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Narcotics Flashcards

1
Q

MOA of narcotic full agonist

A

bind mu opioid receptor in brain causing them to produce endorphins (opioids) to give pain relief

NO CEILING for analgesic effect

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2
Q

SE of full agonists at high doses & freq.

A

addiction

euphoria

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3
Q

what patients do you need to use caution with when giving morphine? which drug is safest for renal insufficiency?

A

renal insufficiency use hydromorphone or methadone

morphine undergoes extensive first pass metabolism, if the liver isn’t working accumulation of toxic metabolites can lead to agitation, confusion, & delerium

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4
Q

how much more potent is oxycodone than morphine? than oral codeine?

A
  1. 5x morphine

9. 5x oral codeine

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5
Q

what is oxycodone usually dosed with for acute pain? what version of oxycodone is used for chronic pain

A

acetaminophen

use extended release for chronic pain

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6
Q

what is oxymorphone a metabolite of? how much more potent is oxymorphone than morphine?

A

oxymorphone is a metabolite of oxycodone

it is 3x more potent than morphine

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7
Q

list the routes of administration for oxycodone hydromorphone and oxymorphone.

A

oxycodone: PO
oxymorphone: PO or IV
hydromorphone: IV, PR, PO

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8
Q

benefit of hydromorphone over oxycodone?

A

less somnolence

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9
Q

what should you do before starting transdermal use of fentanyl?

A

titrate the patient with a short acting opioid

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10
Q

what increases release of drug from fentyanl patch? consequences?

A

heat (heating pad, increased exertion, fever)

can lead to respiratory depression

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11
Q

why do you need to be careful when switching patients from an opioid agonist to methadone?

A

because the equivalent doses are not well known

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12
Q

SE of methadone?

A
  1. QT prolongation
  2. torsades
  3. death
  4. dysphoria
  5. irritability
  6. tremors
  7. seizures
  8. antimuscarinic effects (dilated pupils & tachycardia)

4-7 are seen more frequently with PCAs and elderly with renal function

all are dose related

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13
Q

use of methadone?

A

q8hours for pain with:
renal insufficiency
cancer (can be 1st line)

and…
qD for opioid withdrawl in licensed rehab centers

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14
Q

meperidines onset of action is ____ than morphines.

A

faster (VERY RAPID) and so short acting as well

metabolite (normeperidine) half life of 15 to 30 hours

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15
Q

what should meperidine not be mixed with? why?

A

MAOIs

can causes severe encephalopathy & death

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16
Q

what drug is contraindicated in children undergoing tonsillectomy and adenoidectomy?

A

codeine

can cause death

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17
Q

what happens to pt who are good/poor metabolizers (or on CYP2D6 inhibitors like fluoxetine) of codeine?

A

good: higher levels of codeine broken into morphine so increased effect

poor/on inhibitors: no effect possible

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18
Q

hydrocodone is converted to what in the body? what is it often combinded with?

A

hydromorphone

often added to acetaminophen or ibuprofen

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19
Q

you must wait 14 days within use of an MAOI before prescribing what opioid?

A

tapentadol

20
Q

tramadol is what type of opioid agonist? MOA?

A

centrally acting

it blocks repute of NE & serotonin, binds to narcotic receptor weakly (most analgesic effect is due to its active metabolite)

21
Q

which opioid is only partially reversed by naloxone?

22
Q

what are the benefits of tramadol?

A

no effects on respiration or CVS

23
Q

SE of tramadol?

A

seizures, N, V, suicide (in suicidal, emotionally disturbed, or prone to addiction)

24
Q

what medications increase your risk of seizures with tramadol?

A 
TCADs
SSRIs
MAOIs
Opioids
Antipsychotics
25
contraindications to prescribing tramadol?
Hx seizures | on drugs than lower seizure threshold
26
what controlled substance class is tramadol?
Class IV
27
MOA of partial agonists? how does it differ
bind mu receptor to induce production of endorphins (but less than full agonists) they have a ceiling affect
28
distribution of opioids?
rapidly leave blood compartment and concentrate in highly perfused tissues
29
what drugs are metabolized to M3G? normerperidine? what is the concern about M3G, normerperidine, and metabolism?
morphine and hydromorphine concerned that M3G & normerperidine can cause seizures accumulation can lead to seizures in renal failure or when high doses are given over a long period of time, especially in the elderly presentation: agitation, confusion, delerium
30
least sedation with which opioids?
oxycodone, hydromorphone*, hydrocodone*
31
CNS affects of opioids?
``` euphoria sedation respiratory depression cough supression* miosis N, V ```
32
what drug majorly supresses cough?
codeine
33
peripheral CVS effects of narcotics?
if pt has CVD or hypovolemic narcotics can could hypotension & dilation meperidine has anticholinergic propertieis: can cause tachycardia
34
peripheral GI effects of narcotics?
gallbladder contraction | decreased GI motility
35
what SE of opioids do not exhibit tolerance?
miosis constipation (esp. morphine) seizures
36
uterine effects of opioids?
decrease uterine tone potentially prolonging labor (still use them)
37
skin effects of opioids?
``` flushing warmth urticaria more common with IV not an allergic rxn ```
38
toxicities of narcotics?
``` N, V respiratory depression constipation tolerance Physical & psych dependence ```
39
how long until you become tolerant to narcotics?
2-3 weeks
40
Sx of physical dependence to full/partial narcotics?
``` withdrawl Sx: N, V, D lacrimation rhinorrhea mydriasis goose bumps sweating irritability dysphoria yawning* ```
41
Sx of physical dependence mixed narcotics?
anxiety anorexia tachycardia
42
contraindications to narcotics?
renal/hepatic failure respiratory disorders pregnancy head trauma (ICP)
43
MOAI + Narcotic =
HTN
44
Antipsychotics + Narcotics =
sedation
45
benzos + narcotics =
CNS depression
46
adrenal insufficiency or hypothyroidism + narcotics =
exaggerated effects
47
what narcotic in acute pulmonary edema?
IV morphine if pain decreases SOB by decreasing anxiety, preload, and after load good for MI, CP, & pulmonary edema or LVH if no pain: furosemide

Pharm III (5 decks)

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