Ch 28 Opioid

Question 1

__ are drugs that relieve pain without causing loss of consciousness.

Answer 1

Analgesics

Question 2

__ are the most effective analgesics available.

Answer 2

Opioids

Question 3

There are three major classes of opioid receptors, designated (3).

Answer 3

mu, kappa, and delta

Question 4

Morphine and other pure opioid agonists relieve pain by __.

Answer 4

mimicking the actions of endogenous opioid peptides— primarily at mu receptors, and partly at kappa receptors.

Question 5

Opioid-induced __ can complement pain relief.

Answer 5

sedation and euphoria

Question 6

Because opioids produce __, they have a high liability for abuse.

Answer 6

euphoria and other desirable subjective effects

Question 7

__ is the most serious adverse effect of the opioids.

Answer 7

Respiratory depression

Question 8

Other important adverse effects of opioids are __.

Answer 8

constipation, urinary retention, orthostatic hypotension, emesis, miosis, birth defects, and elevation of ICP.

Question 9

Because of __, oral doses of morphine must be larger than parenteral doses to produce equivalent analgesic effects.

Answer 9

first-pass metabolism

Question 10

Because the __ is poorly developed in infants, these patients need smaller doses of opioids (adjusted for body weight) than do older children and adults.

Answer 10

blood-brain barrier

Question 11

With prolonged opioid use, tolerance develops to __.

Answer 11

analgesia, euphoria, sedation, and respiratory depression, but not to constipation and miosis

Question 12

Cross-tolerance exists among the various opioid agonists, but not between opioid agonists and __.

Answer 12

general CNS depressants

Question 13

With prolonged opioid use, ___.

Answer 13

physical dependence develops.

An abstinence syndrome will occur if the opioid is abruptly withdrawn.

Question 14

In contrast to the withdrawal syndrome associated with general CNS depressants, the withdrawal syndrome associated with __, although unpleasant, is not dangerous.

Answer 14

opioids

Question 15

To minimize symptoms of abstinence, opioids __.

Answer 15

should be withdrawn gradually

Question 16

Precautions to opioid use include (4).

Answer 16

pregnancy, labor and delivery, head injury, and decreased respiratory reserve.

Question 17

Patients taking opioids should avoid alcohol and other

CNS depressants because these drugs __.

Answer 17

can intensify opioid induced sedation and respiratory depression.

Question 18

Patients taking opioids should avoid anticholinergic drugs (e.g., antihistamines, tricyclic antidepressants, atropine-like drugs) because these drugs __.

Answer 18

can exacerbate opioid-induced constipation and urinary retention.

Question 19

Opioid overdose produces a classic triad of signs:

Answer 19

coma, respiratory depression, and pinpoint pupils.

Question 20

All __ are essentially equal to morphine with regard to analgesia, abuse liability, and respiratory depression.

Answer 20

strong opioid agonists

Question 21

Use of meperidine should be avoided so as to prevent accumulation of __.

Answer 21

normeperidine, a toxic metabolite

Question 22

Like morphine, codeine and other moderate to strong opioid agonists produce:

Answer 22

analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis.

These drugs differ from morphine in that they produce less analgesia and respiratory depression and have a lower potential for abuse.

Question 23

The combination of codeine with a nonopioid analgesic (e.g., aspirin, acetaminophen) produces __.

Answer 23

greater pain relief than can be achieved with either agent alone

Question 24

Most __ act as agonists at kappa receptors and antagonists at mu receptors.

Answer 24

agonist-antagonist opioids

Question 25

__ produce less analgesia than morphine and have a lower potential for abuse.

Answer 25

Pentazocine and other agonist-antagonist opioids

Question 26

With agonist-antagonist opioids, there is a ceiling to __.

Answer 26

respiratory depression

Question 27

If given to a patient who is physically dependent on pure opioid agonists, an agonist-antagonist will __.

Answer 27

precipitate withdrawal.

Question 28

__ act as antagonists at mu receptors and kappa receptors.

Answer 28

Pure opioid antagonists

Question 29

___ can reverse respiratory depression, coma, analgesia, and most other effects of pure opioid agonists.

Answer 29

Naloxone and other pure opioid antagonists The only exception is methylnaltrexone, which doesn’t cross the blood-brain barrier.

Question 30

__ are used primarily to treat opioid overdose.

Answer 30

Pure opioid antagonists Two agents—methylnaltrexone and naloxegol— are used for opioid-induced constipation, and another— alvimopan—for opioid-induced ileus.

Question 31

If administered in excessive dosage to an individual who is physically dependent on opioid agonists, __ will precipitate an immediate withdrawal reaction.

Answer 31

naloxone

Question 32

Opioid dosage must be __.

Answer 32

individualized. Patients with a low tolerance to pain or with extremely painful conditions need high doses. Patients with sharp, stabbing pain need higher doses than patients with dull pain. Older adults generally require lower doses than younger adults. Neonates require relatively low doses.

Question 33

As a rule, opioids should be administered __ postoperatively.

Answer 33

on a fixed schedule for the first 24 hours postoperatively (with supplemental doses for breakthrough pain) rather than PRN.

Question 34

Most PCA devices are electronically controlled pumps | that can be activated by the patient to deliver a __.

Answer 34

preset dose of opioid through an indwelling catheter. Some PCA devices also deliver a basal opioid infusion.

Question 35

__ provide steady plasma drug levels, thereby maintaining continuous pain control while avoiding unnecessary sedation and respiratory depression.

Answer 35

PCA devices

Question 36

Use of __ can suppress uterine contractions and cause respiratory depression in the neonate.

Answer 36

parenteral opioids during delivery

Question 37

__ is a primary chronic disease characterized by an individual pathologically pursuing rewards and/or relief by substance use and other behaviors.

Answer 37

Addiction Physical dependence and addiction are not the same.

Question 38

__ is defined as drug use that is inconsistent with medical or social norms.

Answer 38

Abuse

Question 39

Because of excessive and inappropriate fears about addiction and abuse, providers frequently prescribe __.

Answer 39

less pain medication than patients need, and nurses frequently administer less medication than was prescribed.

Question 40

Dispel your concerns about abuse and addiction, and __.

Answer 40

give your patients the medication they need to relieve suffering. That’s what opioids are for, after all.