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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 31 - Opioids > Flashcards

Chapter 31 - Opioids Flashcards

(69 cards)

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1
Q

What chemical mediators are released with tissue injury?

A

-bradykinin
-histamine
-substance P
-prostaglandins
-serotonin
-leukotrienes

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2
Q

Opiod

A

any drug, natural or synthetic, that has actions similar to morphin

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3
Q

Opiate

A

term that applies only to compounds present in opium

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4
Q

Which 3 peptide families have opioid-like properties?

A

-enkephalins
-endorphins
-dynorphins

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5
Q

What are Mu opioid receptors?

A

receptors that are the MOST important for opioids - involve analgesia, respiratory depression, euphoria, sedation, physical dependence

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6
Q

What are kappa opioid receptors used for?

A

analgesia and sedation

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7
Q

What receptor is responsible for underlying psychomimetic effects?

A

kappa receptors

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8
Q

Which receptor type does not interact with opioids?

A

delta

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9
Q

What receptors do pure opioid agonists interact with?

A

Mu and kappa

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10
Q

What effects do pure opioid agonists produce?

A

-analgesia
-euphoria
-sedation
-respiratory depression
-physical dependence
-constipations

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11
Q

What drugs are pure opioid agonists?

A

morphine and codeine

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12
Q

What drugs are agonist-antagonist opioids?

A

-pentazocine
-nalbuphine
-butorphanol
-buprenorphine

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13
Q

What effect do agonist-antagonist opiods have when administered alone?

A

analgesia

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14
Q

What do agonist-antagonist opiods do with pure agonists?

A

antagonize analgesia

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15
Q

All opiods are measures against what drug??

A

morphine

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16
Q

How does morphine act?

A

mimics actions of endogenous opioid peptides primarily at Mu receptors

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17
Q

What are the adverse effects of morphine?

A

-**respiratory depression
-constipation
-urinary retention
-drowsiness
-orthostatic hypothension
-emesis
-miosis
-cough suppression
-tolerance and dependence
-brain fog

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18
Q

WHAT IS A MAJOR COMPLICATION OF OPIOIDS?

A

RESPIRATORY ARREST

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19
Q

Who is most susceptible to resp. depression from morphine?

A

infants and elderly

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20
Q

What is the onset of IV morphine?

A

7 mins

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21
Q

What is the onset of IM morphine?

A

30 min

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22
Q

What is the onset of subQ morphine?

A

up to 90 mins

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23
Q

How long does morphine last?

A

4-5 hrs

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24
Q

Spinal morphine injection may be ______________

A

delayed

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25
What contributes to constipation from morphine?
-suppressed propulsive contractions -intensified non-propulsive contractions -increased anal sphincter tone -inhibited secretion of fluids into lumen
26
What is the tx for morphine induced constipation?
-activity -fibre and fluid intake -stimulant laxatives -stool softeners -polyethylene glycol
27
How does morphine cause orthostatic hypotension?
blunts baroreceptor reflex by causing vasodilation
28
How does morphine cause urinary retention?
-increase tone in bladder sphincter -increased tone in detrusor muscle -suppresses awareness of bladder stimuli
29
How does morphine suppress cough?
-acts on receptors in medulla to suppress reflex -secretions accumulate in airway
30
What does patient teaching about coughing post-morphine occur?
cough reflex is suppressed, secretions must be cleared at regular intervals
31
How does morphine produce emesis?
-direct stimulation of chemoreceptors in medulla -rxn. greatest with initial dose -more common in recumbent patients
32
How does morphine elevate ICP?
-reduced respirations increases CO2 in blood that dilates cerebral vasculature
33
Euphoria
exaggerated sense of well-being caused by Mu receptor activation
34
Dysphoria
sense of anxiety and unease
35
When does dysphoria occur?
when morphine is taken in the absence of pain
36
How do you avoid sedation with morphine?
-smaller doses more often -use opioids with short half-lives
37
Miosis
pupillary constriction
38
How do pupils appear with morphine toxicity?
pinpoint pupils
39
What are risk factors for neurotoxicity caused by morphine?
-renal impairment -pre-existing cognitive impairment -prolonged opioid use
40
How is neurotoxicity managed with morphine use?
hydration and dose reduction
41
Is morphine lipid soluble?
not really, doesn't cross BBB easily
42
What AEs does morphine tolerance develop to?
-analgesia -euphoria -sedation -respiratory depression -NOT CONSTIPATION OR MIOSIS
43
What are the initial morphine withdrawal symptoms that start 10hrs after the last dose?
-yawning -rhinorrhea -sweating
44
What are the subsequent symptoms of morphine withdrawal?
-violent sneezing -weakness -nausea -vomiting -diarrhea -abdominal cramps -bone and muscle pain -muscle spasms -kicking movements
45
How long does morphine withdrawal last if untreated?
7-10 days
46
What is the classic triad of morphine TOXICITY?
-coma -respiratory depression -pinpoint pupils
47
What is the treatment for morphine toxicity?
ventilation support and NALOXONE (narcan)
48
2 guidelines for morphine?
-monitor vitals -give on fixed schedule
49
How many times more potent is fentanyl than morphine?
80-100x
50
___% of codeine is converted to morphine via CYP2D6
10
51
What strength are codeine, oxycodone, and hydrocodone?
moderate to strong opioid agonists
52
What kind of opioid is Buprenorphine?
an agonist-antagonist opioid
53
How is buprenorphine administered?
-7 day patch -SL tabs
54
Why is Buprenorphine used over other drugs?
substance use replacement therapy because it works differently
55
How does buprenorphine act?
as a partial agonist at Mu receptors and antagonist at kappa receptors
56
What effect does buprenorphine provide?
analgesic effects (like morphine) with less respiratory depression
57
What is an adverse effect of buprenorphine?
prolonged QT interval
58
When are opioid antagonists used?
-treatment of OD -constipation relief -reversal of post-op effects -reversing neonatal respiratory depression -addiction management
59
What is naloxone (narcan)?
a reversal agent for opioids
60
What receptors does naloxone work at?
Mu and Kappa
61
What opioid antagonist is used more often to treat addiction?
naltrexone - prevents euphoria if user takes an opioid
62
What is methylnaltrexone (antagonist) used to treat?
opioid-induced constipation
63
How do non-opioid centrally acting analgesics act?
relieve pain in a way unrelated to opioid receptors
64
Do non-opioid analgesics have the same risks?
no respiratory depression or abuse
65
What are the 2 non-opioid analgesics?
tramadol and tramacet (tramadol and acetaminophen)
66
What receptors do tramadol and tramacet work at?
NE and 5-HT (serotonin)
67
Tramadol and tramacet are ___________ analogues
codeine
68
What are the side effects of tramadol and tramacet?
-sedation -dizziness -headache -dry mouth -constipation
69
When should tramadol and tramacet not be used?
high suicide risk pts

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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