B6.017 - Opiods Flashcards Preview

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Flashcards in B6.017 - Opiods Deck (18):
1

name the weak opiods

Oxycodone
Hydrocodone
Codeine
Tramadol
Tapentadol

2

describe oxycodone

one of the most popular
schedule 2
1.5 morphine

3

hydrocodone

slightly less potent than oxy
poor metabolizers can accumulate
schedule 2

4

codeine

200x less affinity for mu receptor
CYP metabolized
Codeine APAP schedule 3
contraindicated in pts <18 bc resp depression/death

5

tramadol

schedule 4
weak mu agonist inhibits NE and serotonin uptake
6000 x less affinity

6

tapentadol

schedule 2
stronger mu opiod agonist and NE inh that works both ascending and descending pathways
2-3x less potent
50x less affinity
can increase serotonin but not directly

7

name the strong opiods

1. meperidine
2. morphine
3. oxycodone
4.oxymorphone
6. hydromorphone
7.methadone
6. buprenorphine
8. fentanyl
9. sufentanil
10. alfentanil
11. remifentanil

8

features of meperidine

IM
can lead to CNS hyperactivity/seizures
1/10 morphine
cardiac (orthostatic hypoTN, Myocardial depression)
anticolinergic
local anesthetic
coadmin with monoamine reuptake inhibitors can be fatal

9

morphine

lost of ways to give it
morphine 3 - glucu metabolite has no opiod receptor activity
morphin 6 -glucu agonist sustains analgesia, etc.
longer BBB transit

10

oxycodone

long acting, and higher acting preparations
abuse deterrent preparations
rapid onset of action
more potent than morphine
fewer side effects

11

oxymorphone

semisynthetic
IR SR
10x morphine
fast
higher delta opiod receptor activity
low bioavail
alcohol can increase plasma concentration by 300%

12

hydromorphone

analog of morphine formed by N demethylation of hydrocodone
short or long acting
5-7x morpine
active metabolite doesnt stop pain but can cause neurotoxicity

13

methadone

used for pain but also in opiod disorder, heroin addiction maintenance
fast onset
QT prolongation, v dangerous
weak NMDA antagonism

14

buprenorphine

alternative to methadone maintenance
often with naloxone
full agonist at mu for pian, partial at mu for respiratory depression
antagonist at kappa delta
blocks other opioids from binding, higher dose full mu may be necessary can also precipitate withdrawal if given to someone on full mu regimen

15

fentanyl

mostly mu, little kappa delta
75-125x
transdermal buccal only for opioid tolerant
less constipation bc doesn't pass thru GI can be used for pts with gut resorption issues
IR preps v rapid and potent you gotta train to give
PATCHHHHH

16

sufentanil

mostly perioperative IV
rapid, short
5-7x fentanly
dose dependent skeletal muscle rigidity
heroin deaths due to mix

17

alfentanil

operatively given
smaller vol, low prob of accumulation

18

remifentanil

most potent mu opiod receoptor
used for anesthesia
not met by liver (kidneys)
ester side chain linkage leads to rapid degradation by tissue and plasma esterases