5 Opioid Ag Antag

Question 1

When pain is inhibited v augmented

Answer 1

Inhib: spinal neurons release gaba and glycine or descending pathway releases ne, 5-ht, and endorphins. Augmented by sensitization and wind up

Question 2

Opioid moa

Answer 2

Binds to receptor, G protein activ, Adenylate cyc inhib/less camp, ca dec and k inc

Question 3

Mu: ligand, cv resp, cns resp, gi

Answer 3

Endorphins, bradycardia, sedation/euphoria/prolactin/mild hypothermia. Nv, inc biliary p dec peristalsis

Question 4

Delta receptor: ligand, se

Answer 4

Enkephalins, resp dep, urine ret, itching

Question 5

Kappa: ligand, se

Answer 5

Dynorphin. Resp dep, sedation/dysphoria/halluc, miosis, diuresis. Antishivering

Question 6

Mu 1, 2, 3 main differences

Answer 6

1: supraspinal/spinal analgesia, euphoria, bradycardia, less abuse potential. 2: spinal analgesia, resp dep, constip, dependence. Mu3: immune sup

Question 7

Opioids most to least potent

Answer 7

Su, fent= remi, alfent, dilaudid, morphine, demerol

Question 8

Early and late se of withdrawal

Answer 8

Early: sweat, insomnia, restless. Late: abd cramp and nv

Question 9

S.s serotonin syndrome, drug to avoid

Answer 9

Demerol. Hyperthermia, mental status changes, hyperreflexia, sz, death

Question 10

Mao inhibitors

Answer 10

Phenelzine, isocarbozadid, trancyclopromine

Question 11

Opioids that cause histamine release

Answer 11

Demerol, morphine, codeine, oxycodone

Question 12

Pka: highest, lowest

Answer 12

Demerol 8.5 alfentanil 6.5

Question 13

Highest and lowest unionized percent

Answer 13

89% alfentanil, 7% demerol

Question 14

Highest and lowest protein binding

Answer 14

Remi and sufentanil 93, morphine 35

Question 15

Lowest and highest vd

Answer 15

Lowest remi 0.39 highest fentanyl 4

Question 16

Things that dec opioid hyperalgesia

Answer 16

Ketamine and mag

Question 17

Methadone moa

Answer 17

Mu agonist, nmda antag, Maoi inhib

Question 18

What inc with opioid induced skel muscle rigidity

Answer 18

02 consump, PVR, ICP

Question 19

Buprenorphine: moa, strength, reversal ability, features

Answer 19

Partial mu, greater than morphine, not reversed well. Long duration, can give transdermal

Question 20

Nalbuphine: moa, analgesia strength, reversal ability, features

Answer 20

Kappa agonist mu antag, sim to morphine, reversible, doesnt inc bp or hr, useful if heart disease

Question 21

Butorphanol: moa, analgesia strength, reversible, features

Answer 21

Kappa agonist weak mu antag. > than morphine, reversible. Can tx shivering and give intranasal

Question 22

Narcan: dose, duration, metab

Answer 22

1-4 mcg/kg. 30-40 min. Liver, first pass metab

Question 23

Narcan se

Answer 23

Pulm edema, tachycardia, dysrhythmias, sudden death, NG

Question 24

Methylnaltrexone: type of drug, useful when

Answer 24

Quaternary, doesnt reverse resp dep, tx peripheral effects of opioids like constip

Question 25

Nalmefene: use

Answer 25

Opioid abuser maintenance, lasts 10 hrs

Question 26

Phenanthrenes

Answer 26

Morphine, codeine

Question 27

Phenylpiperidines

Answer 27

Meperidine, fentanyl, sufent, remi, alfent

Question 28

Morphine derivatives

Answer 28

Dilaudid, heroin, narcan, naltrexone

Question 29

Opioids usually dont cause myocardial ____, exception

Answer 29

Depression. Demerol

Question 30

Fentanyl and demerol withdrawal: onset, peak, duration

Answer 30

4 hrs onset, 8 hr peak, 4 days

Question 31

Morphine and heroin withdrawal: onset, peak, duration

Answer 31

12 hrs, 48 hrs, 8 days

Question 32

Methadone withdrawal onset, peak, duration

Answer 32

36 hrs, 18 days, 6 weeks

Question 33

Which opioid inhib nerve conduc

Answer 33

Demerol

Question 34

Endogenous pain modulation pathway

Answer 34

Periaqueductal gray to rostroventral medulla to sub gelatinosa