Opioids

Question 1

stimulatory effects of opioids

Answer 1

miosis
convulsions
constipation
vomiting

Question 2

brain mu

Answer 2

mu 1

Question 3

peripheral mu

Answer 3

mu 2

Question 4

endorphin

Answer 4

mu

Question 5

enkephalin

Answer 5

delta

Question 6

dynorphin

Answer 6

kappa

Question 7

analgesia: increase pain tolerance and decrease perception and rxn to pain
sedation
respiratory depression: decrease response to increase pCO2, increase intracranial pressure
(do not give O2, give naloxone)

Answer 7

Gi coupling side effects of opioids

Question 8

cardiovascular - vasodilation ( avoid in head injury)
urinary retention, urgency to void
biliary: sphincter constriction causing biliary colic
renal fxn (gfr) is decrease by opioids due to decrease renal blood flow
can cause gynecomastia or SIADH (stim release of ADH, PRL, somatotropin)
increase histamine release - pruritus
cough suppression - codeine

Answer 8

other SE of opioids

Question 9

CI: head injury, pulmonary dysfxn, pregnancy, hepatic/renal dysfxn, adrenal/thyroid def

Answer 9

opioids

Question 10

mu agonist

glucuronidation
motphine 6 glucuronide is highly active, caution in renal dysfxn

Answer 10

morphine

Question 11

MOA: ionic channel, through release of endogenous opioid peptides, modulate pain through ascending/descending nerves

Answer 11

opioids

Question 12

Classic triad: OD toxicity

Answer 12

pinpoint pupils
respiratory depression
coma

Question 13

tx for OD toxicity

Answer 13

IV naloxone

Question 14

occurs to all effects, except mitosis and constipation

Answer 14

tolerance of opioids

Question 15

physical and psychological - addiction

Answer 15

dependence of opioids

Question 16

Mech of tolerance

Answer 16

1) increase cAMP
2) receptor recycling blockage
3) receptor and G protein coupling

Question 17

uses for opioids

Answer 17

analgesia
Anesthesia 
manage acute pulmonary edema
cough suppression
antidiarrheal

Question 18

opioids used in anesthesia

Answer 18

fentanyl
morphine

can cause chest muscle tone increase, chest rigidity

Question 19

opioids in used in cough suppression

Answer 19

codeine

dextromethorphan

Question 20

opioids used as antidiarrheal

Answer 20

loperamide

diphenoxylate

Question 21

metabolized by liver p450 CYP2D6 (demethylation) to morphine

Answer 21

codeine

Question 22

proopiomelanocortin (POMC)

Answer 22

precursor for endorphins and enkephalins

Question 23

yawning, anxiety, sweating, goose bumps, lacrimation, rhinorrhea, salivation, spasms, muscle cramps, CNS originating pain

Answer 23

withdrawal - abstinence syndrome of opioids

Question 24

tx for withdrawal

Answer 24

methadone
buprenorphine
clonidine

Question 25

long acting t half 25-52 hrs Maintenance programs for addicts permits slow tapering effect and diminishes intensity of abstinence syndrome

Answer 25

methadone

Question 26

maintenance program t half 24-60 hrs low efficacy at mu receptor with high affinity

Answer 26

buprenorphine

Question 27

A2 agonist | cancel over activity of sympathetic nerve system

Answer 27

clonidine

Question 28

opioid antagonists

Answer 28

naloxone Naltrexone methylnaltrexone

Question 29

IV reversal for respiratory depression

Answer 29

naloxone

Question 30

PO, decrease craving for alcohol and used in opiate addiction

Answer 30

naltrexone

Question 31

tx for post op ileus, opioid induced constipation (doesn't cross BBB) and won't precipitate withdrawal

Answer 31

methylnaltrexone

Question 32

tx for baby with opioid withdrawal sx

Answer 32

1) diazepam 2) camphorated tincture of opium - oral 3) methadone - oral

Question 33

opioids that interact with SSRI or MAOI causing serotonin syndrome

Answer 33

meperidine dextromethorphan tramadol

Question 34

stong agonists

Answer 34

``` morphine methadone meperidine fentanyl heroin ```

Question 35

moderate agonists

Answer 35

codeine | oxycodone

Question 36

mixed agonists/antagonists

Answer 36

buprenorphine butorphanol pentazocine nalbuphine

Question 37

agonist and reuptake inhibitors

Answer 37

tapentadol | tramadol

Question 38

used in moderate pain and RA

Answer 38

tapentadol | tramadol