Opioid Analgesics Flashcards
(55 cards)
1
Q
Morphine is obtained from which plant
A
Papaver sominiferum
2
Q
Classify opioids
A
- Opioid agonists:
i)Natural Opium alkaloids
ii)Semi synthetic opiates
iii)Synthetic opioids - Opioid agonist-antagonists
- Partial Mu-receptor agonist and Kappa-receptor antagonist
3
Q
Name natural opium alkaloids
A
- Morphine
- codeine
- Thebaine
- papaverine
- Noscapine 
4
Q
Name semi synthetic opiates
A
- Heroin
2. hydromorphone - Oxymorphone
- Pholcodine
5
Q
Name synthetic opioids
A
- Pethidine
- Tramadol
- Methadone
- Dextropropoxyphene
- Fentanyl
- Alfentanil
- Sufentanil
- Remifentanil
6
Q
Name opioid agonist-antagonist
A
- Pentazocine
- Butorphanol
7
Q
Name partial mu-receptor agonist and Kappa-receptor antagonist
A
Buprenorphine
8
Q
What are the effects of activating mu opioid receptors
A
- analgesia
- respiratory depression
- dependency
- sedation
- euphoria
- meiosis
- decrease in G.I. motility
9
Q
What are the effects of activating kappa receptors
A
- Analgesia
- Respiratory depression
- dependence
- dysphoria
- Psychotomimetic effect
10
Q
what are the effects of activating delta receptors
A
- Analgesia
- respiratory depression
- proconvulsant action
11
Q
Where are opioid receptors located
A
Spinal, superaspinal and peripheral nerves
12
Q
What is the most common cause of death in a cute opioid poisoning
A
Respiratory depression
13
Q
How does morphine cause respiratory depression, both rate and depth
A
It reduces sensitivity of the respiratory centre to CO2
14
Q
What are the functions/actions of morphine
A
- Miosis 
- Analgesia
- Respiratory depression
- Physical and psychological dependence
- histamine release, hypotension, hypothermia
- itching
- nausea and vomiting
- euphoria
- cough suppression, Constipation
- Vagal stimulation (bradycardia) (vasodilation)
- Sedation and hypnosis
- Urinary retention
- Increases intrabilary pressure
- Physical and psychological dependence
15
Q
How does morphine produce miosis, constriction of the pupil?
A
Stimulation of III cranial nerve Nucleus
16
Q
How does morphine cause nausea vomiting
A
Direct stimulation of CTZ in the medulla
17
Q
Which drugs can be used to control Opioid induced nausea and vomiting
A
- 5-HT3 antagonists
- H1 blockers 
18
Q
What does morphine relieve
A
- Pain
- fear
- anxiety
- apprehension
- feeling of sickness
19
Q
How does morphine cause vasodilation full of BP
A
- Depression of VMC
- Histamine release
- direct action on blood vessels
20
Q
What is the metabolite of morphine that is more potent and excreted in the urine
A
Morphine-6-glucuronide
21
Q
What are the signs and symptoms of dependence of morphine
A
- Irritability
- body shakes
- yawning
- lacrimation, sweating
- fever
- diarrhoea
- palpitation
- insomnia
- high blood pressure
- weight loss
22
Q
Dependence of morphine is mediated through which receptor
A
Mu receptors
23
Q
Which drug can be used to substitute Morphine during with drawl
A
Methadone or buprenorphine
24
Q
How do you treat morphine dependence
A
- Hospitalization
- Gradual withdrawal of morphine
- Substitution therapy using opioid agonist
- 1 mg Methadone will substitute 4mg Morphine. Dose is reduced slowly and completely stopped within 10 days.
- Pure opioid antagonist like naltrexone is used for detoxification to produce opioid blockade to prevent relapse.
- Psychotherapy, occupational therapy, community treatment, rehabilitation
25
Why are opioid agonist, like methadone, are preferred when treating morphine dependence
1. Are they effective
2. longer duration of action
3. Withdrawal symptoms are mild: 1 mg of methadone or substitute 4 mg of morphine
26
What are the signs of acute morphine poisoning
Cyanosis, coma, Convulsions, shock, hypertension, pinpoint pupils, respiratory depression
27
What is the treatment for acute morphine poisoning
1. Hospitalization
2. Maintain airway, breathing and circulation
3. Ventilation support
4. gastric lavage with potassium permanganate
5. Specific antidote: naltrexone 0. 420. 8 mg IV. Dose is repeated till respiration becomes normal
28
What are the adverse effects of morphine
1. Nausea, vomiting, constipation, respiratory depression, hypotension, mental clouding, confusion, itching
2. Difficulty in micturition
3. Respiratory depression in newborn due to administration of morphine to mother during labour
4. Drug tolerance
5. Drug dependence
6. Acute morphine poisoning
7. Seizure threshold is lowered
29
Why is morphine contraindicated in cases with head injuries
1. Vomiting, miosis and mental clouding can interfere with assessment of progress in head injury patients
2. Cerebral vasodilation increases intracranial tension
30
What are the contraindications of morphine
1. Head injury
2. asthma
3. chronic obstructive pulmonary disease (COPD)
4. hypotensive states
5. hypothyroidism and hypopituitarism
7. infants and elderly
8. undiagnosed acute abdominal pain
31
Which opioid drugs are used to suppress dry cough
Codeine
Dextromethorphan
32
Codeine potentiates analgesic affect of which drugs
Aspirin
paracetamol
33
What are the main side effects of codeine
Constipation and sedation
34
Codeine should be avoided in which patients
Children and asthmatics
35
What is the difference between codeine and pholcodeine 
Codeine has analgesic affect while pholcodeine doesn’t
36
What is the metabolite of Pheyidine?  what are its adverse effects
Norphethidine 
Same as morphine as well as tremors, hallucinations, muscle twitches, and rarely convulsions

37
Why is diphenoxylate not used for the treatment of Diarrhoea anymore
It causes paralytic ileus
38
What are the therapeutic uses of opioids
1. Analgesic
2. pre-anesthetic medication
3. acute pulmonary oedema
4. post anaesthetic medication
5. cough
6. diarrhoea
39
Which opiates are used in the treatment of diarrhoea
Loperamide
Diphenoxylate
40
What are the adverse effects of Pethidine?
1. Similar Morphine effects
2. Anticholinergic
3. Seizures, tremors
4. with SSRI serotonin syndrome
41
Which drugs cause serotonin syndrome with SSRI
Tramadol
pethidine 
42
Actions of which drug cannot be completely reversed by naltrexone
Buprenorphine
43
Which drug is also able Inhibit the uptake of norepinephrine and serotonin
Tramadol
44
What are the actions of tramadol
1. Analgesia
2. respiratory depression
3. physical and psychological dependence
4. nausea and vomiting
5. euphoria
6. constipation
7. sedation
45
Which drug is 100 times more potent than morphine as an analgesic 
Fentanyl
46
What are the effects of methadone
1. Miosis
2. analgesia
3. respiratory depression
4. physical and psychological dependence
5. nausea and vomiting
6! euphoria
7. cough suppression, constipation
8. sedation 
47
Which drug because cardiotoxicity and Pulmonary oedema as adverse affect
Dextropropxyphene
48
Which drug may cost hallucination and nightmares as an adverse effect
Pentazocine
49
What are the effects of Pentazocine
1. Analgesia
2. respiratory depression
3. physical and psychological dependence
4. Nausea and vomiting
5. constipation
6. biliary spasm 
50
What are the effects of buprenorphine 
Same as morphine but is more potent than morphine in causing analgesia
51
Name opioid antagonist
1. Naltrexone
2. Naloxone
3. Nalmefene
52
What are the uses of naloxone 
1. Treatment of morphine and other opioid poisoning
2. Opioid overdose
3. Neonatal asphyxia
53
What are the uses of naltrexone
1. Opioid blocking therapy to prevent relax
2.  treatment of alcoholism
54
What is the function of methynaltrexone
Treatment of constipation due to opioids 
55
Name Endogenious opioid peptides that are involved in placebo and acupuncture induced analgesia
Endorphins, enkephalins, dynorphins. 
