Opiods

Question 1

In what year was morphine first derived from opium?

Answer 1

1801

Question 2

Define opioid

Answer 2

Natural and synthetic substances which bind opioid receptors

Question 3

Name the three subtypes of opioid receptors

Answer 3

Delta, mu, kappa

Question 4

What effect does opioid receptor agonism have?

Answer 4

Decrease in secretion of pain-inducing neurotransmitters

Question 5

List seven adverse effects of opioids

Answer 5

Sedation, decreased peristalsis, pruritis, respiratory depression, nausea/vomiting, miosis, peripheral vasodilation

Question 6

Why should you avoid opium in pancreatic cancer?

Answer 6

Causes contraction of sphincter of Oddi – pressure on biliary tree worsens pancreatic pain

Question 7

Which drug should be given to patients with pancreatic cancer pain?

Answer 7

Meperidine

Question 8

Name the antidote to opium overdose

Answer 8

Naloxone (Narcan) or naltrexone (longer acting)

Question 9

State the new naloxone EMT laws in Kentucky

Answer 9

Naloxone can be dispensed without prescription and given by injection, intranasal, or inhalation (like EpiPen) in opioid emergencies

Question 10

Which opioid is most resistant to naloxone?

Answer 10

Methadone

Question 11

Defined the following dosage forms: SC, TD, IT, PCA

Answer 11

Subcutaneous, transdermal, intrathecal, patient controlled analgesia

Question 12

Which opioid is the gold standard?

Answer 12

Morphine

Question 13

Which opioid is highly water-soluble?

Answer 13

Morphine

Question 14

Which opioid is preferred and chest pain due to reduced sympathetic tone and little reflex tachycardia?

Answer 14

Morphine

Question 15

List the IV to PO ratio of morphine

Answer 15

IV to PO= 6:1 (significant first pass effect- must give larger oral dose)

Question 16

List the three effects of opioids

Answer 16

Analgesia, antitussive, constipation

Question 17

Is meperidine more or less potent than gold standard opioid?

Answer 17

Less potent (100g=10g MS)

Question 18

How is meperidine (Demerol) metabolized?

Answer 18

Hepatically metabolized to normeperidine

Question 19

Name 4 adverse affects of meperidine

Answer 19

Potential renal failure, lowers seizure threshold, may cause reflex tachycardia (avoid in chest pain), can increase serotonin levels (risk of serotonin syndrome)
Also miosis, constipation (due to Ach effects)

Question 20

List four signs of serotonin syndrome

Answer 20

Tremors, seizures, hallucinations, death

Question 21

Which opioid should not be combined with SSRIs?

Answer 21

Meperidine (Demerol)

Question 22

Which opioid has a role in obstetrics (won’t prolong labor)?

Answer 22

Meperidine (Demerol)

Question 23

Which semi-synthetic opioid has high lipophilicity, and is converted to morphine after crossing blood brain barrier?

Answer 23

Diamorphine (heroin)

Question 24

Where does codeine provide the most pain relief?

Answer 24

Above the shoulders

Question 25

How does codeine derive most of its analgesic effects?

Answer 25

Metabolism to MS

Question 26

What drug does codeine often come in combination with?

Answer 26

Tylenol (APAP)

Question 27

Name the semi synthetic opioid with twice the potency of MS

Answer 27

Oxycodone (OxyContin)

Question 28

How are the adverse affects of oxycodone different from morphine?

Answer 28

Oxycodone causes less pruritis and fewer mental status changes, has higher abuse potential

Question 29

Which drugs comprise Percocet, and which comprise Percodan?

Answer 29

Percocet=oxycodone and APAP | Percodan=oxycodone and ASA

Question 30

Where does hydrocodone produce the most pain relief?

Answer 30

Below the shoulders

Question 31

List two co-formulations of hydrocodone and their level of control

Answer 31

APAP: Vicodin and Lortab | C2 controlled substance

Question 32

Which opioid is commonly used in maintenance for opioid addiction/ withdrawal and why?

Answer 32

Methadone- Long duration of action, reduces cravings and euphoric effects of other opioids

Question 33

List two concerns of methadone use

Answer 33

Potential QT prolongation | Difficult to reverse in overdose

Question 34

Which opioid has the highest potency?

Answer 34

Fentanyl (Duragesic)

Question 35

Which property of Fentanyl makes it a good transdermal agent?

Answer 35

High lipophilicity

Question 36

How often must a fentanyl patch be changed?

Answer 36

Every three days

Question 37

List three fentanyl analogues and their properties

Answer 37

Alfentanil (Quick onset of action, less potent) Remifentanil (Quick onset of action, equal potency, esterase metabolism) Sufentanil (more potent than Fentanyl)

Question 38

Which opioid is a weak centrally acting analgesic?

Answer 38

Tramadol (Ultram)

Question 39

Describe tramadol's MOA

Answer 39

Inhibits NE reuptake, enhances serotonin release

Question 40

What class of drug is tramadol?

Answer 40

C4 (previously C6, but found to be more addictive)

Question 41

List two positives and one negative of tramadol

Answer 41

Causes less respiratory depression, less addictive potential, but reduces seizure threshold

Question 42

Which opioid is both an agonist and antagonist

Answer 42

Bupenorphine

Question 43

Name some dosage forms of Bupenorphine

Answer 43

IM, IV, PO, TD

Question 44

Which is a longer lasting trans-dermal opioid, fentanyl or Bupenorphine?

Answer 44

Bupenorphine- lasts seven days (Fentanyl lasts three days)

Question 45

Which class of drugs is Bupenorphine?

Answer 45

C3

Question 46

Which antitussive is a six cousin to opioid narcotics?

Answer 46

Dextromethorphan