Chapter 8: Drugs To Treat Pain - Opioid Analgesics

Question 1

Name a low potency opioid.

Answer 1

Codeine

Question 2

Name a medium potency opioid.

Answer 2

Morphine

Question 3

Name an opioid.

Answer 3

• hydrocodone
• oxycodone

Question 4

Name a extremely high potency opioid.

Answer 4

Fentanyl

Question 5

Name an illegal opioid.

Answer 5

Heroin

Question 6

Name an opioid antagonist.

Answer 6

Naloxone

Question 7

Prescribers should consider opioid therapy only if…

Answer 7

The expected benefits for both pain and function are anticipated to outweigh the risks to the patient

Question 8

If opioids are used, they should be combined with _______ therapy and _______ _______ therapy, as appropriate.

Answer 8

• nonpharmacologic
• nonopioid pharmacologic therapy

Question 9

Opioid drugs act by binding to _____ _____, primarily located in the ______, the _______ ______ _____, and the _______ _____.

Answer 9

• opioid receptors
• CNS
• peripheral nervous system
• gastrointestinal tract

Question 10

Onset of analgesic effect for oral opioids:

Answer 10

45 min

Question 11

Peak effect of oral opioids usually occurs when?

Answer 11

1-2 hours after administration

Question 12

Name some symptoms of opioid addiction or opioid use disorder.

Answer 12

• inability to control opioid use
• uncontrollable cravings
• drowsiness
• changes in sleep habits
• weight loss
• frequent flulike symptoms
• decreased libido
• lack of hygiene
• changes in exercise habits
• isolation from family and friends
• stealing from family, friends, or businesses
• new financial difficulties

Question 13

What is Norco, Lortab, or Vicodin?

Answer 13

Combination of hydrocodone and acetaminophen

Question 14

What is Percocet?

Answer 14

Oxycodone and acetaminophen

Question 15

What is vicoprofen?

Answer 15

Hydrocodone and ibuprofen

Question 16

The extended release (ER) form of all opioids should be used only for ______ _____ and is dosed ….

Answer 16

• chronic pain
• around the clock rather than on an as-needed basis

Question 17

What is opioid-induced constipation?

Answer 17

Reduction of spontaneous bowel movement from baseline to typically < 3 bowel movements per week after commencing opioid therapy.

Question 18

What reverses the constipation associated with opioids?

Answer 18

Peripherally Acting Mu-Opioid Receptor Agonists (PAMORA)

Question 19

What happens when you combine opioids and benzodiazepines or sleep hypnotics?

Answer 19

• significant sedation
• respiratory depression
• coma, death
• should be avoided, especially when driving

Question 20

What are the 3 primary FDA opioid warnings?

Answer 20

1. Risk of addiction, abuse, and misuse.
2. Life-threatening respiratory depression.
3. Risks from concomitant use with benzodiazepines or other CNS depressants.

Question 21

What effects does codeine have?

Answer 21

• low-potency opioid analgesic
• antitussive

Question 22

What is the onset of action, peak effect, duration, bioavailability, and half life of codeine?

Answer 22

• onset of action: 0.5-1 hr
• peak effect: 1-1.5 hr
• duration: 4-6 hr
• bioavailability: 53%
• half life: 3 hr

Question 23

How is codeine metabolized and excreted?

Answer 23

• hepatic
• urine, feces

Question 24

What is equianalgesic?

Answer 24

• the standard against which new analgesics are measured
• morphine

Question 25

What are congeners?

Answer 25

Semisynthetic derivatives

Question 26

What effect does morphine have?

Answer 26

Medium-potency opioid analgesic

Question 27

Routes of administration for morphine:

Answer 27

- oral (IR, ER) - rectal - IV - IM - SQ

Question 28

What is the onset of action, peak effect, duration, bioavailability, and half-life of morphine?

Answer 28

- onset of action: ~30 min (patient dependent) - peak effect: 1 hour - duration: patient dependent - bioavailability: 17-33% (first pass effect limits oral bioavailability) - half life: 2-4 hr

Question 29

How is morphine distributed?

Answer 29

- skeletal muscle, liver, kidneys, lungs, intestinal tract, spleen, and brain - binds to opioid receptors in the CNS and periphery (eg. GI tract)

Question 30

How is morphine metabolized and excreted?

Answer 30

- hepatic - urine and feces

Question 31

When is morphine indicated?

Answer 31

- for management of pain severe enough to require daily, around-the-clock, long-term opioid treatment - alternative treatment options are inadequate

Question 32

Name 2 synthetic derivatives of morphine. They are widely used in combination with _______.

Answer 32

- oxycodone - hydrocodone - acetaminophen

Question 33

Hydrocodone is approximately equipotent to ______, with an onset of action of ______ min, duration of ______ hours, and a serum half life of about ______ hours.

Answer 33

- oxycodone - 10-30 min - 4-6 hours - 4 hours

Question 34

Fentanyl is ____ times more potent than morphine.

Answer 34

100

Question 35

Fentanyl is most widely used for….

Answer 35

Intraoperative and periprocedural analgesia

Question 36

Time to peak analgesic effect after IV administration of fentanyl vs morphine.

Answer 36

- ~ 5 min - ~ 15 min

Question 37

What routes of administration are preferred when using fentanyl for chronic pain management?

Answer 37

- poorly absorbed in the GI tract - transdermal or buccal administration methods preferred

Question 38

Transdermal fentanyl patches (Duragesic) provide sustained release for _____ hours. However, factors promoting increased absorption such as _______, _____ ______, can lead to overdosage and increased side effects.

Answer 38

- 48-72 hours - fever, moist heat

Question 39

The transdermal patch fentanyl is indicated only for what type of patients?

Answer 39

- opioid-tolerant patients - patients who have been on 60 mg of morphine/day or an equianalgesic dose of another opioid for at least a week

Question 40

How does Naloxone work?

Answer 40

Binds competitively to opioid receptors but does not produce an analgesic or opioid side-effect response. Used to reverse the toxic effects of opioid agonists. - can completely or partially reverse opioid depression (including respiratory depression)

Question 41

How much Naloxone can be administered how often?

Answer 41

2 mg every 2 or 3 minutes