Opioids (Wolff) Flashcards

1
Q

What are the three major classes of opioid receptors?

A

mu, kappa and delta

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2
Q

Morphine and other pure opioid agonists relieve pain by mimicking the action of?

Primarily at what receptors?

A

1) Endogenous opioid peptides (endorphins, enkephalins, etc.)
2) Mu receptors but partly at kappa receptors

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3
Q

What is the most serious adverse effect of opioids?

A

Respiratory depression

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4
Q

What precautions are there for opioid use?

A

1) Pregnancy

2) Head injury

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5
Q

Opioid overdose produces what classic triad of signs?

A

1) Coma
2) Respiratory depression
3) Pinpoint pupils

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6
Q

Which pure opioid is 100X more potent than morphine, has the same adverse effects, and is notable for having multiple formulations?

A

fentanyl

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7
Q

alfentanil, remifentanil, and sufentanil are pure opioids used for?

Which is an IV opioid with rapid onset and brief duration due to rapid metabolism by blood esterase?

A

1) Induction and maintenance of anesthesia

2) remifentanil

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8
Q

Meperidine (Demerol) which is often abused by healthcare workers because of its anticholinergic effects lacks what classic sign of other opioids?

A

Lacks pinpoint pupils

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9
Q

Methadone which shares major properties of morphine, is also an antagonist of what other receptor?

A

NMDA receptor

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10
Q

Which pure opioid is indicated for moderate to severe pain, adverse effects are similar to morphine and reversed by naloxone, and is more water soluble so can be diluted in a smaller volume for injection?

A

hydromorphone (Dilaudid)

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11
Q

What is the prototype for moderate to strong opioid agonists?

A

Codeine

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12
Q

~10% of each dose of codeine is metabolized to morphine by what CYP?

A

CYP2D6

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13
Q

Oxycodone which is a moderate to strong opioid agonist similar to codeine, is metabolized by which CYP?

A

CYP3A4

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14
Q

What type of opioid is pentazocine and butorphanol?

A

Mu antagonist and Kappa agonist

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15
Q

What type of opioid is buprenorphine?

A

Mu partial agonist and Kappa antagonist

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16
Q

Naloxone and naltrexone are what type of drugs?

A

Pure Opioid Antagonists

17
Q

What effect does Naloxone have?

A

Reverses most effects of opioid agonists including respiratory depression

18
Q

What does naloxone precipitate in people who are psychically dependent on opioids?

A

Immediate withdrawal reaction

19
Q

What effects do naltrexone have?

A

1) Prevents euphoria from opioids but does not prevent craving
2) Reduces craving and heavy drinking associated with alcoholics

20
Q

What is methylnaltrexone?

What is it indicated for?

A

1) μ-opioid antagonist that cannot readily cross BBB

2) Opioid-induced constipation

21
Q

What is loperamide?

What is it indicated for?

A

1) μ-opioid agonist that cannot readily cross BBB

2) Acute and chronic diarrhea

22
Q

Patients that ingest loperamide in large quantities to get high or alleviate withdrawal symptoms have a great risk of?

A

Torsade’s de pointes due to QT prolongation

23
Q

How is it best to administer opioids?

A

On a fixed schedule

24
Q

In the setting of renal insufficiency which opioid is safe for use?

Which are not recommended because of toxicity of their metabolites?

A

1) Fentanyl

2) Meperidine and codeine

25
Q

In the setting of hepatic insufficiency which opioid is safe for use?

Which are not recommended because of toxicity of their metabolites?

A

1 Fentanyl

2) Meperidine, codeine, and methadone

26
Q

What is the outcome of adverse interactions between opioids and CNS depressants such as:

Barbiturates
Benzodiazepines
Alcohol
General anesthetics
Antihistamines
Phenothiazines
A

Increased respiratory depression and sedation

27
Q

What is the outcome of adverse interactions between opioids and Agonist-antagonist opioids?

A

Precipitation of withdrawal reaction

28
Q

What is the outcome of adverse interactions between opioids and Anticholinergic Drugs such as:

Atropine-like drugs
Antihistamines
Phenothiazines
Tricyclic antidepressants

A

Increased constipation and urinary retention

29
Q

What is the outcome of adverse interactions between opioids and hypotensive agents?

A

Increased hypotension

30
Q

What is the outcome of adverse interactions between opioids and Monoamine oxidase inhibitors?

A

Hyperpyrexic coma