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BB Test 4 > Opioid Use Disorder > Flashcards

Opioid Use Disorder Flashcards

(60 cards)

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1
Q

(T/F) Any substance that may bind to an opioid receptor is considered an opioid.

A

True.

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2
Q

What are the natural opioids, aka opiates?

A
  • Morphine
  • Codeine
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3
Q

What are the semisynthetic opioids?

A
  • Heroin
  • Oxycodone
  • Hydrocodone
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4
Q

What are the synthetic opioids?

A
  • Methadone
  • Levo-α-acetylmethadol (LAAM)
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5
Q

What are the endogenous opioids?

A
  • β-endorphine
  • Enkephalins
  • Dynorphin
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6
Q

What are the common opioid antagonists?

A
  • Naloxone
  • Naltrexone
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7
Q

What is the opioid partial agonist/antagonist?

A
  • Buprenorphine
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8
Q

Morphine is derived from the poppy plant. It may also be converted into ____________ by synthetic methods.

A

Heroin

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9
Q

Codeine is derived from the poppy plant. It may also be converted into ____________ and ____________ by synthetic methods.

A

Oxycodone and hydrocodone

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10
Q

What are the three different opioid receptors?

A
  • δ (delta)
  • κ (kappa)
  • μ (mu)
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11
Q

The (δ/κ/μ) opioid receptor primarily modulates analgesia, endocrine changes, and dysphoria.

A

κ (kappa)

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12
Q

The (δ/κ/μ) opioid receptor primarily modulates tolerance.

A

δ (delta)

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13
Q

The (δ/κ/μ) opioid receptor primarily modulates analgesia. It may be activated by morphine, along with serving as the primary action site for all other opioids. It is located primarily within the CNS and GI tract, and has also been linked to abuse and dependence.

A

μ (mu)

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14
Q

What are the most common acute effects associated with opioid ingestion?

A
  • Analgesia (thalamus)
  • Sedation and euphoria (VTA and nucleus accumbens)
  • Respiratory depression (medullary respiratory center)
  • Miosis (Edinger-Westphal nucleus) - Except meperidine
  • Nausea and vomiting (chemoreceptors in area postrema)
  • Antitussive
  • Constipation (decreased peristalsis)
  • Contraction of smooth muscle (biliary tract, increased ureter and bladder sphincter tone, and reduction in uterine tone)
  • Flushing
  • Pruritus (itching of the skin)
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15
Q

Opioids cause (mydriasis/miosis). The exception to this rule is ____________.

A
  • Miosis
  • Exception is meperidine
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16
Q

Opioids cause respiratory (depression/stimulation). They do this by affecting the ____________________ of the brain.

A
  • Depression
  • Medullary respiratory centers
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17
Q

Opioids cause sedation and euphoria. They accomplish this by affecting the _________________ and _________________ of the brain.

A
  • Ventral Tegmental Area (VTA)
  • Nucleus accumbens (NAc)
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18
Q

Opioids may also cause nausea and vomiting. This is brought about by effects on the ________________ of the brain.

A

Area postrema

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19
Q

(T/F) Opioids may serve as antitussives.

A

True.

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20
Q

Opioids cause (increased/decreased) peristalsis in the intestines. This can cause (constipation/diarrhea).

A
  • Decreased peristalsis
  • Constipation
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21
Q

Opioids cause the (contraction/relaxation) of smooth muscle within the biliary tract.

A

Contraction

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22
Q

Opioids may cause (decreased/increased) ureter and bladder sphincter tone.

A

Increased

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23
Q

Opioids can also cause (increased/decreased) uterine tone.

A

Decreased

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24
Q

(T/F) Opioids can cause flushing and a burning sensation on the skin.

A

False. Opioids cause flushing and pruritus, an intense itching sensation on the skin.

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25
Opioids have (increased/decreased) **protein binding capabilities** compared to most other analgesics.
Increased
26
Opioids most commonly undergo (renal/hepatic) **metabolism**.
Hepatic
27
What are the two most common methods of **opioid excretion**?
* Kidney * GI tract (bile)
28
What are some of the clinical uses for opioids?
* Analgesia * Cough suppression * Treatment of diarrhea * Anesthesia * Opioid dependence treatment
29
(T/F) Opioids are most often administered alone
False. Opioids are most often administered in **combination** with **APAP** or **NSAIDs**.
30
The US consumes about \_\_\_% of the world's opioid supply annually.
80%
31
The main causes of mortality seen in opioid abuse are ___________ and \_\_\_\_\_\_\_\_\_\_.
* HIV/AIDS (from sharing needles) * Overdose
32
Opioid Use Disorder is characterized by the presence of **two criteria** occurring within a **twelve month** period. What are these criteria?
* Use results in **failure to fulfill roles** at work, school, or home * Use in situations where it is **physically hazardous** * **Continued use** in spite of **social** or **interpersonal problems** * **Tolerance** * **Withdrawal** * Substance taken in **larger amounts** or over **longer period** than intended * **Unsuccessful** efforts to **cut down** use * Great deal of **time** devoted to obtaining substance * Important **activities** are **given up** because of use * Use is continued despite **knowledge** of **having problem** * **Cravings** or strong desires to use substance
33
A patient is in (early/sustained) remission if **no criteria for opioid use disorder is present** for **12 months or longer**. **Craving** is the exception and may still be present.
Sustained
34
A patient is in (early/sustained) remission if **no criteria for opioid use disorder is present** for at **least 3 months** but **less than 12 months**. **Craving** is the exception and may still be present.
Early
35
A patient is specified as ("on maintenance therapy"/"in a controlled environment") if in a setting where **access to opioids is restricted**.
In a controlled environment
36
A patient is specified as ("on maintenance therapy"/"in a controlled environment") if **naltrexone**, **naloxone**, **methadone**, or **buprenorphine** is being administered and none of the criteria for Opioid Use Disorder is met, **except for tolerance** and **withdrawal**.
On maintenance therapy
37
What are the severity specifiers in relation to opioid use disorder?
* Mild: 2-3 criteria * Moderate: 4-5 criteria * Severe: 6 or more criteria
38
(Mild to moderate/Severe) opioid intoxication is a life threatening medical emergency.
Severe
39
(Mild to moderate/Severe) opioid intoxication presents as **euphoria** or **sedation** and is relatively not life threatening.
Mild to moderate
40
Eventually, patients develop tolerance to opioids through chronic use and abuse. (Minimal/Increased) tolerance is seen for **constipation**, **miosis**, and **sweating**.
* **Minimal** tolerance * Patient will still experience these effects no matter the dose.
41
Eventually, patients develop tolerance to opioids through chronic use and abuse. (Minimal/Increased) tolerance is seen for **euphoria**, **sedation**, **respiratory depression**, **vomiting**, and **analgesia**.
* **Increased** tolerance * Patients require increasing doses to elicit these effects.
42
(T/F) If the patient exhibits physical dependence symptoms, administration of naloxone or naltrexone may precipitate withdrawal.
True.
43
For clinical diagnosis of opioid intoxication, what must be observed in the patient?
* **Pupillary constriction** (required) * Drowsiness or coma * Slurred speech * Impairment in speech or memory * Abnormal mental status
44
What is the opioid overdose "**toxicity triad**"?
* **Miotic** pupils * **Abnormal mental** status * **Respiratory depression** ( \<12/min)
45
What is the general **supportive treatment** for opioid intoxication?
* Maintain **airway** * Stabilize **breathing** * Administer **naloxone** * Monitor **circulation** **A**lways **b**e **n**ice, **c**hildren.
46
\_\_\_\_\_\_\_\_\_\_\_\_ is a pure opioid antagonist administered in overdose cases. It has a very **quick onset** of around **2 minutes** and a relatively **short half life** of approximately **64 minutes**.
Naloxone
47
Why is being familiar with naloxone's half life clinically important?
If a patient has overdosed on a drug that has a half life of longer than one hour, they will begin to display overdose symptoms again once the naloxone has been broken down. * **Must dose frequently**
48
\_\_\_\_\_\_\_\_\_\_\_ is a long-acting, pure opioid antagonist with a **long half life**, able to block heroin's effects for up to **48 hours**. It is primarily used in **alcohol dependence** to decrease alcohol cravings.
Naltrexone
49
Opioid withdrawal is (fatal/not fatal)
**Not fatal**
50
Most withdrawal symptoms may be linked to **hyperactivity** of the ___________ within the brain, providing a **stimulatory effect** for the **body**.
Locus ceruleus
51
What are the signs of **opioid withdrawal**?
* **One** of the following: * Prolonged and heavy reduction in opioid use * Administration of opioid antagonist after use * Accompanied by **three** of the following: * Dysphoria * Nausea/vomiting * Muscle aches * Lacrimation or rhinorrhea * Pupillary dilation, piloerection, sweating * Diarrhea * Yawning * Fever * Insomnia
52
\_\_\_\_\_\_\_\_\_\_\_\_ is most often given in opioid withdrawal cases to **attenuate the α-adrenergic effects** caused by the locus ceruleus.
Clonidine
53
Opioid maintenance therapy decreases mortality rates by \_\_\_%.
70%
54
\_\_\_\_\_\_\_\_\_\_\_\_\_ and ____________ are the choices available for **opioid maintenance** **therapy** (**OMT**).
* Methadone * Buprenorphine
55
What is the mechanism of action for **methadone** and **buprenorphine**?
Both provide levels of opioid stimulation that, **when administered at prescribed doses**, allow the patient to **maintain alertness without cravings**, **withdrawal symptoms**, or **drug preoccupation**.
56
(Methadone/Buprenorphine) is a **partial opioid agonist**. It is dispensed in sublingually dissolved tablets. Its **half life** is around **72 hours**.
Buprenorphine
57
(Methadone/Buprenorphine) is a **full opioid agonist**. It is dispensed in liquid form with a half life of **24-36 hours**. Steady state doses are achieved with this drug in 3-7 days.
Methadone
58
Methadone is metabolized by \_\_\_\_\_\_\_\_\_\_\_, a cytochrome P450 enzyme.
CYP3A4
59
(T/F) Methadone causes decreased QT intervals in patients.
False. **Methadone** causes **prolonged QT intervals** in patients.
60
(Methadone/Buprenorphine) is the gold standard for use in **pregnant patients**.
**Methadone** * However, in MOTHER study, **Buprenorphine** is showed to be equally safe, now the **preferred treatment** at **UAMS**

BB Test 4 (14 decks)

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