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Pharm week 5, 6, 7, 8, old stuff > Week 8: opioids > Flashcards

Week 8: opioids Flashcards

1
Q

Pain scale
1-3?
4-6?
7-10?

A

Mild- ibuprofen
Moderate- morphine
Severe- fentanyl

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2
Q

MORPHINE AND MORPHINE LIKE DRUGS

morphine, codeine, hydromorphone, oxycodone, hydrocodone

Used for what kind of pain?
Also used for what?
Combined with?

A

MODERATE and/or SEVERE PAIN (NOT mild, review the pain ladder)

COUGH/ANTI-TUSSIVE (prescription only, generally liquid cough syrups)

Frequently combined with Non-opioids:

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3
Q

MORPHINE AND MORPHINE LIKE DRUGS

morphine, codeine, hydromorphone, oxycodone, hydrocodone

What kind of opioid agonist?
Black box warning for?

A

Pure opioid agonist receptors in the CNS and periphery (Mu + Kappa)

Black box warning for respiratory depression!!!

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4
Q

Adverse effects of

M.O.R.P.H.I.N.E.

NO ALCOHOL WITH OPIOIDS!!!

A

Miosis (constriction of the pupil)

Out of it (sedated)

Respiratory depression

Pruritus (common)

Hypotension (dizzy) & Head injury(avoid!)

Infrequency of urination and bowel movements (referring to urinary retention or constipation)

Nausea/Narcotics

Emesis

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5
Q

moRphine =Respiratory Depression

2 rules?
Do not mix opioids with what?
B AND Z rule? 6

A

1) Hold if respiratory rate <12

O2 <90% and notify provider

This is what KILLS people!!

*#2) Know what drugs NOT to mix/ what drugs can INCREASE the risk for respiratory depression

B AND Z RULE
*Don’t mix Opioids with:
*BOOZE/Alcohol/EtOH
*Back pain medication (Baclofen)
*Barbiturates (“itals” like phenobarbital)
*Benzodiazepines (diazepam, alprazolam, lorazepam, etc.)
*Zzzz drugs (Ambien®= zolpidem)
*Benadryl (diphenhydramine and other 1st generation antihistamines

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6
Q

morPhine=Pruritis (Itching)

Do not give if?

A

Sometimes this may lower blood pressure + HR.

Do not give if
HYPOTENSIVE (SBP<90, DBP<60) or BRADYCARDIA (HR<60)

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7
Q

morpHine= Hypotension + (Head pressure)

Don’t give if what?
What can occur?
Risk for what?

A

Do not give if
HYPOTENSIVE (90/60)
BRADYCARDIA (HR<60)

Dizziness can occur! CHANGE POSITIONS SLOWLY (Fall RISK!)**

*Due to vessel dilation from histamine, this may cause cerebrovascular dilation = elevated intracranial pressure (^ ICP)

*This means avoid in head trauma/injuries where elevating pressure in the brain would worsen it!

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8
Q

morphIne=Infrequency (bowel movements and urination)

Opioids cause what?
Do patients adapt?
Whats the rule?

A

Opioids will cause CONSTIPATION

*Patients never ADAPT to this, you will always have constipation

The rule is “All MUSH, no PUSH”

(CANT PUSH OUT POOP DUE TO NO PERISTALSIS)

This means that patients have soft stools, but their intestinal muscles aren’t working

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9
Q

morphiNe=Nausea/Narcotic and morphinE=Emesis

Opioids stimulate receptors where?

How is morphine taken?

A

Opioids stimulate receptors in the GUT and BRAIN and can make patients feel nauseated

Prescribers have anti-nausea drugs (called anti-emetics) ordered

Counsel patients to TAKE WITH FOOD

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10
Q

OTHER ADVERSE EFFECTS: Opioids

A

*Diaphoresis/Flushing/Sweating
*Tolerance / dependence
*EUPHORIA/ addiction
*Allergic Reactions (itching vs difficulty breathing!)

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11
Q

What is stronger?

Morphine or HYDROmorphone?

A

HYDROmorphone is 7x stronger than morphine

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12
Q

Non-Morphine Opioid Agonist

Prototypes:Tramadol, methadone, fentanyl, meperidine

what are they?

A

These drugs are still opioids used for moderate to severe pain

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13
Q

Non-Morphine Opioid Agonist

Tramadol

Increases risk for what?
Caution?

A

can increase risk for SEIZURES and SEROTONIN SYNDROME

Caution for: History of seizures

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14
Q

Non-Morphine Opioid Agonist

Meperidine

Used for what?
Increases risk for what?

A

May seen used in the OR to reduce SHIVERING

Postoperative shivering

can increase risk for SEIZURES and SEROTONIN SYNDROME

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15
Q

Non-Morphine Opioid Agonist

METHadone

Used for?
Also used for?
Can do what?
Patients require what?

A

SPECIAL USE: SUBSTANCE USE DISORDERS!!!

Also used in MODERATE/SEVERE PAIN

***can prolong the QT interval (dysrhythmia risk).

Patients require periodic EKGs

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16
Q

Non-Morphine Opioid Agonist

Fentanyl

Routes?
Used for?

A

MOST POWERFUL OPIOID

IV is only allowed in critical care areas (ICU, OR, ED). Should not be used in Med-Surg

Oral Pill= NONE

Sublingual/Buccal= Lollipops
-Actiq®

Works FAST for extreme pain. Prescribed for severe cancer pain or used by military for combat injuries/trauma

17
Q

Fentanyl

Apply how often?
Do not apply what and why?
How to discard?
Only for what type of pain?
How long does it take to work?
Only for people who?

A

Change every 72 hours

Do not apply heating pads (why?) increases absorption

-Discard appropriately (sharps container/coffee grounds, FDA says OKAY to FLUSH!)

Only for Chronic Pain (not acute)

Take 12+ hours to work (again, not for acute pain)

Only for people who have been taking large doses of opioids

18
Q

Partial / Mixed Opioid Agonists

Pros?
Cons?
They have what?

A

PARTIAL opioid activation

PROS: partial respiratory distress, ceiling effect

CON: Less pain relief

Partial Agonists have a HIGH AFFINITY for opioid receptor

19
Q

Mixed/Partial Agonists types

BUprenorphine

Used for?

A

Pain management

BUPRENORPHINE- Addiction management (Substance Use Disorders

20
Q

Route options for opioids

Immediate Release?
Extended Release (long-acting opioids)?
Fentanyl and Buprenorphine Patches?
Buccal Fentanyl Lollipop?

A

Immediate Release:
◦Pills, liquid, IV

Extended Release:
◦Do NOT Crush

Fentanyl and Buprenorphine Patches:
◦SLOW to work
◦Do NOT apply heating pads, throw away in sharps container or FLUSH patches

Buccal Fentanyl Lollipop
◦Works extremely fast for SEVERE acute pain (think cancer pain, combat injury)
◦Keep secured, Storage in original container, keep away from children

21
Q

Opioid overdose

3 primary symptoms

A

Miosis
Respiratory distress
Coma

22
Q

Opioid overdose antidote?

When to give?

A

NaloXone = X out the Opioids!
AKA Narcan

THREE primary s/s of opioid overdose

Give if RR< 12
Give if Oxygen Saturation <90% (SpO2)
Give if patient passed out and you cannot wake them/stimulate them

23
Q

Naloxone

Symptoms needed to give naloxone?

How to give in the hospital and outpatient?

A

THREE primary s/s of opioid overdose
Give if RR < 12
Give if O2 less than 90%
Give if patient passed out and you cannot wake them/stimulate them

How to give:
Hospital= Administer IV
Outpatient= Nasal Spray, IM/SC Injection

24
Q

Naloxone

Only works for what?
Can u give another dose?
Half life?

A

*Only works for opioids

*If it didn’t work, feel free to give another dose

*It will NOT harm someone

*Has short half life (less than 1 hour)

*Patient may need repeat doses (call 911 if outpatient)

*Continue to monitor RR and Mental status q 5 min

25
Q

Peripheral Mu Opioid Antagonist (PAMORA):

MethylnaltreXOne

used for?
Only works where?
Don’t use in what?

A

Antidote for Opioid Induced Constipation (OIC)

MethylnaltreXone= X out the Opioids in the GI TRACT ONLY

Do not use in bowel obstruction

26
Q

Anti-Diarrheal Opioids:

Loperamide, diphenoxylate

Used for what?
Don’t work in what?
Don’t use in patients with?

A

Used to treat diarrhea

Do not work in the brain/spinal cord and do NOT cause any pain relief (don’t cross the BBB)

Do not use in patient with C. DIFF

Pharm week 5, 6, 7, 8, old stuff (14 decks)

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