[PHARM] Opioids [Iszard]

Question 1

What is the general MOA of Opioids?

Answer 1

Bind to Opioid Receptors in the CNS –> inhibits ascending pain pathways –> alters perception of pain –> CNS Depression

Question 2

What is the onset of action of the following?

Oral Opioids (Immediate Release)

IV

Answer 2

Oral –> 30 mins

IV –> 5-10 mins

Question 3

What is the intended duration of action for the following:

Immediate Release –>

Extended Release –>

Epidural/Intrathecal –>

Suppository –>

Answer 3

Immediate Release –> 3-5 hrs

Extended Release –> 8-24 hrs

Epidural/Intrathecal –> 24 hrs

Suppository –> 3-7 hrs

Question 4

What are some adverse effects of Opioids?

Answer 4

CNS Depression

Constipation

Hypotension

Question 5

What is the black box warning of Opioids?

Answer 5

Fatal Respiratory Depression

Question 6

What is the correct order of Opioid Potency from least to greatest?

Oxycodone, Hydrocodone,Methadone, Fentanyl

Answer 6

LEAST: Hydrocodone

Oxycodone

Methadone

Fentanyl: GREATEST

Question 7

What are some of the clinical uses of Opioid use in clinical settings to help reduce pain?

Answer 7

MI

Sickle Cell Crisis

Post OP

Trauma

Cancer

Kidney Stones

Back Pain

Question 8

What are the 3 Opioid Receptors?

What are their endogenous opioid peptide affinities?

Answer 8

Mu –> Endorphins > Enkephalins > Dynorphins

Delta –> Enkephalins > Endorphins > Dynorphins

Kappa –> Dynorphins >> Endorphins - Enkephalins

Question 9

Which of the opioid receptors fxns as a supraspinal and spinal analgesia, psychotomimetic effects, and slow gastrointestinal transit?

Answer 9

Kappa

Question 10

Which of the Opioid Receptors fxns as a supraspinal and spinal analgesia, modulation of hormone and NT release?

Answer 10

Delta

Question 11

Which of the opioid receptors fxns as a supraspinal and spinal analgesia, sedation, inhibition of respiration, slowed GI transit, modulation of hormone and NT release?

Answer 11

Mu

Question 12

List what type of fxnal class each of the drugs are:

Methadone

Buprenorphine

Naloxone

Answer 12

Methadone –> Full Agonist

Buprenorphine –> Parial Agonist

Naloxone –> Antagonist

Question 13

In general what are some of the effects of opioids that garner a HIGH degree of tolerance from long lasting use of Opioids?

Answer 13

Analgesia

Euphoria

Mental Clouding

Sedation

Respiratory Depression

Antidiuresis

N/V

Cough Suppression

Question 14

In general what are some of the effects of opioids you dont see patients developing a tolerance for with long lasting use of opioids?

Answer 14

Miosis

Constipation

Convulsions

(Bradycardia – moderate amount)

Question 15

What are some of the Chronic Adverse effects of Opioid Use?

Answer 15

Hypogonadism

Immunsuppression

Increased Feeding

Increased GH sec

Withdrawl

Tolerance

Abuse

Hyperalgesia

Impairment while driving

Question 16

If you have a patient that comes in while taking Opioids who complains of Respiratory Depression, Pruritis, N/V, Delirium, Sedation, Constipation, or Seizures – what sort of adverse effects to opioids are these?

Answer 16

Acute Adverse Effects

Question 17

If a patient comes in while taking an opioid and they have increased CNS depression, and respiratory depression – what sort of drug interaction must you be worried about?

Answer 17

Opioid interactions with SEDATIVE-HYPNOTICS

Question 18

If a patient comes in while taking an Opioid and complains of Increased Sedation, and accentuation of cardiovascular effects, and some variable respiratory depression – what sort of drug interaction are you thinking of?

Answer 18

Opioid interactions with Anti-Psychotic Agents

Question 19

If you have a patient come in while taking an Opioid and they have hyperpyrexic coma and HTN – what sort of Opioid drug interactions should you think about?

Answer 19

Opioid interactions with MAOI

Question 20

If someone comes in with an Opioid Overdose what drug should you give them?

Answer 20

Naloxone (Narcan)

–Pure opioid antagonist (releasing catecholamines)

Question 21

What is the indicated use of Naltrexone (an Opioid Antagonist)?

Answer 21

(Works on Mu Receptors)

Tx of Alcohol use disorder

blocks effects of exogenously administered opioids

Question 22

If a patient was recently given Naltrexone, what warning or precaution should you let them know about?

Answer 22

They may respond to lower opioid doses than previously used – watch out for opioid intoxication

Also watch out for Acute Opioid Withdrawl

Question 23

What are the 9 Opioid Agonists?

Answer 23

Morphine

Hydromorphine

Methadone

Meperidine

Fentanyl

Codeine

Oxycodone

Hydrocodone

Propoxyphene

Question 24

What are the 4 mixed agonist/antagonist (partial agonist) Opioids?

Answer 24

Pentazocine

Nalbuphine

Buprenorphine

Butorphanol

Question 25

What are the 2 Opioid Antagonists?

Answer 25

Naloxone

Naltrexone

Question 26

Morphine, Hydromorphone, Hydrocodone, Oxycodone are what type of chemical class of Opioids?

Answer 26

Phenanthrenes

Question 27

Fentanyl, Meperidine are what type of chemical class of Opioids?

Answer 27

Phenylpiperidines

Question 28

Pentazocine and Loperamide are what chemical class of Opioids?

Answer 28

Benzomorphans

Question 29

Methadone and Propoxyphene are what chemical class of Opioids?

Answer 29

Diphenylheptanes

Question 30

Morphine Sulfate is a whay type of opioid?

What are its contraindications?

What warnings are involved?

What are some adverese reactions?

Answer 30

Opioid Agonist – tx pain not responsive to non-narcotic analgesics

Hypersensitivity to morphine, Asthma, UAO

Dosing Errors, Resp Depression, CNS Toxicitiy, CNS Depressants

Sedation, N/V/Lightheadedness, Constipation

Question 31

What is the drug Buprenorphine used for?

What is a warning for using this drug?

It has the same adverse effects as regular opioids.

What drug interactions does it have?

Answer 31

Tx of Opioid Dependence

Can be abused like opioids, Resp Depression,

CYP3A4 inhibitors/inducers