Opioids Flashcards
(65 cards)
1
Q
Define narcotic
A
- Addictive properties
- Produces analgesic and sedative effects
2
Q
Morphine is primarily ____ receptor-mediated
A
Mu
3
Q
Opiate is derived from _____.
A
Opium
(ex: morphine and codeine)
4
Q
Opioid is a drug (natural or synthetic with ______ qualities.
A
morphine-like
(narcotic)
5
Q
Opioid analgesics are collectively called _______ (3).
A
- Narcotic
- Opiate
- Opioid
6
Q
Opioid abstinence syndrome: symptoms (4)
A
- Muscle aches
- Chills
- Nausea
- Diarrhea
(overdose would cause coma)
7
Q
What is an opioid agonist/antagonist used for?
A
Opioid rehab programs
8
Q
Opioid types (made for a certain symptom) (4)
A
- Analgesic
- Anesthetic
- Antitussive
- Antidiarrheal
9
Q
Moderate opioid Agonist: 2 examples
A
- Codeine (robitussin AC)
- Hydrocodone
10
Q
Combination opioid meds typically have ______ and are _______ at lower doses.
A
- acetaminophen combination
- Synergistic
11
Q
Why are opiates a concern for geriatric patients?
A
Significantly depress the CNS
12
Q
_____ may produce varied analgesic responses due to a genetic polymorphism.
A
Codeine
(metabolized by 2D6)
13
Q
Which weak opiate agonist are used for a diarrhea (2)?
A
- Loperamide (imodium)
- Dephenoxylate (lomotil) combine w/atropine
14
Q
What is the first line in treating heroin patients (2)
A
- Methadone
- Then mixed opioid antagonist
15
Q
Opioid MOA
A
mu, kappa, delta receptor agonist
16
Q
List the endogenous opioids that modulate the pain gate pathway
A
- Endorphins
- Dynorphins
- Enkephalins
17
Q
Opioid receptor locations in the CNS (in order of abundance).
A
- cerebral cortex
- amygdala
- septum
- thalamus
- hypothalamus
- midbrain
- spinal cord
18
Q
Opioids: 3 primary sites of action
A
- Spinal cord
- Thalamus and limbic system
- Brainstem
19
Q
Opioid: mechanism of action
A
TQ!!
20
Q
Morphine: uses (3)
A
- Severe and chronic pain (post-op, cancer)
- Acute pulmonary edema
- Palliative
21
Q
Morphine: contraindications (4)
A
- Respiratory compromise
- Asthma
- Pregnancy
- Increased ICP
22
Q
What makes morphine a unique opioid?
A
Initially causes nausea and vomiting, but it releases histamine so it can cause bronchospasm, blepharitis and hypotension
23
Q
Tell-tale sign of patient on morphine
A
Meiosis (“pinpoint pupils”)
24
Q
Morphine: peripheral effects (4)
A
- Cardio: vasodilation, decreases blood pressure negative ionotropic response
- Skin: histamine release→ itchiness
- Pulmonary: bronchospasm
- GI: constipation (decreased motility)
25
Morphine: effect on smooth muscle (4)
1. Biliary tract: tenfold increase of normal pressure (contraction of sphincter of Odi)
2. Urinary bladder: increased detrusor tone
3. Bronchospasm
4. Uterus: reduced tone (may prolong labor)
26
Which opiate is recommended during labor and delivery (2)?
1. **Meperidine (demerol)**
2. Fentanyl
27
Metabolism of morphine
* Undergoes conjugation to active metabolites: morphine 6β glucoronide (6xs the analgesic potential) and morphine 3β glucoronide .
* Renal excretion
(can sequester in adipose tissue)
28
List 3 strong opioids
1. morphine
2. meperideine
3. methadone
29
Which strong opioid is used during labor and delivery, as a pre-op medication, and comes in a transdermal patch for chronic pain patients?
Fentanyl (sublimaze, duragesic)
| (rapid onset, short-acting)
30
Side effects of meperidine (demerol) (2)
1. normeperidine (metabolite) → seizures
2. Normeperidine inhibits serotonin reuptake → serotonin syndrome
(***_TQ!!!_*** Also avoid in renal dysfunction pts)
31
Why is methadone used for heroin rehabilitation (3)?
1. Long-acting (half-life 24 hrs)
2. As potent as morphine (strong)
3. Low addiction potential
(can also displace any left-over heroin)
32
How is heroin administered (3)?
1. Injected
2. Snorted
3. Smoked
(contamination → cardiovascular collapse)
33
Heroin characteristics (3)
1. Lipophilic (enters BBB)
2. 3 times more potent than morphine
3. No medicinal value
34
Classification of codeine and hydrocodone
Moderate opioid Agonist
| (Next Step Up from NSAIDs)
35
Codeine uses (2)
1. Antitussive (relieves cough)
2. Analgesic (dental procedures)
(Low abuse potential; usually combined with acetaminophen)
36
Codeine eventually gets metabolized to \_\_\_\_\_.
morphine
\*some people may have an issue w/CyP**2D6** → metabolism is not the same for everyone, it affects them differently
37
Propoxyphene is a derivative of\_\_\_\_\_.
methadone
38
Propoxyphene use
Analgesic similar to aspirin (usually combined w/acetaminophen)
(weak opioid agonist)
39
Dextromethorphan use
Antitussive (Delsym, Robituussin DM)
40
\_\_\_\_\_ (opioid) should be avoided with patients on antidepressants.
Meperidine
(can increase the risk of seizure→serotonin syndrome)
41
If you have a patient who is traveling or away from home and has had unrelenting diarrhea for the past 48 Hours, what do you recommend?
Loperamide (Imodium)
***_(GI effects only; as opposed to Diphenoxylate (Lomotil) which has CNS effects \*sedation_*****_\*_*****_also)_***
42
What would you prescribe a patient who has unrelenting diarrhea that has kept them from sleeping at night?
Diphenoxylate
***_(GI & CNS → sedation)_***
43
List the two anti-diarrheal opioids
1. Loperamide (Imodium)
2. Diphenoxylate (Lomotil)
44
Anti-diarrhea opioids cause ______ (2) at high doses.
1. respiratory depression
2. euphoria
45
Which medications are used to treat heroin withdrawal (3)?
1. Pentazocine (Talwin)
2. Nalbuphine (Nubain)
3. Butorphanol (Stadol)
46
Buprenorphine (Subutex) use
outpatient opioid detoxification
47
Medication given during opioid overdose?
IV Naloxone (narcan)
48
Naloxone: mechanism of action
* Binds to opioid receptor → displacing opioid
* 10 fold affinity to Mu receptor
(IV Administration→ quick and dramatic reversal)
49
Why might you need to give multiple administrations of naloxone to a patient who is overdosing on opioid?
Heroin has a longer half-life than naloxone
50
List the different types of pain
1. Mechanical / nociceptive pain in response to noxious stimuli
2. Inflammatory pain
3. Neuropathic pain
4. Functional pain
51
NSAIDs are used for which type of pain?
Mechanical and inflammatory
52
Pain management treatment options (6)
1. Non-opioid
2. Opioid
3. Antidepressant
4. Anticonvulsants
5. CBT
6. CAM
(step-wise treatment from weak to strong)
53
Define Fibromyalgia (3)
1. Widespread pain for at least 3 months
2. Pain on both sides of the body, above and below the waist
3. Axial skeletal pain
54
Fibromayalgia: pathophysiology
55
Fibromyalgia: Rx
1. Pregabalin
2. Duloxetine/Gabapentin
3. Tizanidine
56
Migraine: Rx
Antiemetic-triptan-NSAIDs combination
(**primarily the triptan portion that has the greatest effect; causes vasoconstriction**)
57
High yield triptan?
Sumatriptan (agonist at 5HT-1D receptors)
58
List four causes of neuropathic pain
1. Peripheral neuropathy
2. Trigeminal neuralgia
3. Post-stroke pain
4. Spinal cord injury
59
5 types of neuropathic pain
| (description/feels like…)
1. Burning pain
2. Cold
3. Itching
4. Tingling / prickling
5. Shooting / stabbing
60
\_\_\_\_\_ is used to treat post herpetic neuralgia
Gabapentin/pregabalin
61
\_\_\_\_\_\_ is used to treat trigeminal neuralgia
Carbamezapine
62
\_\_\_\_\_\_\_\_ is used to treat diabetic peripheral neuropathy
Pregabalin/Duloxetine
63
\_\_\_\_\_\_ is used to treat cancer pain
opioids
(must increase as the cancer progresses)
64
Morphine inhibits the release of substance P from the primary afferent nerve endings and spinal cord by\_\_\_\_\_.
inhibition of calcium influx
65
A patient is administered meperidine for pain management and develop seizures. Further investigation reveals she is on medication for psychiatric condition. Which drug most likely potentiated this side effect?
Imipramine (TCA antidepressant)
