Drugs for Pain - Martin

Question 1

opiod full agonst

Answer 1

morphine

fentanyl

Question 2

opiod partial agonist

Answer 2

codeine
hydrocodone
oxycodone

Question 3

mixed agonist/antagonist at opiod

Answer 3

buprenorphine

Question 4

opiod antagonist

Answer 4

naloxone

Question 5

loss of pain perception

Answer 5

analgesia

Question 6

morphine tx

Answer 6

aware of pain sensation - but not unpleasant

Question 7

opiod to pt with no pain

Answer 7

nausea and vomiting

Question 8

pain

Answer 8

sensory - component due to activation of pain receptors

reactive - altered by level of anxiety and stress

Question 9

narcotic

Answer 9

any substance producing stupor and analgesia

Question 10

opiate

Answer 10

any derivative of opium poppy

Question 11

opioids

Answer 11

compounds that bind opioid receptors

Question 12

endogenous opioid agonists

Answer 12

endorphins
enkephalins
dynorphins

Question 13

synthesis of endogenous opioid peptides

Answer 13

from POMC

Question 14

opioid receptors

Answer 14

mu - euphoria

kappa - dysphoria

delta

Question 15

opioid receptor mechanism

Answer 15

all GPCRs

inhibit cAMP

modulate K channels - K efflux and hyperpolarization

reduce Ca influx - inhibit NT release - glutamate, substance P

Question 16

spinal cord opiod receptors

Answer 16

pain signaling

Question 17

limbic system

Answer 17

addiction potential

-with opioid receptors

Question 18

heroin OD death

Answer 18

resp depression

Question 19

euphoria

Answer 19

with mu receptors

Question 20

adverse of opioids

Answer 20

constipation

Question 21

opioid effects

Answer 21

analgesia
euphoria/dysphoria
sedation
resp depression
cough suppression

Question 22

coma and resp depression with miosis

Answer 22

pupil constriction

hint that pt is drug user - opioids

dilated pupil - other types of coma

Question 23

if asphyxia develops with opioid overdose

Answer 23

get mydriasis - pupil dilation

Question 24

severe brain injury

Answer 24

CI for opioid use

because they increase CSF pressure

Question 25

constipation

Answer 25

with chronic therapy with opioids

Question 26

opioids and asthmatics

Answer 26

no - because release histamine can result in bronchoconstriction

Question 27

morphine

Answer 27

binds all opioid receptor -high affinity at mu high abuse potential and analgesia high addiction potential**

Question 28

pharmacokinetics of morphine

Answer 28

high first pass effect need to give 4x oral vs. IV dose distributed to tissues - even fetus - not during pregnancy

Question 29

fentanyl

Answer 29

start quickly and stop quickly

Question 30

severe constant pain tx

Answer 30

morphine

Question 31

sharp intermittent pain tx

Answer 31

NSAIDs

Question 32

pain and anxiety with MI

Answer 32

tx - morphine - 1st line

Question 33

relief of dyspnea from left ventricular failure and acute pulmonary edema

Answer 33

tx - morphine - anxiolytic - reduced perception of SOB

Question 34

cough suppression

Answer 34

dextromorphan and codeine

Question 35

diarrhea

Answer 35

loperamide diphenoxylate difenoxin atropine added to dephenoxylate and difenoxin - to prevent addiction

Question 36

fentanyl

Answer 36

100x more potent than morphine used in anesthesia rapid onset of action and short duration of action epidural - analgesia post op and during labor

Question 37

methadone

Answer 37

less euphoria and long duration of action used for withdrawal of heroin or morphine users oral pt slowly weaned off methadone -causes a withdrawal syndrome that is milder

Question 38

meperidine

Answer 38

OB/GYN use -dilates pupils less effect on smooth muscle - so can use in obstetrics short term use only - toxins accumulate

Question 39

heroin

Answer 39

diacetylmorphine - schedule I - converted to morphine in body

Question 40

partial agonists

Answer 40

codeine hydrocodone oxycodone combined with NSAIDs - increase analgesia

Question 41

outpatient analgesics

Answer 41

``` tylenol with codeine codeine/aspirin hydrocodone/acetaminophen oxycodone/acetaminophen oxycodone/aspirin ```

Question 42

buphrenorphine

Answer 42

partial agonist at mu receptor use - opioid detox not as bad withdrawal as methadone

Question 43

tx opioid OD

Answer 43

naloxone naltrexone opioid antagonists

Question 44

antagonist to pt dependent on opioids

Answer 44

precipitates withdrawal syndromes

Question 45

opiate reward pathways

Answer 45

GABA and dopamine pathways opiate agonist - reduce excitability and transmitter release inhibit in VTA on GABA interneurons increase outflow from ventral pallidum - correlated with positive reinforcing state

Question 46

opioid tolerance

Answer 46

to analgesia, resp depression, euphoria, and sedation NOT to miosis and constipation

Question 47

cross-tolerance

Answer 47

to all opioid agonists

Question 48

withdrawal rom opioid sx

Answer 48

rhinorrhea, lacrimation, yawning, chills, piloerction, hyperventilation, hyperthermia, mydriasis, vomiting, diarrhea, anxiety

Question 49

tx of opioid withdrawal

Answer 49

supportive care clonidine - alpha2 agonist -reduce craving, anxiety, and sympathetic outflow

Question 50

opioid overdose

Answer 50

1 lethargy/coma 2 depression of respirations 3 pinpoint pupils also - hypotension, hypothermia, pulmonary edema, convulsion, hypoxia - dilated pupils

Question 51

tx opioid OD

Answer 51

opioid antagonist - naloxone