Opioids Dr. Izard

Question 1

highest class of pain killers are the what opioids

Answer 1

Phenylpiperidines

Question 2

Opioid Agonists

Answer 2

Morphine 
Hydromorphine 
Methadone
Meperidine 
Fentanyl 
Codeine
Oxycodone
Hydrocodone
= can go all the way up to coma and death
Propoxyphene

Question 3

Mixed Agonist/Antagonist (Partial Agonist) opioids

Answer 3

Pentazocine
Nalbuphine
Buprenorphine 
Butorphanol
= plataus up to a certain point

Question 4

Opioid Antagonist

Answer 4

Naloxone
Naltrexone
= no effect

Question 5

oral and IV opioid time to effect pt

Answer 5

ORAL = 30min 
IV = 5-10min (can shut CNS down immediatly)

Question 6

settings where to use opioid 9

Answer 6

1. MI
2. Sickle cell
3. Post op precedures
4. Trauma
5. cancer
6. kidney stones
7. Back pain
8. Anti-diarrhea (Loperamide)
9. with anesthesia

Question 7

acute effects of opioid

Answer 7

sedation, euphoria, slow NS, slow HR, X cough reflex, N/V, coma/death

Question 8

opioid interact with what 3 drug classes

Answer 8

1. MOA
2. Sedative/hypnotics
3. Anti-psychotic agents

Question 9

u (mu) opioid receptor has affinity for

Answer 9

Endorphins > Enkephalins > Dynorphins

Question 10

Delta receptor opioid (has affinity for what)

Answer 10

Enkephalines > Endorphins > dynorphins

Question 11

Kappa opioid receptor has affinity for

Answer 11

Dynorphins > Endorphins > Enkephalins

Question 12

Morphine uses what opioid receptor

Answer 12

mu, delta, kappa

Question 13

Methadone uses what opioid receptor

Answer 13

mu

Question 14

Buprenorphine uses what opioid receptor

Answer 14

mu, delta, kappa

Question 15

Naloxone uses what opioid receptor

Answer 15

mu, delta

Question 16

Morphine

1. contraindications
2. used for

Answer 16

1. sulfur hypersensitivity, bronchial asthma or resp problems
2. management of pain

Question 17

Fentanyl use when

Answer 17

1. manage persistent mod to severe chronic pain (continuous adminitsration) last resort
   (100 x more potent then morphine)

Question 18

Methadone used when

Answer 18

1. abstinence sx management + tx opioid disorder + heroin disorder
   (not dosed high enough for pharmacologic response)

Question 19

Hydrocodone used for and is similar to what drug + usually combined with what

Answer 19

1. mod to mod severe pain + antitussive (relieve cough)
2. codeine
3. usually combined with acetaminophen (hepatic problems if OD)

Question 20

Pentazocine MOA, used for, NOT used for, contraindications

Answer 20

1. partial agonist
2. when no other pain med is enough severe pain needing opioid + preoperative + with anesthesia
3. not for tx addiction
4. not take with benzodiazepines or other depressants , preg (neonatal opioid WD syndrome)

Question 21

Meperidine MOA, used for, RISK for what, interacts with

Answer 21

1. agonist
2. opioid needed pain
3. misuse by anesthesiologists since they have access to it
4. partial agonists + antagonists

Question 22

Codeine used for, special for, risk, important to know with the use of this

Answer 22

1. antitussive (cough)**, mild pain, Diarrhea
2. least opioid activity drug of all
3. addiction, OD
4. gradually taper to stop medication

Question 23

Loperamide used for, what can be given if OD, special thing about this one

Answer 23

1. Diarrhea, OTC
2. Naloxone
3. taken my morphine addicts when they cant find it

Question 24

Buprenorphine MOA, used for, interacts with

Answer 24

1. partial agonist
2. opioid and narcotic pain reliever addiction TX, pain
3. CYP3A4 inhibitor or inducer **

Question 25

Naloxone MOA, used for, risks

Answer 25

1. opioid antagonist 2. opioid overdose (inhibits receptors and takes over them) to reverse effects 3. releases catacholamines --> lead to acute WD or pain (need to monitor)

Question 26

Naltrexone MOA, used for, risks

Answer 26

1. opioid antagonist (mu receptors) (so even if pt takes opioid they get no effect, receptors are blocked) 2. alcohol and opioid addiction or overdose = rehab drug 3. pt after this can be way more sensitive to opioid in future (can die from what they thought was normal dose), can give WD and pain symptoms ****