module 4 opioid agents Flashcards by Chelsey Miller

morphine MOA

mu receptor agonist

- min. effect on Kappa and sigma Rc

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morphine AE

nausea
myoclonus
hallucination
pruritis d/t histamine release
supraspinal analgesia 
resp depressin
euphoria
sedation 
dec. GI motility
pupil constriction

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Morphine Contraindication

renal insufficiency: Inc. AE

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Morphine administation

PO
IM
IV
SubQ
rectal
epidural
intrathecal

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Codeine administration

PO
IV
IM
SubQ
Combo with:
- APA
- guaifenesin
- promethazine

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Codeine prodrug

active form: morphine

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codeine use

antitussive effect without conversion

cough

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hydrocodone administration

always combined with 
- APAP
- ASA
- ibuprofen
- antihistamine
PO

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hydrocodone use

analgesic

antitussive

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oxycodone administration

PO
in combination with
- APAP
- ASA 
No active metabolites: safer with renal dysfunction

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hydromorphone administration

PO
IV
IM
SubQ
rectal 
epidural 
- semi-synthetic 
- no major metabolites: safer with renal dysfunction

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Methadone administration

PO
IV
SubQ
Long half life
no active metabolites: safer with renal dysfunction

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methadone use

opioid addiction treatment or maintenance
daily dosed
pain management: 2-3/day

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Meperidine administration

PO
IV
IM
rectal
epidural
intrathecal 
- synthetic
main metabolite: normeperidine 
- long half life

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meperidine use

post-op for shakes/chills
epidural
spinal analgesia ST

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meperidine AE

CNS excitation
anxiety
seizures

Meperidine caution

elderly

renal dysfunction

fentanyl administration

IV
transdermal patch (q72h)
transmucosal lozenge
buccal tablets

fentanyl uses

transdermal for chronic pain: after titration with short acting opioid
transmucosal for breakthrough pain

Fentanyl precautions

80-100X more potent than morphine

buprenorphine administration

SL
parenteral
Has a ceiling effect

buprenorphine MOA

partial agonist

- can precipitate withdrawal s/s if already on full agonist: displaces full-agonist and has less effect

buprenorphine uses

sublingual tablets: opioid dependence tx.

- alone or combined with naloxone

Heroin

3x more potent than morphine due to greater lipid solubility

metabolized to morphine
crosses BBB quickly

3-methylfentanyl (china white)

1000x more potent than morphine | metabolites can accumulate

opioid AE

``` most common: - sedation - dizzy - N/V - itching - sweating - constipation Most serious: - resp. depression ```

tolerance to AE of opioids

tolerance to sedative and emetic effects | no tolerance to constipation

opioid dosage

no min. or max. dose except limitation by the dose of APAP or ASA - use dose to maintain optimum pain relief with tolerable AE

Sustained release use

chronic pain

immediate release use

breakthrough pain

PCA use (IV, SQ)

when oral route not feasible

tramadol administration

PO | metabolite 200x greater affinity for mu Rc

tramadol MOA

blocks reuptake of Norepi and serotonin

tramadol use

moderate to severe pain

tramadol AE

seizures possible w/ MAOI or antipsychotic use | only partially reversible with naloxone