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Pharm exam 5 chapters > Ch 24 > Flashcards

Ch 24 Flashcards

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1
Q

drugs that relieve pain without causing loss of consciousness

A

Analgesics

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2
Q

the most effective pain relievers available

A

Opioid analgesics

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3
Q

medications in the opioid analgesics family

A

morphine
fentanyl
codeine
oxycodone (OxyContin)

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4
Q

any drug, natural or synthetic that has actions similar to those of morphine

A

opioid

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5
Q

a more specific term that applies only to compounds present in opium

A

opiate

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6
Q

What are the 3 families of peptides that have opioid -like properties

A

enkephalins
endorphins
dynorphins

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7
Q

what 3 categories do the opioid analgesics fall into?

A

1) pure opioid agonists
2) Agonist-antagonist opioids
3) pure opioid antagonists

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8
Q

what effects do pure opioid agonists produce?

A 
analgesia
euphoria
sedation
resp depression
physical dependence
constipation
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9
Q

prototype of the strong opioid agonists

A

Morphine

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10
Q

Prototype of the moderate to strong agonists

A

Codeine

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11
Q

List the 4 agonist-antagonist opioids available

A

Pentazocine
nalbuphine
butorphanol
buprenorphine

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12
Q

When administered alone, the agonist-antagonist opioids produce

A

analgesia

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13
Q

when an agonist-antagonist opioid is given with a pure opioid agonist, these drugs can

A

antagonize analgesia caused by the pure agonist

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14
Q

what drug is considered the prototype for the agonist-antagonist opioid group

A

Pentazocine

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15
Q

which drug class in the opioid analgesic grouping is manly used for reversal of resp and CNS depression caused by overdose with opioid agonists?

A

pure opioid antagonists

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16
Q

what is the prototype drug for pure opioid antagonists

A

Naloxone (Narcan)

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17
Q

what pure opioid antagonist is used to treat opioid induced constipation

A

methylnaltrexone

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18
Q

pharm effects of morphine

A 
analgesia
sedation
euphoria
resp depression
cough suppression
suppression of bowel motility
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19
Q

side effects of morphine

A 
urinary retention
emesis
orthostatic hypotension
miosis
biliary colic
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20
Q

The time course for resp depression after PO morphine begins up to ___ minutes after ingestion

A

90

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21
Q

what populations are most sensitive to resp depression with morphine

A

very young
older adults
those with resp disease

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22
Q

what should be avoided while taking morphine to prevent further resp supression

A

alcohol
barbiturates
benzodiazepines

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23
Q

potential complications of constipation secondary to opioid use is

Study These Flashcards
A

fecal impaction
bowel perforation
rectal tearing
hemorrhoids

24
Q

Goal for management of constipation secondary to opioid use

Study These Flashcards
A

produce a soft, formed stool every 1-2 days

25
Principal nondrug measures to combat constipation secondary to opioid use
physical activity | increased intake of fiber and fluids
26
prophylactic treatment for constipation secondary to opioid use
a stimulant laxative such as senna to counteract reduced bowel motility plus Miralax (osmotic laxative)
27
rescue therapy for constipation secondary to opioid use
strong osmotic laxative such as lactulose or sodium phosphate
28
last resort for constipation secondary to opioid use
methylnaltrexone (Relistor)
29
Can methylnaltrexone (Relistor) cross the blood brain barrier?
no and hence does not reverse opioid induced analgesia
30
classic triad of signs for opioid overdose
coma resp depression pinpoint pupils
31
what are the 4 different routes that fentanyl can be given?
parenteral transdermal transmucosal intranasal
32
what schedule med is fentanyl
II
33
Fentanyl is metabolized by
CYP3A4 (isoenzyme of cytochrome P450)
34
where should a fentanyl patch be applied
skin of the upper torso
35
what is the time line for fentanyl patch
reaches effective levels in 24 hours | levels remain steady for another 48 hours
36
age weight min for transdermal Fentanyl
should not be used in children younger than 2 years or children younger than 18 who weigh less than 110 lbs
37
fentanyl overdose risk for transdermal patch
If resp depression develops, it may persist for hours after patch removal, due to continued absorption of fentanyl from the skin
38
Transmucosal fentanyl rules
approved only for breakthrough cancer pain in patients at least 18 years old who are already taking opioids around the clock and have developed some degree of tolerance, defined as needing, for 1 week or longer, at least: 60mg of oral morphine a day, or 30 mg of oral oxycodone a day or 25mg of oral oxymorphine a day or 8mg of oral hydromorphone a day or 25mcg of fentanyl per hour or an equianalgesic dose of another opioid .
39
if a patient switches from one transmucosal product to another.....
dosage of the new product must be titrated to determine a strength that is safe and effective
40
what is Methodone (Diskets, Dolophine, Methadose) used for
pain and to treat opioid addiction
41
what test should be run before a pt is placed on Methodone (Diskets, Dolophine, Methadose)
This drug can cause QT prolongation Pt should receive an ECG before treatment, 30 days later and annually thereafter. If the QT interval exceeds 500ms, stopping or reducing the methodone should be considered
42
Black box warning Methodone (Diskets, Dolophine, Methadose)
QT prolongation Torsades de pointes If pt has existing QT prolongation or a family history of long QT syndrome and in those taking other QT prolonging drugs consider not using resp depression that can be fatal
43
what schedule drugs are Hydromorphone, Oxymorphone, Levorphanol
II
44
what is the difference between a moderate to strong opioid agonist and morphine which is a strong opioid agonist?
both produce analgesia, sedation and euphoria the both can also cause resp depression, constipation, urinary retention, cough suppression and miosis. The differences are quantitative: the moderate to strong opioids produce less analgesia and resp depression than morphine and have a somewhat lower potential for abuse
45
codeine alone is classified under what schedule?
II
46
Codeine combo such as norco is under what schedule
III
47
codeine used in cough syrups is what schedule
V
48
Blackbox for codeine
In the liver about 10% of each dose of codeine undergoes conversion to morphine. The enzyme responsible is CYP2D6 (The 2D6 isoenzyme of cytochrome P450) Among ultrarapid metabolizers, which carry multiple copies of the CYP2D6 gene, codeine is unusually effective and has led to death in some children. Severe toxicity can also develop in breastfed infants whose mothers are taking codeine. The cause is high levels of morphine in breast milk, due to ultrarapid codeine metabolism.
49
Oxycodone (oxycontin, Roxicodone) and Hydrocodone has analgesic actions equivalent to those of
codeine and is a schedule II
50
Codeine Oxycodone Hydrocodone Tapentadol fall into what class?
Moderate to strong opioid agonists
51
which moderate to strong opioid agonists causes less constipation than traditional opioids
Tapentadol (Nucynta)
52
pain medications in the Agonist-Antagonist Opioid Category
Pentazocine (Talwin) | Buprenorphine (Butrans)
53
what Agonist-antagonist opioid can be pre-treated with Narcan to prevent toxicity. However it cannot readily reverse toxicity bc it binds very tightly to its receptors and hence cannot readily be displaced by narcan
Buprenorphine (Butrans)
54
What is Buprenorphine approved for
analgesia and opioid addiction
55
Cardiac precautions for Buprenorphine
prolongs QT interval should not be used by patients with long QT syndrome or a fam history of long QT or by patients using QT prolonging drugs
56
Risk for adverse effects of Buprenorphine may be increased by
psychosis alcoholism adrenal corticoid insufficiency severe liver or renal impairment
57
opioid agonist with less constipation than traditional opioids
Tapentadol

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