Opioids and Non-Opioids

Question 1

Name the 3 main opiate receptors

Answer 1

Mu (analgesia, resp depression, euphoria, sedation, physical dependence), Kappa (Analgesia, sedation, pschytomimetic effects, psychotic), and Delta (No interaction)

Question 2

Describe agonist”

Answer 2

drugs that occupy receptors and ACTIVATE them

Question 3

Describe Antagonist+Agonist

Answer 3

Less activation

-Blocking/antagonist effect at Mu receptor and Activation/agonist effect at Kappa receptor

Question 4

Agonist Opioids

Answer 4

FULL ACTIVATION; Drugs that bind to Mu and Kappa

Question 5

Antagonist Opioids

Answer 5

No activation; drugs that occupy receptors, but don’t activate them.

Question 6

What happens if you administer an antagonist after an agonist?

Answer 6

Withdrawal–> blocks agonist

Question 7

Why would you use a pure antagonist?

Answer 7

Overdoses, respiratory depression, or sedation. Narcan (naloxone)

Question 8

List 5 Strong Opioid Agonists

Answer 8

1. Morphine Sulfate
2. Hydromorphone (Dilauded)
3. Fentanyl (Duragesic)
4. Meperidine (Demerol)
5. Methadone (Dolophine)

Question 9

For what pain scale would you use a Strong Opioid?

Answer 9

7-10

Question 10

List 4 Moderate-Strong Opioids

Answer 10

1. Codeine & Tylenol (Tylenol #3)
2. Hydrocodone & Tylenol (Vicodin, Lortab)
3. Oxycodone & Tylenol (Percocet, Tylox)
4. Oxycontin (ER oxycodone)

Question 11

For what pain scale would you use a Moderate-Strong Opioid

Answer 11

4-6

Question 12

List 4 Agonist-Antagonists

Answer 12

1. Butorphanol (Stadol)
2. Pentazocine (Talwin)
3. Buprenorphine
4. Nalbuphine

Question 13

When would you use an Agonist-Antagonist?

Answer 13

Moderate-Severe Pain,

During birth

Question 14

What are the SE of Agonist-Antagonists?

Answer 14

WITHDRAWAL, Less analgesia, less respiratory depression, Pstychotomimetic effects, strange thoughts, nightmares, hallucinations, delirium

Question 15

What can Methadone cause?

Answer 15

Torsad’s De Point

Question 16

What’s an advantage of Agonist-Antagonists?

Answer 16

Less potential for abuse

Question 17

Why would you give a mother Agonist-Antagonists during delivery?

Answer 17

Because they reduce risk for respiratory depression

Question 18

How long does Narcan last?

Answer 18

1 hour. Requires redosing due to long half-life of strong opiates

Question 19

What vitals should you look at before administering Opioids?

Answer 19

RR (<12 intervene), BP (don’t give if BP is too low, usually systolic <100)

Question 20

What are the 6 main SE of opioids?

Answer 20

1. Respiratory Depression/Sedation
2. Constipation
3. Nausea/Vomiting
4. Itching
5. Hypotension/Postural hypotension
6. Urinary Retention

Question 21

Other symptoms:

Answer 21

Neurotoxicity, Miosis, Euphoria/dysphoria, immune depression with prolonged use

Question 22

Name 2 contraindications (not RR) for opioids

Answer 22

1. Increased ICP

2. Biliary colic (can cause spasms in the common bile duct. Use Demerol or Dilaudid)

Question 23

Special Concerns for Meperidine (Demerol)

Answer 23

Seizures

Question 24

Discuss Tramadol (Ultram)

Answer 24

Non-opioid, centrally-acting, analog of codeine. Substance 4
Relieves pain through combo of opioid and non-opioid mechanisms (weak action at Mu, AND blocks NE & serotonin) risk for suicide (contraindication)

Question 25

Discuss Alvimopan (Entereg)

Answer 25

Counteracts ADRs of opioid and bowel function. Used to prevent ileus in bowel resection surgery and accelerate bowel recovery. Stop as soon as pt has BM post-op.

Question 26

What is the key risk for Alvimopan (Entereg)?

Answer 26

HEART ATTACK!

Question 27

COX. What it do?

Answer 27

Synthesize prostaglandins (promote inflammation, sensitize receptors to painful stimuli) Prostaglandins that protect GI mucosa Synthesize thromoxane for platelet aggregation/clotting Work on kidneys to promote vasodilation and renal flow Work in brain to mediate fevers and contribute to pain perception. Work in uterus to promote uterine contractions

Question 28

COX-1:

Answer 28

GOOD GUY - pathway does good for the body. - Promotes GI protection, bleeding/hemostasis, and renal impairment

Question 29

COX-2:

Answer 29

BAD BOI -Promotes pain, inflammation, and fever Causes the risk for MI/Stroke

Question 30

NSAIDS

Answer 30

Non-steroidal inflammatory drugs (cyclooxygenase inhibitors) inhibit COX function

Question 31

1st 1st generation NSAIDS

Answer 31

Aspirin, Goody's Powder

Question 32

2nd Generation NSAIDS

Answer 32

Celebrex (Celecoxib)

Question 33

How much Aspirin is needed to prevent MI? How long does it last?

Answer 33

81mg. 8 days, the lifespan of the prostaglandin

Question 34

1st generation NSAIDS

Answer 34

ibuprofen, naproxone, diclofenac acid, ketoralac (IV form)

Question 35

What syndrome is a risk with NSAIDS?

Answer 35

Reye's syndrome- don't give to kids if they have viral illness

Question 36

What organ is most affected by NSAIDS? Acetaminophen?

Answer 36

Kidneys and Liver respectively

Question 37

What wound one give to reverse an acetaminophen overdose?

Answer 37

Acetylcystine (mucomyst)