E1- Opioids

Question 1

Which opioid is most likely to cause N/V?

Answer 1

Injected Morphine

Question 2

Which opioids are most likely to be used as antitussives?

Answer 2

Codeine and Dextromethophan

Question 3

Which opioid does not suppress cough?

Answer 3

Meperidine

Question 4

Do opioids cause mitosis or mydriasis?

Answer 4

Mitosis

Question 5

What is the only opioid that causes mydriasis?

Answer 5

Meperidine

Question 6

Which opioid is most likely to cause truncal rigidity

Answer 6

Fentanyl, IV

Question 7

What are the cardiovascular effects of opioids?

Answer 7

Bradycardia

Decreased BP

Question 8

What is the only opioid that may cause tachycardia?

Answer 8

Meperidine

Question 9

What is the GI effect of opioids?

Answer 9

Constipation

Question 10

What are the GU effects of opioids?

Answer 10

Decreased urine output
Harder to urinate
Harder to pass kidney stones

Question 11

What is the effect of opioids on the uterus?

Answer 11

Prolong labor

Question 12

What are the endocrine effects of opioids?

Answer 12

Increases ADH, prolactin, somatotropin

Inhibits LH

Question 13

Why do some people claim they are allergic to opioids?

Answer 13

Opioids release histamine

Produces flushing, itching sweating

Question 14

Which opioid is most likely to produce a histamine reaction?

Answer 14

Injected Morphine

Question 15

What is the effect of opioids on body temperature?

Answer 15

Decreased body temperature

Question 16

Which opioid is contraindicated in pts with a hx of seizures?

Answer 16

Meperidine

Question 17

What are SE of opioids?

Answer 17

N/V
Constipation
Urinary retention
Itching/hives
Respiratory depression
Postural hypotension
Restlessness
Dysphoria

Question 18

What can occur with chronic opioid use?

Answer 18

Tolerance

Hyperalgesia

Question 19

What can decrease tolerance dependence, and hyperalgesia?

Answer 19

NMDA receptor antagonist

Question 20

What effects of opioids can develop tolerance?

Answer 20

Analgesia
Sedation
Euphoria
N/V
Respiratory depression

Question 21

What effects of opioids do not develop tolerance?

Answer 21

Miosis
Constipation
Seizures

Question 22

Are pts more likely to become addicted if they are over or under prescribed?

Answer 22

UNDERprescribed

Question 23

What can be used to reduce symptoms of opioid withdrawal?

Answer 23

Clonidine
Methadone
Buprenorphine

Question 24

What can cause withdrawal if a pt if dependent on opioids?

Answer 24

Opioid antagonsit

Question 25

What are some symptoms of opioid withdrawal

Answer 25

``` Dysphoria Anxiety Insomnia Piloerection Increased BP, HR, temp Muscle aches, twitches ```

Question 26

What are signs of opioid OD?

Answer 26

CNS depression Respiratory depression Pin point pupils

Question 27

What is the treatment of opioid OD?

Answer 27

``` Support respiration Opioid antagonist (Naloxone) ```

Question 28

What are the clinical uses of opioids?

Answer 28

``` Analgesia Acute pulmonary edema Antitussive Diarrhea Anesthesia ```

Question 29

What are possible drug interactions of opioids?

Answer 29

Sedative hypnotics Antipsychotics MAO inhibitors (Meperidine, Dextromethorphan- but best to avoid all opioids) CYP2D6 inhibitors (Fluoxetine)

Question 30

What are contraindications to opioids?

Answer 30

Use of partial agonist with full agonist (cause withdrawal) Pts with head injuries (increase in intracranial pressure) Pregnancy Impaired pulmonary function function Impaired hepatic or renal function

Question 31

What route of administration of Morphine most effective?

Answer 31

More effective when injected than PO due to high first-pass metabolism

Question 32

Which opioid is more potent than morphine, but less likely to cause itching, and is a good choice for pts with renal dysfunction?

Answer 32

Hydromorphone

Question 33

Which 2 opioids are Mu agonist?

Answer 33

Methadone | Meperidine

Question 34

What are the uses of Methadone?

Answer 34

Long-term control of pain (hard-to-treat cases) | Maintenance treatment of addicts

Question 35

When should Meperidine not be used?

Answer 35

For more than 48hrs, in high doses, or in renal failure due to accumulation of metabolite that can cause seizures

Question 36

Which opioid causes serotonin syndrome when used with MAOIs?

Answer 36

Meperidine

Question 37

Fluoxetine inhibits the effects of which opioids?

Answer 37

Codeine, Oxycodone, Hydrocodone (metabolized by CYP2D6)

Question 38

Is it recommended to prescribe hydrocodone with/without acetaminophen?

Answer 38

WITHOUT

Question 39

What is being added to Oxycodone and Buprenorphine to prevent their effects if injected?

Answer 39

Naloxone or Naltrexone

Question 40

What is the MOA of Pentazocine/naloxone?

Answer 40

Kappa receptor agonist, Mu receptor partial agonist

Question 41

What is the MOA of Buprenorphine?

Answer 41

Mu receptor partial agonist

Question 42

Which opioid has a ceiling effect to the euphoria leading to a low abuse potential?

Answer 42

Buprenorphine

Question 43

What is the MOA of Tramadol?

Answer 43

Weak Mu agonist, inhibits NE/5-HT reuptake

Question 44

What should you not combine Tramadol with? Why?

Answer 44

Antidepressants --> seizures | MAOIs, TCAs, SSRIs --> serotonin syndrome

Question 45

What should you not combine with Dextromethophan? Why?

Answer 45

MOAIs- --> serotonin syndrome

Question 46

What is DOC for opioid overdose?

Answer 46

Naloxone

Question 47

How is Naloxone administerted?

Answer 47

Must be injected (give until pupils dilate)

Question 48

What is the concern for Naltrexone and alcoholics?

Answer 48

May cause liver toxicity when used chronically

Question 49

What are the 2 opioid antagonist?

Answer 49

Naloxone | Naltrexone