39 - Opioid analgesics - ha

Question 1

Opioid that provides relief for moderate to severe acute and chronic pain.

Answer 1

Morphine

Question 2

Pure opioid.

Answer 2

Morphine

Question 3

In addition to reducing pain, what are other indications for Morphine?

Answer 3

• Induce sleep
• Treat diarrhea
• Relief of dyspnea (pulmonary edema assoc. w/LVF)
• Antitussive

Question 4

Dangers of morphine:

Answer 4

Respiratory depression
Dependency/Abuse
Severe Hypotension

Question 5

What should you always prescribe along with Morphine to avoid one of its major side effects?

Answer 5

Laxative

Question 6

Semisynthetic analogue of morphine AND codeine.

Answer 6

Hydromorphone (Dilaudid)

Question 7

Semisynthetic analogue of CODEINE.

Answer 7

Hydrocodone (Vicodin)

Question 8

This is 5x more potent than morphine. It relieves moderate to SEVERE pain.

Answer 8

Hydromorphone (Dilaudid)

Question 9

Why is hydromorphone an antitussive?

Answer 9

It directly acts on the medulla to suppress cough

Question 10

Combination of a centrally-acting analgesic (codeine) and peripherally-acting analgesic (acetaminophen).

Answer 10

Tylenol w/Codeine (T3)

Question 11

Slightly less potent than morphine; relief of mild to moderate pain.

Answer 11

Tylenol w/codeine

Question 12

When taking T3 or percocet, what should your patient avoid?

Answer 12

Other products that contain acetaminophen! Do not exceed 3000mg per day (per PKM)

Question 13

Combination of hydrocodone and acetaminophen.

Answer 13

Hydrocodone (Vicodin)

Question 14

Hydrocodone (Vicodin) is used for what type of pain?

Answer 14

Similar potency as morphine; moderate to severe pain.

Question 15

This is about 2x as potent as morphine, used in patients tolerant to opioids.

Answer 15

Oxycodone

Question 16

Semisynthetic derivative of morphine.

Answer 16

Oxycodone

Question 17

Synthetic opioid structurally UNRELATED to morphine

Answer 17

Meperidine (Demerol)

Question 18

Why is Meperidine NOT recommended for long-term pain?

Answer 18

It has active metabolic toxic metabolites (normeperidine) which have neurotoxic properties.

Question 19

In addition to common adverse reactions of opioids, what other SEs are associated with Meperidine?

Answer 19

• anxiety
• tremors
• muscle twitches
• anticholinergic effects
• PUPIL DILATION
• hyperactive reflexes

Question 20

What is unique about the extra SEs caused by Meperidine?

Answer 20

They cannot be reversed with the administration of naloxone.

Question 21

This centrally-acting opioid weakly inhibits reuptake of norepinephrine and serotonin, in addition to binding to the mu receptors

Answer 21

Tramadol (ultram)

Question 22

What type of pain is tramadol used for?

Answer 22

moderate to moderately severe pain

Question 23

This can cause toxicity when combined with TCAs and SSRIs, possibly leading to serotonin syndrome.

Answer 23

Tramadol

Question 24

This synthetic opioid is good for both nociceptive and neurogenic pain; works well for chronic pain

Answer 24

Methadone

Question 25

In addition to common adverse reactions of opioids, what other SEs are associated with Methadone?

Answer 25

- Cardiac arrhythmias - Torsades de pointes - Cardiac arrest!

Question 26

This is well-absorbed orally and has a longer duration of action than morphine.

Answer 26

Methadone

Question 27

Fentanyl is a centrally-acting opioid that weakly inhibits reuptake of norepinephrine and serotonin, in addition to binding to the mu receptors. What are the differences between this and Tramadol?

Answer 27

- It is a STRONG agonist - It has a RAPID ONSET and SHORT DURATION (but may take 48hrs to reach steady state) - May require a break-through drug

Question 28

Used to induce anesthesia and for analgesia during labor (epidural).

Answer 28

Fentanyl (Duragesic)

Question 29

Fentanyl (Duragesic) is used for patients with this type of pain.

Answer 29

Fluctuating pain levels (*esp for pts that can't tolerate oral admin)

Question 30

What is one of the most common SEs of Hydromorphone (Dilaudid)?

Answer 30

Vomiting