Opioid Analgesics 3 Flashcards Preview

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Flashcards in Opioid Analgesics 3 Deck (36)
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1

What is the most widely used route of administration for morphine?

IM

2

What is the structure of morphine and why is it important?

Piperidine ring structure - 6 sided

Needed to bind to opiate mu receptor

3

What is the most widely abused drug by hospital personnel?

meperidine (Demerol)

No miosis - unlike morphine

4

How is meperidine (Demerol) used in dentistry?

IV sedation (conscious sedation)

Orally for moderate to severe pain

5

What is one of the most frequently prescribed opioids in dentistry, and how is it used?

codeine - used in combination products with acetaminophen or aspirin because of the many GI side effects

6

What is the optimum dose of codeine?

60 mg - if exceed 60 mg, no greater analgesic effect but more side effects

7

How does codeine compare to morphine?

1/6th its potency

10mg morphine = 60 mg of codeine

8

Oral morphine is poorly absorbed, so instead we use?

codeine given orally

9

In dentistry we use codeine in combination preparations with?

aspirin, acetaminophen

10

What is codeine indicated for?

Moderate to moderately severe pain

Not good for severe pain (use oxycodone)

11

What is the drug of choice for cough suppression?

codeine

12

How does the codeine dosing work?

codeine containing preparations are identified by numbers that reflect the mg concentration:

  1. #1 - 8 mg (not sold in US)
  2. #2 - 15 mg 
  3. #3 - 30 mg
  4. #4 - 60 mg

13

What is the most widely prescribed codeine product by dentists?

Tylenol #3

codeine (30mg)/ acetaminophen (300mg)

14

What opioid is 3 times more powerful than codeine?

hydrocodone

15

Hydrocodone is prepared with acetaminophen, what are examples of these drugs?

  • Vicodin
  • Lorcet/Lortab

16

What drug uses acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage and combines it with 10 mg hydrocodone?

Norco - stronger opiate dose, baseline acetaminophen dose

17

Is hydrocodone prepared with ibuprofen?

Yes

  • Vicoprofen, Ibudone, Reprexain
  • Constant ibuprofen dose - 200mg

18

What opioid has the same efficacy/potency as codeine?

dihydrocodiene (Synalgos DC)

no more effective than Tylenol #3

19

Which drug is highly addictive, as potent as morphine and used in dentistry in combo products for severe pain?

oxycodone (schedule II)

20

What are the drug examples of oxycodone?

  • Percocet - 5/325 (acetaminophen)
  • Tylox - 5/325 (same as Percocet, diff name)
  • Percodan 
  • Roxicet 

21

Which drug should you be cautious about patients asking specifically for by name?

Roxicet - extended release tablet, with concentrated core that people would get high on

22

What is oxycodone 5mg with ibuprofen 400 mg called?

Combunox - a short term management of acute, moderate-to-severe dental pain

23

What drug is 100 times more potent than morphine? And what is it used for?

fentanyl - in dentistry used for conscious sedation only (IV, transdermal, lollipop)

24

What is the most potent opiate used in dentistry?

fentanyl - conscious sedation

25

What is the opiate that is not scheduled by the DEA?

tramadol

26

What does tramadol do?

  • binds to mu opiate receptors in CNS, which inhibit ascending pathways
  • Inhibits the reuptake of norepinephrine and serotonin
  • Also associated with seizures
  • Only use for up to 5 days

27

What is a brand name for tramadol?

Ultram

28

What is Ultracet?

acetaminophen and tramadol

29

What NSAID provides analgesia at the opioid level?

ketorolac (Toradol)

30

RULES

  1. Most patients are better managed with ____?
  2. Start with _______ preparations?
  3. Only prescribe stronger opioids for ______ periods of time, then switch.
  4. Prescribe _______ quantities without ______.
  5. Prescribe only if the patients has _______.
  6. If pain persists, ________?
  7. If patient demands more drugs?
  8. Chronic pain is managed ________?

  1. NSAIDS
  2. combination
  3. short
  4. small, refills
  5. received dental treatment
  6. bring patient back for evaluation and local treatment
  7. refer to pain clinic
  8. differently