Flashcards in Exam 4: Opioid Analgesics-Part 2 Deck (106):
Desired Clinical Effects of Opioid Drugs...KNOW THIS, OWN IT: Potent _______....Sedation and ________.....______ suppression
Desired Clinical Effects of Opioid Drugs...KNOW THIS, OWN IT: GI effects- _______ smooth muscle tone, _____ propulsion and motility, used for treatment of _______.
Adverse Reactions: Physical _______
Adverse Reactions: _______ depression (____ related)...dcreases brainstem sensitivity to _____.
Adverse Reactions: Opioids directly stimulate the chemoreceptor trigger zone the in medulla to produce ______ and _______. BUT don't worry, regular, repeated dosing prevents this by depressing its center (floor of fourth ventricle).
nausea and vomiting
Adverse Reactions: this reason is why opiods are given to stop diarrhea (off label)...
MAD constipation yo
Adverse Reactions: pinpoint pupils (scientifically named ______)... this is a diagnostic for addiction.
Adverse Reactions: When on opioids, the production of _____ is stimulated and there for you retain urine, this can be an issue if the pt has _______ problems already.
Adverse Reactions: Opioids can occasionally stimulate _____ effects: anxiety, restlessness, nervousness, dysphoria
Adverse Reactions of Opioid Drugs-Cardiovascular: _______ the vasomotor center and stimulates the vagus nerve so at high doses you can get _____tension, _______cardia, and syncope.
Adverse Reactions of Opioid Drugs-Biliary tract _______
– Biliary colic (watch in patients with gallstones)
Adverse Reactions of Opioid Drugs: ________ release! causing itching and urticaria...
Adverse Reactions of Opioid Drugs-Pregnancy and lactation....______ labor; depress fetal _______ if given near term.....Infants born to addicts have marked depressed respiration and experience withdrawal....Cross into _______.....morphine and codeine=FDA Pregnancy category “___”
Adverse Reactions of Opioid Drugs--Severity of side effects is proportional to ______.
efficacy... HA I bet you thought it would be potency
Adverse Reactions of Opioid Drugs--Overdose: Major symptom: ________ depression, Pinpoint pupils, Coma, Treated with antagonist = ________
Adverse Reactions of Opioid Drugs-Withdrawl: Occurs after abrupt discontinuance of drug....Yawning, lacrimation, perspiration, rhinorrhea, gooseflesh and piloerection (“_______”), irritability, nausea, vomiting, tachycardia, tremors, chills
Hypersensitivity Reactions to Opioids--Most are ________ – Skin rashes, urticaria...Differentiate from symptoms caused by histamine release (itching)..If true allergy, avoid.....Some preparations contain _________ (allergy to sulfites)
Clinical indications- Dentistry: ________ & ________, in medicine-those two AND _______, _______.
Analgesia, sedation....cough suppression and diarrhea
Opium = dried juice obtained from unripe seed capsules of poppy plant (Paparer somniferous)...25% of the dried juice consists of the ______: morphine, codeine
Heroin is a ________ morphine product.
Please name the 8 PURE agonists
1.morphine 2. oxycodone(percocet) 3.hydrocodone(vicodin) 4.codeine 5.dihydrocodeine 6.propoxyphene (withdrawn) 7.meperidine 8.fentanyl (most potent)
What is the mixed agonist/antagonist that is Equally as potent as morphine?
What schedule is Methadone?
II (mixed agonist/antagonist for detox/chronic pain)
Methadone inhibits _______ pain pathways.
Methadone produces generalized _____ depression.
Mathadone has SUPERIOR ______ efficacy.
Methadone has a ____ duration of action.
long (6 to 12 hours)
Methadone was initially used as a maintenance regimen for ______ abuse = FDA approved detoxication and maintenance programs & ______ therapy.
When you hear pure antagonist, think of the _______!!!! (reversing some of the negative effects of opioids.
KEEP a drug of this type in the dental offices that administer sedation to reverse effects...its effects occur in ___ to ___ MINUTES and last for ___-___ hours...What are 2 examples of this?
A pure antagonist..1 to 2 minutes....1 to 4 hours....nal-ox-one & nal-trex-one
Which one is used for alcohol abstinence..naltrexone or naloxone?
Naloxone (Narcan)...In dental office, IV to reverse overdose of _______ and _______ (sedation).
fentanyl and meperidine
What is the PROTOTYPE Pure Agonist?
Morphine- Acts like internal _______/_______.
Morphine- ______ mediated receptor function.
Morphine- Decreased ___________ in pain
pathways and it acts ______.
What is the most widely used route of administration for morphine?
Oral morphine is ______ absorbed....Not used in _______
Morphine has the ______ ring structure = which is ___ sided...Needed to bind to opiate (___) receptor
What is the most widely abused opiate in hospital personnel? WHY?
Mep-er-id-ine (Dem-erol)...Does not cause MIOSIS (masks the pinpoint pupils
Meperidine (Demerol) is an Excellent analgesic, but its _______.
Meperidine (Demerol) does not have mitosis, but does display _______, which is an atopine effect.
Meperidine (Demerol)-synthetic or natural?...How much sedation/euphoria compared to morphine/heroin?
synthetic.. Not as much sedation and euphoria as
with morphine or heroin
Meperidine (Demerol)...What are the 2 primary side effects?
1. Nausea 2.Respiratory Depression
How is meperidine (Demerol) mainly used in dentistry?
meperidine (Demerol)-Not as _______ as fentanyl, Not as much risk for ________ as with fentanyl
meperidine (Demerol)- has a ______ margin of safety with a ___ mg dose, administered via _______.
meperidine (Demerol)-can be given ______ for moderate to severe pain, ____-____ mg every 4 hours as needed (so ___ hours of duration)
What is one of the most frequently prescribed opioids in dentistry?
Codeine-Not used as ____- agent in dentistry = moderate efficacy, but many _______ side effects...used in combination products with ________ or ________.
sole...GI...acetaminophen or aspirin
Codeine-has 1/__ the potency of morphine, so 10 mg of morphine = ____ mg of codeine
1/6th....60 mg codeine
Codeine-What is the OPTIMUM dose?..if exceeded no greater ________ effect, but more _______!
60 mg...analgesic...side effects
Oral morphine is poorly absorbed, so we use ________, given orally, instead. BUT, there is risk for _______.
Codeine is indicated for _______ to moderately ______ pain...not indicated for _______ pain!
moderate to moderately severe...severe!
What is the drug of choice for cough suppression?
Codeine, rather typical side effects like nausea, dizziness, constipation, hypersensitivity, but _______ is an odd one.
Codeine dosing- __ to __ mg every 4-6 hours...#1=__ mg, #2=___ mg, #3= __ mg, #4=___ = 60 mg
15-60mg every 4-6 hours....#1=8mg (OTC in Canada!! Yay Canada!)....#2=15mg....#3=30mg....#4=60mg
What is the MOST WIDELY prescribed codeine product by dentists? What schedule is it?
Tylenol #3-300 mg acetaminophen and 30mg codeine..schedule 3
This is a good product for tension headaches!- C-III
• butalbital 50 mg (barbiturate) • aspirin 325 mg
• caffeine 40 mg
Ms. Fior-in-al with Codeine
What drug is 3 times more potent than codeine, has low incidence of side effects, and is typically assoc with acetaminophen?
What type of drug is Vicodin?
Hydrocodone (5mg) + Acetaminophen (500 mg)
What kind of drug is Lorcet/Lortab?
Hydrocodone (5mg) + Acetaminophen (500mg)
What does the term "CET" wedged into a drug name indicate?
That it has aCETaminophen!!
What is in our New Drug, Norco? What is a great FDA approved benefit? How does it still work?
10mg of hydrocodone and 325 mg acetaminophen..FDA likes the less amount of acetaminophen to guard against acute liver damage...works with a bit higher opiate dose
What is Vicodin's brand new schedule?
C-II, thanks DEA...
What are 2 examples of hydrocodone + ibuprofen? (hint they have some part of ibuprofen in their names)
1. Vico-Profen 2. Ibu-done
In hydrocodone + ibuprofen, the ibuprofen dose stays consistent at ____ mg...but many clinicians want to it the ibuprofen ceiling, so they will add ___ mg.
200mg...supplement with 200 more mg to get the 400 mg ceiling
Dihydrocodeine has the same efficacy/potentcy as _______, so its no more effective then ________.
What is an example of dihydrocoeine?
Synalgos DC (dihydrocodeine, aspirin, caffeine)
What is AS potent as morphine and is HIGHLY addictive? There for it is more potent then ______, which means more ______.
What is the schedule for Oxycodone? How is it usually paired in dentistry?
C-II...usually combined with an NSAID
What are the 3 oxycodone drugs that have oxycodone and acetaminophen/aspirin/ibuprofen?
PercoCET (acetamin), Percodan(aspirin), RoxiCET (acetamin), Combunox (ibu)
What is the NEW drug with oxycodone and ibuprofen? How much of each?
COMB-UN-OX.. 5 mg oxycodone, 400 mg ibuprofen
Combunox-Short term management of acute,
moderate-to-_____ dental pain, Use for __-__ days only, ______ available
fentanyl is ____ times more potent than morphine! AND ____ times more potent then meperidine.
100 times!!!....500 times
In dentistry, fentanyl is used for __________ only*, via which 3 ways?
conscious sedation...via IV, transdermal, or a LOLLIPOP
What is the great dental opiate not scheduled by DEA (May be scheduled in certain states)...for moderate to moderately-severe pain
Tramadol-Use for ≤___ days for acute dental pain
Tramadol-Binds to ____ opiate receptors in CNS, which inhibits ________ pain pathways, altering perception of and response to pain
Tramadol-Also inhibits the reuptake of ________ and ________....
norepi and serotonin
What is a brand name for tramadol?
tramadol-Immediate release given 50-100 mg every 4 to 6 hours, not to exceed ____ mg/day = titrate up
tramadol-a rare complication:_________ and it is also associated with ________.
are complication = anaphylaxis.....Associated with seizures
PLEASE DONT CRUSH YOUR tramadol!!!!!!!Rapid release and absorption of extended release formulation if broken, crushed or chewed can lead to potentially lethal ________.
Ultracet is a combination of _______ and _______. What ingredient dictates the max daily dose?
acetaminophen (325 mg ) and tramadol (37.5 mg)...acetaminophen dictates
What is our kick ass NSAID that provides analgesia at the opioid level? Therefore its indicated for moderate to _______ dental pain
ket-or-olac (Tor-a-dol)- SHORT term use, less than or equal to ___ days of use.
ket-or-olac (Tor-a-dol)- since its an NSAID, watch for ______ and _______ complications.
Prescribing Considerations-Most patients are better managed with _______ (anti- inflammatory effect)
Prescribing Considerations- Start with ________ preparations (containing codeine or hydrocodone)
Prescribing Considerations- Only prescribe stronger opioids for ______ periods of time, then switch to something else
Prescribing Considerations- rescribe ______ quantities without ______.
Prescribing Considerations- should be straight forward, but prescribe only if patient has received _________.
Prescribing Considerations- If _____ persists, bring patient back for evaluation and local treatment
Prescribing Considerations- If patient demands more drugs, refer to a _______ (chronic pain). Because it is managed differently!
Key Points to Remember- Opiates are ________ substances in the US
Key Points to Remember-We write for limited quantities due to the potential for ________
– **Limit use to ___-___ days (acute pain only)
addiction...3 to 5 days
Key Points to Remember-__________ with ________ is most widely used opiate agent for the management of dental pain (Vicodin or Lorcet)
hydrocodone with acetaminophen
Key Points to Remember-Of the codeine preparations, _______ is the most widely prescribed in dentistry
Key Points to Remember-________ with __________ is used to treat the more SEVERE degrees of pain
oxycodone with acetaminophen
Key Points to Remember- __________ is useful for patients with a history of CODEINE ALLERGY.
Key Points to Remember- ______ and _________ (Dilaudid) are NOT indicated as analgesics in ANY dental situation!
Key Points to Remember- Whenever possible, an ______ is preferred to a opiate agent for pain management
– Opiates do not reduce ________, which is the most common etiology for dental pain
– Treating inflammation will reduce _____
Key Points to Remember- All opiates will cause _______ in most patients, ________ is another common complaint
Key Points to Remember- _______ patients: use caution – NSAIDS and GI bleeding– Aspirin and hemorrhage– Opiates and constipation– Opiates and CNS effects = disorientation, falling– Liver and renal function = start lowest dose, titrate up