Flashcards in Opioids Deck (84):
ANY substance with abuse or addictive potential
naturally derived opiates or those synthesized to have similar properties
What are the different levels of DEA Drug scheduling?
Which one has absolutely no medicinal purpose or is not medically used?
In what order does the scheduling scale go?
C5-C1. C5 has the least addiction or abuse potential, and C1 has the most addiction or abuse potential
What type of pain is there evidence that opioids are effective?
Acute pain (surgery, acute illness, trauma, labor, and medical procedures)
What type of pain is caused by changes in nerve function and typically doesn't have data to support efficacy and safety of opioids?
What type of pain includes both acute and chronic pain and is usually treated with opioids?
What are the three types of opioids?
2) Semi-Synthetic Opioids
3) Synthetic Opioids
What are the Opioids?
1) Codeine/Acetaminophen (Tylenol 3)
What are the Semi-Synthetic Opioids?
1) Hydrocodone (Vicodin)
2) Oxycodone/Acetaminophen (Endocet, Percocet)
3) Oxycodone IR and ER
What are the Synthetic Opioids?
True or False? All Opioids are created equally.
False, not all opioids are created equally. If you take a certain amount of one opioid, you have to dose adjust another opioid.
What is the brand name for Codeine/APAP 30/300mg?
What is the brand name for Fentanyl?
What is the brand name for Hydrocodone/APAP?
Vicodin (May see as Lortab and Norco)
What is the brand name for Hydrocodone extended release?
What is the brand name for Methadone?
What are the brand names for the liquid version of Methadone?
Methadose and Methadose Intensol
What is the brand name for Morphine ER?
What is the brand name for Oxycodone ER?
What is the brand name for Oxycodone IR?
What is the brand name for Oxycodone/APAP?
Percocet, Endocet, Roxicet (not produced anymore)
What is the brand name for nasal spray version of Naloxone?
What is the brand name for the auto-injector version of Naloxone?
What is the brand name for Tramadol?
What is the brand name for Buprenorphine Naloxone?
What is the term for codeine, and what is it converted to once digested?
Codeine is a prodrug that is converted, by the body, into morphine
In the conversion process of codeine to morphine, what effects the degree of pain relief?
A person's metabolism. A person with a poor metabolism will have little to know pain relief while a person will a high metabolism runs the risk of overdose/toxicity
What are the long-acting opioids?
1) Oxycodone ER
2) Morphine Sulfate ER
3) Fentanyl Patch
What are the short-acting opioids?
4) Oxycodone IR
What is the mechanism of action for opioids?
They alter the response to pain centrally and peripherally because of their affinities for the mu, delta, and kappa receptors
Which receptor is located all over the body, and what does that cause?
The mu receptor is located all over the body, and this is usually why there are so many differing side effects
What are the approved indications for opioids?
Moderate to severe pain
What are the side effects for opioids?
4) respiratory depression
What are the drug interactions with opioids?
1) Benzodiazepines (sedation potential and respiratory depression)
2) CNS depressants (including alcohol)
3) Muscle relaxants
What are the box warnings associated with opioids?
1) Accidental ingestion
2) Addiction, abuse, misuse
3) Respiratory depression
What are the precautions associated with opioids?
1) respiratory depression
What are the two opioids that most commonly cause an allergic response?
Codeine and morphine
What is special about the semi-synthetic and natural opioids that people often mistake for an allergic reaction?
These opioids cause an increase in the release of histamine which is responsible for the development of rashes and other allergy-like symptoms
What are signs of true allergies?
rash or anaphylaxis
Which opioids may cross interact with each other?
Morphine, codeine, hydromorphone, oxycodone, and hydrocodone
What are the important patient counseling points for opioids?
1) Patients need stimulant laxative (Senna)
2) May cause drowsiness
3) May be habit-forming
4) Do not crush or cut controlled-release medications
5) Can take with food to minimize nausea/vomiting
Which schedule cannot have refills?
CII substances must have a new prescription everytime
How many strengths does the Fentanyl patch come in?
How often are Fentanyl patches applied?
Every 72 hours, one patch at a time (some patients may use one every 48 hours)
Where should fentanyl patches be applied?
To clean, dry, unbroken skin
Can a fentanyl patch be cut?
What should a patient do with the patch once it has been used?
Fold upon itself and flush immediately. Then wash hands after handling.
Can heat be applied to a fentanyl patch?
No, it can cause increased absorption and toxicity
How long does it take for the medication to start working?
Should a patient taking a Fentanyl patch also be on another extended-release opioid?
Where are good locations to apply fentanyl patches?
Chest, back, hip, and arm
What are the FDA approved indications for Fentanyl?
Moderate to severe chronic pain that can't be managed by other means in opioid-tolerant patients
What is the mechanism of action of Fentanyl?
It is absorbed into the adipose tissue where it forms a depot that slowly releases systemically
What is the boxed warning for Fentanyl?
What is the contraindication for Fentanyl?
Opioid naive patients
What are the precautions with Fentanyl?
Cachetic, debilitated patients, and elderly
What is another indication besides pain management for Methadone?
What is the brand name for Tramadol?
What is the brand name for Tramadol/APAP?
How does Tramadol work?
It works on similar receptors as antidepressants to increase availability of norepinephrine and serotonin
What is the FDA-approved indication for Tramadol?
Chronic, moderate to moderately-severe pain
What is the DEA scheduling for Tramadol?
What are the adverse effects of Tramadol
5) respiratory depression
9) suicidal thoughts (rare)
What are the drug interactions with Tramadol?
1) other drugs that affect serotonin
2) opioids and opioid antagonists
3) benzodiazepines and muscle relaxants
What are the patient counseling points for Tramadol?
1) Do not stop abruptly
2) Tolerance/dependence may occur
3) laxative agent needed to treat constipation
4) May increase risk for seizures
5) Use caution when doing activities that require alertness
What is the brand name for Naloxone (nasal spray)?
What is the brand name for Naloxone (auto-injector)?
What is the brand name for Naloxone/Buprenorphine
What is the FDA-approved indication for Naloxone?
Opioid overdose (reversal of respiratory depression)
How does Naloxone work?
It goes to the kappa, mu, and delta receptors and kicks off the opioid and takes its place.
What are the adverse effects of Naloxone?
1) opioid withdrawal
2) anxiety, restlessness, muscle aches, inability to sleep, sweating
3) injection site reaction
4) anger after waking up from the overdose
What are the drug interactions with Naloxone?
What are the warnings/precautions for Naloxone?
1) Will cause acute opiate withdrawal (call 911)
2) Family and friends need to be trained on how to administer
What is the patient counseling for Naloxone?
1) Initial dose is 2mg (can be used every 2-3 minutes) with a max dose of 10mg
2) Immediate treatment is needed due to potential short duration of action
Who are candidates for Naloxone?
1) patients who are on high doses for long-term pain (> 50 mg morphine equivalents)
2) patients receiving rotation opioid medication regimens
3) patients who have been discharged following opioid poisoning
4) patients taking certain extended-release or long-acting opioid medications
5) patients completing mandatory opioid detoxification programs
How does Suboxone work?
It is a partial opioid agonist and antagonist combination that is available as a sublingual tablet or film
What is the FDA-approved indication for Suboxone?
What DEA schedule is Suboxone?
What is the requirement for physicians before prescribing Suboxone?
They have to have an X in their DEA number to show that they have completed certification in dealing with opioid overdoses/abuse
What are the adverse effects of Suboxone?
1) withdrawal syndrome
3) film: gum and mouth irritation
What are the drug interactions with Suboxone?