

A

IS2
Injecting IV / IM after Dissolving in a spoon of Water
Snorting : up by nose by 20$
Smoking : heating up poweder and inhalation of fumes by a small tube of foil

80
Q

Methadooooooone
Duration ? IMP

A

24-36 hours
so it is useful in Detocification of Herioin in addicts as It takes longer to leave opioid receptors making the withdrawal smoother and less severe

81
Q

Methadone Indications ?

A

Analgesic equal to morphine
detoxification in opioid addicts
long duration less severe and smoother withdrawal

82
Q

Make a comparsion between methadone and Heroin at
Route
Onset
Duration
Euphoria

A

Methadone:
Oral only
30 M
24-36H
Absent
Herion:
IV IM INTRA NASAL
IMMEDIATE
MARKED Euphoria
3-6H

82
Q

Make a comparsion between methadone and Heroin at
Route
Onset
Duration
Euphoria

A

Methadone:
Oral only
30 M
24-36H
Absent
Herion:
IV IM INTRA NASAL
IMMEDIATE
MARKED Euphoria
3-6H

83
Q

Mention adverse effects of methadone

A

As Morphine
QT interval prolongation
Torsade de pointes arrythima

84
Q

Route of Tramadol

A

Oral IV IM

85
Q

Tramadol function

A

It is mixed opioid and non opioid
Non opioid Anaglesia by inhibiting reuprake of serotinin and NE
Weak Mu agonist
so Partly antgonisted by Naloxone
Used in
Analgesia ( post oper+ chronic pain)+ Neuropathic pain

86
Q

Bupernophrine is

A

partial agonist

87
Q

Bubrenorphine has a property over Morphine explain

A

Ceiling effect
Has same effective analgesic Effect
but less Euphoria + less Resp. Depression ……

88
Q

Bubrenrophine how to administrate ?

A

Sublingual
Parentral

89
Q

Mention uses of Bubrenorphine /

A

1-Analgesic in sever pain
2-Detox in Opioid toxicity
as it is used as methadone due to ?
Long duration 24 h and Less severe withdrawal

90
Q

Mention two drugs help in detox of Morphine and give reason

A

Methadone
Bubrenorphine
due to long duration of action so less severe and smoother withdraw

91
Q

Buprenorphine and heroin

A

بيمنع ان الهروين يمسك في المستقبل لان له ارتباطية قوية بالمستقبل
بيحجب النشوة الناتجة عن الهروين
وله ميزتان هو مفيش نشوة + مفيش تثبيط تنفسي

92
Q

bubernorpine
في وحود الهيروين يعتبر ؟

A

antagonist عشان كده مش هنستخدمه في العملية لو الراجل واخذ هيروين لانه يعمل اعراض انسخاب ومش هيشيل الألم

93
Q

Pethidine or Tramadol + MAOI
interactions

A

Pethidine increase sertoinin
Tramadol decrease reuptake serotinine and NE AS MAOI
Causing Serotonin Syndrome

94
Q

Nevere give opioids + CNS depressants
(Sedative+alcohol+antidepress + antipsychotic )

A

it will add CNS depress

95
Q

Acute Morphine toxicity apppear as ?

A

Repsitaroy depression
Pinpoint pupil Miosis
Coma due to CNS depression

96
Q

Treatment of Acute morphine Toxicity?

A

Resp Support
Naloxone competitive opioid antagonist

97
Q

How to treat addiction ?

A

1-Symptomatic treatment
Pain ; NASIADS
Vomiting: antiemetic
2-Sympatholytic: Clonidine
3-Detox : Methadone +Buprenorhpine
4-Maintanance: naltrexone to prevent relpase by euphoria

98
Q

وقيل الحمدلله رب العالمين

A

الحمدلله رب السماوات والأرض رب العالمين

A-CNS Pharma (11 decks)

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