Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuropsychopharmacology > Lecture 14: Pain & Opioids > Flashcards

Lecture 14: Pain & Opioids Flashcards

(81 cards)

Start Studying
1
Q

opioid

A

broadly refers to all compounds related to opium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

endogenous opioid peptides

A

naturally occuring ligands for opioid receptors in animals & humans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

narcotic

A

term used in legal context for substances of abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

natural opioid agonists

A

morphine, codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

semi-synthetic opioid agonists

A

heroin, hydromorphone, oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

synthetic opioid agonists

A

meperidine, methadone, fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mixed opioid agonists/antagonsts

A

pentazocine (agonist activity&raquo_space;> antagonist activity), buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pure opioid antagonists

A

naloxone, naltrexonen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

naloxone function

A

reversal of opioids overdose, treatment of opioid dependence, diagnosis of opioid physical dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

naltrexone function

A

treat alcohol dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

therapeutic uses of opioids

A
  • analgesia
  • anesthesia
  • cough suppressant
  • diarrhea suppressant
  • treats dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why is fentanyl so dangerous

A
  • rapidly crosses the BBB
  • super-potent
  • long lasting due to deposits in fat
  • challenge to neutralize high doses of fentanyl by naloxone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

strong opioids

A

morphine, hydromorphone, fentanyl, methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what should be used to treat severe pain

A

strong opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what shoudl be used to treat moderate pain

A

weak opioid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

weak opioids

A

codeine & tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what should be used to treat mild pain

A

NSAID (ibuprofen, naproxen), acetaminophen, & adjunct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CDC guideline for immediate-release vs extended-release opioids

A

prescribe immediate-release opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CDC guidelines for opioid dosage

A

prescribe lowest effective dosage
- no greater quantity than needed for the expected duration of pain severe enough to require opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when does the CDC reccomend reassessing benefits vs risks

A

at > 50 morphine mg equivalents (MME)/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the maximum dosage CDC recommends

A

90 MME/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are opioid use disorder & opioid misuse associated with

A

duration of treatment & daily dose (50 MME/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the recommendation for smaller breakthrough dose

A

10% of 24 hr dose or 50% of q4h dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

brain region for pain location intensity

A

somatosensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
brain regions for pain processing
spinal cord, thalamus, LC, PAG, RVm
26
brain regions for motivation & reward
mesolimbic DA system (VTA/NAc)
27
brain regions for emotional processing
amygdala, ACC, insular cortex, habenula, septum
28
brain regions for learning & memory
hippocampus, amygdala
29
endogenous opioid peptides
enkephalins, dynorphins, endorphins, endomorphins, nociceptin
30
what is the role of endogenous opioid peptides
control of pain perception, neuroendocrine, cardiovascular, respiratory regulation, psychiatric illnesses, epilepsy, food intake
31
opioid effect on Ca2+ channels
inhibit them in order to block NT/peptide release from pre-synaptic nerve terminals
32
opioid effect on postsynaptic neurons
hyperpolarizing due to activation of K+ currents
33
opioid effect on cell signaling
inhibition of adenylyl cyclase
34
which GPCR do opioids bind to
Gi coupled
35
opioid pharmacological effects
- constipation - nausea - urinary retention - itch - dry mouth - respiratory depression - euphoria - miosis - analgesia - sedation
36
major adverse effects
- respiratory depression - truncal rigidity - nausea/vomiting - constipation - addiction
37
respiratory depression
primary & continuous depression of all phases of respiratory activity, partly via direct effect on brainstem respiratory centers
38
mechanism of respiratory depression
decreased responsiveness of respiratory centers in brainstem to increase Pco2 - also, depression of pontine & medullary centers regulating rhythmicity - death due to opioids usually due to respiratory arrest
39
truncal rigidity
intensification of tone in large trunk muscles - may further compromise respiration
40
plasma half life of morphien
3-6 hours
41
main route of morphine metabolism/inactivation
hepatic metabolism, via conjugation w/ glucuronide
42
morphine metabolites
morphine-6-glucuronide (M6G) & M3G
43
which is the active metabolite of morphine
M6G
44
45
how are glucoronides excreted
in the urine - doses need to be adjusted in renal failure
46
why are opioids good to manage diarrhea
- GI tract contains opioid receptors - actions are to increase tone of intestional smooth muscle - intestional ion & water secretion are inhibited - constipation side effect
47
what can reduce constipation
Alvimopan
48
Meperidine (demerol) usage
- most widely used after morphine or codeine - more efficacy than oral morphine - shorter duration of action - less constipation
49
acute poisoning by meperidine effect on CNS excitation
greater than that of morphine due to normeperidine, a major metabolite
50
normeperidine effects
hepatic or renal failure & increases toxicity
51
methadone characteristics
- longer half life, greater oral efficacy - binds firmly to proteins in tissues from where it is released slowly
52
methadone primary use
treating addicts - suppresses withdrawal symptoms & is effective in treating neuropathic pain bc it is an NMDAR antagonist
53
methadone half life
24 hours
54
fentanyl common use
anaesthetic - reaches high concentrations in CNS & has a short duration of action
55
codeine pharmadynamics
- higher oral bioavailability than morphine - less nausea & vomiting than morphine
56
codeine pharmacokinetics
converted to morphine via CYP2D6
57
codeine use
combined with aspirin or acetaminophen
58
tramadol use
effective for mild to moderate pain
59
tramadol receptor action
weak mu agonist - inhibits reuptake of NE & 5HT
60
perk of tramadol
low risk of respiratory depression, tolerance, and dependence
61
which opioid has highest abuse liability
oxycodone
62
why does oxycodone have the greatest abuse liability
high likeability scores & relative lack of negative subjective effects
63
buprenorphine receptor action
partial mu agonist & kappa antagonist - very slow dissociation from mu receptor
64
advantages of buprenorphine
- treatment of chronic pain - relatively long half life - option of sublingual & transdermal application - excellent safety profile
65
buprenorphine half life
20-73 hr
66
nalbuphine receptor action
mu antagonist & kappa agonist
67
nalbuphine advantage
ceiling effect to respiratory depression
68
nalbuphine disadvantage
resistant to naloxone
69
factors to consider when choosing & prescribing an opioid
- patient's previous experience - pain pattern - GI & renal fxn - cognitive impairment - dose to effect
70
what should you always prescribe w/ opioids
laxative
71
what causes activation of opponent processes
prolonged use
72
how to account for incomplete cross tolerance
subtract 30-50% from the calculated 24h equianalgesic dose of the new opiod
73
addiction
biopsychosocial disorder characterized by the compulsive use of a substance and preoccupation with obtaining it, despite evidence that its continued use results in physical, emotional, social or economic harm
74
drugs used to treat opioid withdrawal
- methadone - buprenorphine - naltrexone
75
benefits of methadone as treatment for opioid withdrawal
prevents withdrawal, reduces craving, reduces euphoria of other opioid use
76
risks of methadone as treatment for opioid withdrwawl
possible overdose, misuse, hyperalgesia
77
benefits for buprenorphine as a withdrawal treatment
reduces craving, daily oral or long lasting implant, can be combined w/ naloxone to prevent misuse
78
risks of buprenorphine as withdrawal treatment
may induce withdrawal, street value due to withdrawal aid, & injected can't tell the difference b/w it & heroin
79
limitations of naltrexone as withdrawal treatment
requires complete withdrawal from opioids or would precipitate withdrawal
80
benefits of naltrexone as withdrawal treatment
prevents opioid intoxication, no addiction potential
81
risk of naltrexone as withdrawal treatment
can change tolerance for future opioid overdose

Neuropsychopharmacology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions