F. Clinical use of analgesic II: opioids and other medicines

Question 1

What are the three types of opioids?

Answer 1

Naturally occurring
Semi-synthetic
Synthetic

Question 2

Give an example of a naturally occurring opioid

Answer 2

Morphine
Codeine
Thebaine
Papaverine

Question 3

Give an example of a semi-synthetic opioid

Answer 3

Oxycodone
Diamorphine (heroin)
Buprenorphine
Hydromorphone

Question 4

Give an example of synthetic opioids

Answer 4

Tramadol
Pethidine
Fentanyl
Alfenranil

Question 5

What receptor provides analgesic and side effects associated with opioids

Answer 5

Meu (MOR)

Question 6

What opioids are used to treat moderate pain (weak opioids)

Answer 6

Codeine
Dihydrocodiene
Dextropropoxyphene

Question 7

What opioids are used to treat severe pain (strong opioids )

Answer 7

Morphine 
Dimorphine
Oxycodone 
Fentanyl 
Tramadol

Question 8

What pain comes under severe pain?

Answer 8

Acute pain

Persistent non cancer pain (low back pain, osteoarthritis)

Palliative pain

Question 9

What are the routes of administration for opioids ?

Answer 9

Oral
Rectal
Transdermal
Sublingual
Topical
Intramuscular
Subcutaneous
Intravenous 
Epidural
Intrathecal

Question 10

What are the common side effects for opioid use ?

Answer 10

Nausea and vomiting 
Constipation 
Sedation 
Respiratory depression 
Hypotension 
Urinary retention

Question 11

What are the less common side effects with opioids ?

Answer 11

Narcotic bowel syndrome
Immunosuppressant
Endocrine dysfunction
Addiction

Question 12

What non pharmacological treatments can be provided to patients suffering from opioid induced constipation?

Answer 12

Diet (fruits and fibre)

Fluids

Question 13

What laxatives can be provided to patients with opioid induced constipation?

Answer 13

Stimulants in combination with stool softeners (Docusate or bisacodyl)

Question 14

What peripherally restricted opioid antagonist can be administered ?

Doesnt get to the central nervous system and doesnt effect the analgesic effect

Answer 14

Methyltrexone
Naloxone
Naloxegrol

Question 15

How would you initiate oral morphine for pain?

Answer 15

• Give a pain assessment, including current analgesia
• Determine opioid requirement
• calculate 24hr requirement
• Convert to modified release formulation eg MST, zomorph

Question 16

How would you initiate oral morphine for pain?

Answer 16

• Give a pain assessment, including current analgesia
• Determine opioid requirement
• Calculate 24hr requirement
• Convert to modified release formulation eg MST, zomorph

Question 17

What are the advantages of PCA?

Answer 17

Rapid analgesia once pain at steady state

Ready preparation

Patient satisfaction
No dose delay

Pain acceptability

No peaks or troughs

Question 18

What are the disadvantages of PCA?

Answer 18

Expensive
Requires IV access
Training
Monitoring

Question 19

What is the drug of choice for PCA ?

Answer 19

Morphine

Question 20

What is the drug of choice if patient is allergic to morphine?

Answer 20

tramadol, oxycodone or fentanyl

Question 21

What does an epidural opioid contain?

Answer 21

Mixture of local anaesthetic and opioid

Such as fentanyl with bupivicaine (or levobupicacaine )

Question 22

Why is fentanyl less likely to cause respiratory depression ?

Answer 22

It has a high lipophilicity therefore cannot cross the bbb

Question 23

What are the adverse effects of epidural opioids ?

Answer 23

Hypotension
Wrong route
Infection
Haemotoma (bad bruise)

Question 24

When can continuous subcutaneous infusions be used ?

Answer 24

• unable to take medicine by mouth
• bowel obstruction
• patients does not wish to take regular medication by mouth

Question 25

What is the opioid if choice for continuous subcutaneous infusion ?

Answer 25

Diamorphine (heroin) due to its excellent aqueous solubility

Question 26

What should be monitored for a patient receiving opioid therapy

Answer 26

Pulse 
BP
Respiration rate 
Pain
Oxygen saturation 
Sedation score 
Opioid usage 
Opioid side effects