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FPM > Analgesics: Narcotics > Flashcards

Analgesics: Narcotics Flashcards

1
Q

What is the MOA of narcotics?

A

Act as mu-opioid receptor agonists

-alter the perception and response to pain centrally and peripherally

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2
Q

Which narcotics also inhibit reuptake of norepinephrine?

A

Modifies the ascending pain pathway
-also are mu- agonists

Tramadol

Tapentadol

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3
Q

Which narcotic is a mu-agonist with weak kappa-antagonist activity?

A

Buprenorphine

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4
Q

Which narcotics are partial agonists of mu- and kappa-receptors?

A
  • butorphanol

- nalbuphine

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5
Q

What are contraindications of narcotics?

A

Severe respiratory disease / depression, including:
-acute asthma (unless patient is mechanically ventilated)

Paralytic ileus

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6
Q

What are black box warnings of narcotics?

A

Serious life-threatening / fatal respiratory depression may occur
-monitor closely for respiratory depression
—especially during initiation / dose escalation

Opioids expose patients to risks of addiction, abuse, and misuse

  • potentially leading to overdose / death
  • assess each patient’s risk prior to prescribing
  • monitor all patients regularly for developing of these behaviors / conditions

Accidental ingestion can result in fatal overdose

  • even one dose of an opioid
  • especially in children
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7
Q

What is the black box warning for opioid use in pregnancy?

A

Prolonged use during pregnancy can result in neonatal withdrawal syndrome
-may be life threatening if not recognized and treated according to protocols developed by neonatology experts

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8
Q

What are common members of the narcotics class?

A
  • buprenorphine
  • fentanyl
  • hydromorphone
  • methadone
  • hydro/oxycodone
  • tramadol
  • tapentadol
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9
Q

What are uncommon members of the narcotics class?

A
  • alfentanil
  • butorphanol
  • codeine
  • levorphanol
  • meperidine
  • nalbuphine
  • opium tincture
  • oxymorphone
  • pentazocine
  • remifentanil
  • sufentanil
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10
Q

What are brand names of buprenorphine?

A
  • Buprenex
  • Belbuca
  • Probuphine
  • Butrans
  • Subutex
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11
Q

What are the dosage forms of buprenorphine?

A
  • injection
  • TD patch
  • buccal film
  • SC implant
  • SL tablet
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12
Q

What is buprenorphine used for?

A
  • management of pain severe enough to require ATC, long term opioid treatment and for which alternative treatment options are inadequate
  • opioid dependence
  • opioid withdrawal in heroin-dependent hospitalized patients
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13
Q

What pregnancy category is buprenorphine?

A

C

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14
Q

What is buprenorphine dosing for pediatric acute pain (moderate-severe) for children 2-12 years?

A

IM, slow IV: 2-6 mcg/kg every 4-6 hours

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15
Q

What is buprenorphine dosing for adults, usual dose?

A

0.15-0.6mg every 4-8 hours PRN

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16
Q

What is buprenorphine dosing for adults, acute pain?

A

0.3mg IM/IV every 6-8 hours PRN

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17
Q

What is buprenorphine dosing for adults with chronic pain, TD patch, opioid-naive?

A

Initial: 5mcg/hour applied once every 7 days

-max patch dose of 20mcg/hour/7days

18
Q

What is buprenorphine dosing for adults with chronic pain, TD patch, receiving daily dose of 30-80mg oral morphine equivalent

A

10mcg/hour/7days

19
Q

What is buprenorphine dosing for adults with chronic pain, buccal film, opioid-naive?

A

Initial: 75mcg once daily

20
Q

What is buprenorphine dosing for adults with chronic pain, buccal film, receiving daily dose of 30-89mg oral morphine equivalents?

A

Initial: 150mcg every 12 hours

21
Q

What is buprenorphine dosing for adults with chronic pain, buccal film, receiving daily dose of 90-160mg oral morphine equivalents?

A

Initial: 300mcg every 12 hours

22
Q

What is buprenorphine dosing for adults with opioid dependence, SL tablets?

A

Day 1: 8mg PO

Usual range: 12-16mg/day during induction

Target dose: 16mg/day maintenance

23
Q

What is buprenorphine dosing for adults with opioid withdrawal in heroin dependent hospitalized patients (unlabeled use), IV?

A

0.3-0.9mg every 6-12 hours

24
Q

How is buprenorphine dosing affected by hepatic impairment, buccal film / SL tablet?

A

For severe impairment (Child-Pugh class C):

-reduce starting dose and titration dose by 50%

25
Q

What are the most common adverse reactions of buprenorphine?

A
  • sedation
  • hypotension
  • dizziness
  • nausea
  • vomiting
  • headache
  • respiratory depression
  • constipation
  • application site rash (patch, implant)
26
Q

What are rare / severe / important adverse reactions of buprenorphine?

A
  • respiratory depression
  • QTc prolongation
  • hepatotoxicity
  • severe allergic reactions
27
Q

What are major drug interactions that affect buprenorphine?

A

CNS depressants and alcohol
-increased sedation / dizziness

CYP 3A4 inhibitors / inducers
-alter its metabolism

QTc prolonging drugs
-may increaserisk of arrhythmias

MAO-I inhibitors
-may increased sedation

28
Q

What are contraindications of the buprenorphine TD patch?

A
  • management of mild / acute / intermittent pain
  • management of pain requiring short-term opioid analgesia
  • management of postoperative pain
29
Q

What are essential monitoring parameters of buprenorphine?

A

-CNS depression

-BP
—for hypotension

-liver enzymes

30
Q

What are counseling points for buprenorphine?

A

-avoid excessive alcohol

-may cause drowsiness
—impair ability to operate machinery

  • may cause constipation requiring laxatives
  • may cause physical / psychological dependence with prolonged use
  • notify healthcare provider if pain unrelieved
  • do not place direct heat (heating pads) on patch
  • report any allergic reactions
  • never cut the TD patches

-rotate patch sites on arms, chest, and back
—apply to hairless / dry area

-keep any used / unused patches away from children

31
Q

What are black box warnings of buprenorphine?

A

Misuse / abuse by chewing / swallowing / snorting / injecting drug extracted from buccal film / TD system will result in:

  • uncontrolled delivery of buprenorphine
  • significant risk of overdose / death

Concomitant use of BDZ / alcohol / other opioids / other CNS depressants may result in:

  • profound sedation
  • respiratory depression
  • coma
  • death

Insertion / removal of implant are associated with risk of:

  • implant migration
  • protrusion
  • expulsion
32
Q

What are rare but serious complications that may result from improper insertion of buprenorphine implant in upper arm?

A

-nerve damage
-migration
—resulting in embolism and death

33
Q

What is preferred over buprenorphine monotherapy for maintenance of opioid dependence?

A

Combination of buprenorphine and naloxone
-naloxone is a non-absorbed opiate antagonist that blocks effects of buprenorphine if snorted / injected
—makes the combo an abuse-deterrent

34
Q

What patch dose of buprenorphine is associated with an increased risk of QT interval prolongation?

A

20mcg/hour

35
Q

What neurological disorder can buprenorphine exacerbate?

A

Cause seizures in patients at risk

-can lower seizure threshold

36
Q

What do prescribers have to be certified in to prescribe buprenorphine tablets and TD patch?

A

REMS program

37
Q

What are brand names of fentanyl?

A
  • Abstral
  • Actiq
  • Duragesic
  • Fentora
  • Sublimaze
  • Lazanda
  • Subsys
38
Q

What are the dosage forms of fentanyl?

A
  • TD patch
  • TD device
  • buccal tablets
  • buccal lozenge
  • nasal spray
  • SL spray
  • SL tablet
  • injection
39
Q

What is fentanyl injection used for?

A
  • relief of perioperative pain

- adjunct to general / regional anesthesia

40
Q

What is fentanyl TD patch used for?

A

-management of pain in opioid-tolerant patients
—severe enough to require:
—

41
Q

What is fentanyl transmucosal lozenge, buccal tablet, NS, SL tablet / spray used for?

A

-management of breakthrough cancer pain in opioid-tolerant patients who are:
—already receiving and tolerant to ATC opioid therapy for their underlying persistent cancer pain

42
Q

What pregnancy category is fentanyl?

A

C

FPM (8 decks)

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