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Weeks 7-11 > Opioids > Flashcards

Opioids Flashcards

1
Q

What are the 5 guiding principals for the WHO analgesic ladder?

A 
By mouth 
By the clock
By the ladder
For the individual 
Attention to detail
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2
Q

What does “ceiling effect” mean?

A

Weak opioids do not increase their analgesic effects with increased dose, however the side effects will increase

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3
Q

What plant is opium extracted from?

A

Papaver somniferum

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4
Q

Define opiate

A

Naturally occurring opioids

Substances found in opium that have effect on opioid receptors

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5
Q

Define opioid

A

Any substance, natural or synthetic, that produce morphine-like effects and are blocked by morphine antagonists

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6
Q

What is the go-to opioid in hospitals?

A

Morphine

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7
Q

What is the official name for heroin?

A

Diamorphine

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8
Q

Which opioid is used as a component of anaesthesia?

A

Fentanyl

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9
Q

What is the opioid of choice in renal failure?

A

Fentanyl

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10
Q

Which opioid does not cause pin point pupils like other opioids?

A

Pethidine

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11
Q

Why is remifentanil given by infusion?

A

Metabolism by plasma esterases

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12
Q

Name 2 naturally occurring weak opioids

A

Codiene

Dihydrocodeine

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13
Q

Which weak opioid was previously an anti-depressant and has anti-convulsant effects?

A

Tramadol

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14
Q

Why does Loperamide prevent diarrhoea but not have the other effects associated with opiates?

A

Acts on the receptors in the myenteric plexus but does not cross BBB so no central CNS effects

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15
Q

Name two opioid antagonists

A

Nalaxone

Nalrexone

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16
Q

Which opioid has has a high bioavailability?

A

Oxycodone

17
Q

Describe the opioid receptors

A

Clustered around areas involved in pain
7 subunit transmembrane protein
G protein coupled

18
Q

Discuss the action of opioid receptors

A

Close calcium channels and open potassium channels
==> Hyperpolarisation
Decreased conversion of ATP –> cAMP
==> Reduced NT release

19
Q

What are the CNS effects of opioids?

A 
Analgesia 
Sedation 
Euphoria 
Pupillary constriction
Respiratory depression
20
Q

Why do opioids cause respiratory depression?

A

Makes brain less responsive to CO2, therefore decrease in respiratory drive (high pCO2)
More marked on respiratory rate than tidal volume

21
Q

What are the respiratory effects of opioids?

A

Respiratory depression
Stop coughing (anti-tussive)
Bronchospasm (histamine release)

22
Q

What are the cardiovascular effects of opioids?

A

Bradycardia

Hypotension (histamine)

23
Q

What are the GI effects of opioids?

A

Constipation

Nausea

24
Q

Why do opioids cause nausea?

A

Act on chemoreceptor trigger zone and vestibular apparatus

Slow transit times - stagnant fluid can cause nausea

25
Q

What are some of the other effects of opioids?

A

Urticaria
Renal failure
Immune supression (suppress NK cells)

26
Q

Name an opioid that is a prodrug therefore needs to be metabolised into active form by CYP450

A

Codeine

27
Q

Why do different people react differently to codeine?

A

Different people have different CYP450 enzymes therefore metabolise codeine at different rates
e.g. Caucasians are slow, african americans are ultrafast

28
Q

Why is codeine no longer prescribed to children?

A

Children given codeine post tonsillectomy

Patients turned out to be ultra-fast metabolisers and died of respiratory depression

29
Q

What protocol must be carried out when prescribing controlled drugs and why?

A

Must write out dose in words and numerals to minimise errors and prevent alterations (drug of misuse and abuse)

30
Q

Which drug is used in opioid overdose?

A

Naloxone

31
Q

What is naltrexone used for?

A

When trying to get people off heroin, given to block opiate receptors
If patient relapses, there will be no affect

32
Q

Why do heroin addicts have bad oral hygiene?

A

Methadone is unpalatable so supplemented with sugar
Methadone gives patients cravings for sweet foods
Methadone dries up mouth preventing cleansing of teeth

33
Q

What may affect absorption of opioids from transdermal patch?

A

Heat may cause vasodilation –> increased absorption

Shock causes vasoconstriction –> decreased absorption

34
Q

Where would you inject an opioid?

A

Upper outer quadrant of buttock to avoid sciatic nerve

35
Q

Name the 4 types of opioid receptor

A

Mu
Kappa
Delta
Nociceptive

36
Q

Give 3 places where opioids work

A

Dorsal horns
PAG
Peripheral tissues

37
Q

Name the 3 types of endogenous opioid

A

Endorphins
Dynorphins
Enkephalins

38
Q

Give an example of opioids being given via the buccal route

A

Fentanyl losengers

39
Q

What are the legal requirements that need to be carried out when prescribing controlled substances?

A

No abbreviations
Quantity in both words and numbers
Signed by hand

Weeks 7-11 (22 decks)

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