Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PPP Winter Midterm > Opioids > Flashcards

Opioids Flashcards

1
Q

What are different types of pain?

A

Nociceptive pain
(Well-localized pain)

Neuropathic pain
(Direct injury to nerve or not well managed chronic nociceptive pain)

Inflammatory pain
(Associated with tissue damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define opiates

A

Naturally occurring alkaloids such as morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define opioid

A

Broadly describes all compounds that work at the opioid receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define endorphin

A

Used to describe endogenous opioid peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the function of the mu receptor stimulation?

A

Supraspinal and spinal analgesia

💤Sedation

🚫Inhibition of respiration

📉Bradycardia

N/V
Slowed gastric motility

Modulation of hormone/NT release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the functions of delta GPCR

A

Supraspinal + spinal analgesia

Modulation of hormone + NT release

Slowed gastric motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are functions of kappa GPCR

A

Spinal analgesia

Dysphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 4 classes of opioids?

A

Phenanthrenes

Phenylpiperidines

Diphenylheptanes

Atypical opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What opioids are phenanthrenes?

A

Codeine
Morphine

Hydromorphone
Hydrocodone
Oxymorphone

Le orphan old

Buprenorphine
Nalbuphine

Butorphanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drugs are phenylpiperidines?

A

Fentanyl

Alfentanil

Sufentanil

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What drug is diphenylheptane?

A

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs are atypical opioids?

A

Tapentadol

Tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where do opioids act?

A

Spinal cord = ascending pathway to inhibit pain transmission

Brain = descending modulation pathway (dec. perception of pain)

Peripheral action (topicals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens after opioid agonist binding to GPCRs?

A

Alpha-GTP can inhibit adenylyl cyclase and dec. intracellular cAMP = dec. Ca

= dec. NT release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do post-synaptic opioids do in spinal cord?

Ascending pathway

A

Increase potassium conductance
= chloride influx and potassium efflux
= dec. response to excitatory neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does GABA do in the endogenous pain regulatory system?

A

GABA inhibits the “off” process of pain …. allows your body to feel pain

Turning off GABA = less pain

17
Q

What is PAG?

A

Periaqueductal grey matter

Primary control center for descending modulation

Opioids inhibit GABA via PAG

18
Q

What does modulation in the descending inhibitory pathway do?

A

Decreases pain

19
Q

Where do opioids distribute?

A

Localize in tissues with highest perfusion

Low blood to fat tissues, but accumulation may be an issue with lipophilic opioids

20
Q

What is significance of morphine metabolites?

A

M3G = can lead to tremors, twitching = accumulation in renal failure can lead to CNS seizures

M6G = analgesia 4-6x more powerful than parent

21
Q

Differentiate metabolism of meperidine and fentanyl

A

Meperidine
= hepatic metabolism, renally cleared

Fentanyl
= metabolized in liver and then further by small intestine (when PO)
No active metabolites

22
Q

What are specific effects of opioids?

A

Analgesia

Euphoria
Dysphoria

Respiratory depression
Sedation

Sleep disturbances
Cough relief (dec. reflex)
Dyspnea relief (dec. resp. Drive)
GI: N/V, constipation
23
Q

Describe respiratory depression effect of opioids

A

Dose-related - Reversal is possible w/ naloxone

When levels of CO2 accumulate, body stimulates to breath

Opioids: brain is unaware of inc. pCO2 and under stimulates breathing..
this decrease is well tolerated in “most” patients

24
Q

Whos at risk for opioid-related respiratory depression?

A

Elderly

Sleep apnea/obese

Smokers, COPD, emphysema, asthma
+use sedatives, benzodiaz., EtOH

Opioid naive
Escalating dose (self-titration)
Long acting opioids

Pain relief

25
Q

Differentiate GI effects from opioids

A

N/V:
Gets better with time because tolerance develops

Constipation:
No tolerance!

26
Q

What is PAMOR antagonist?

A

Peripherally acting Mu-opioid receptor antagonist

Methylnaltrexone or naloxegol

Used for opioid induced constipation + won’t cross BBB or reverse analgesic effects of opioids

27
Q

Describe other specific opioid effects

A

Itching
= more common in morphine than fentanyl

Miosis: pupil constriction
= no tolerance develops - good diagnosis of opioid overdoes

28
Q

What is a drawback of Meperidine?

A

No place in pain management therapy!

= active metabolite can cause seizure

29
Q

Describe Fentanyl

A

*drug of choice in renal and hepatic impairment (no active metabolite)

Extensive metabolism in liver and small intestine if taken PO

Can be used if theres a morphine allergy

30
Q

Describe methadone

A

Causes most deaths
(Elimination is longgggg)

Can be used:
+end stage renal failure
+morphine allergy

Treats nociceptive and neuropathic pain (Mu agonist, NMDA antagonist)

Cardiac arrhythmias
NOT intended end stage liver failure

31
Q

Describe tramadol

A

Nociceptive + neuropathic pain
=(Mu agonist, NE/5HT reuptake inhibitor)

Risk of seizures + serotonin syndrome

Dose adjust for renal/hepatic

32
Q

What is tapentadol?

A

Mu receptor agonist and NE reuptake inhibitor

33
Q

Describe buprenorphine

A

Partial agonist - possibly less addictive and less respiratory depression

“Ceiling effect” of analgesia

Most commonly used to manage opioid addiction

34
Q

What side effects are of concern when using naloxone?

A

Opioid withdrawal from reversal concern:

Agitation
Anxiety

Runny nose
Sweating

N/V

Inc. HR + BP
Unmasking of pain

35
Q

What do neuropathic pain agents do?

A

Increase modulation

36
Q

What are 1st line agents for neuropathic pain?

A

(1) gabapentin/ pregabalin

(2) Tricyclic antidepressants (TCAs)
= amitriptyline, desipramine

(3) serotonin neuroepinephrine reuptake inhibitors (SNRIs)
= duloxetine, venlafaxine

(4) lidocaine path - lidoderm

37
Q

What do TCAs do?

A

Inhibit SERT + NET

Also affinity for ACh M receptor, alpha1, H1 receptor

38
Q

Differentiate between imipramine and desipramine

A

Imipramine:
More selective for ACh and SERT

Desipramine:
More selective for NET

PPP Winter Midterm (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions