Opioids II/III

Question 1

Who is most likely to experience dysphoria from morphine?

Answer 1

-Females
-Pain-free individuals

Question 2

Opiates act on the mu-receptors of ___, which is the reward center, and allows for the reinforcing effect

Answer 2

Nucleus Accumbens

Question 3

Why do some patients taking opioids experience nausea?

Answer 3

Trigger chemoreceptor trigger zone

Question 4

What does tolerance not develop to?

Answer 4

Constricted pupils
Constipation

Question 5

Major toxic effect of opiods?

Answer 5

Respiratory depression (decreased sensitivity to medullary chemoreceptors)

Question 6

In what condition can the respiratory depression caused by opioids be useful?

Answer 6

Pulmonary edema (“air hunger”)
-Alleviates patient’s conscious awareness of respiratory distress

Question 7

Why do opioids have anti-tussive effects?

Answer 7

-Depress cough control center

Question 8

What two ways can opioids cause endocrine disturbances in chronic users?

Answer 8

1) Decrease prolactin, corticosteroid, and gonadotropin levels
2) Menstrual disturbances (females) and impotence (males)

Question 9

How do opiods affect smooth muscle?

Answer 9

-Increase tone of circular smooth muscle
-Less movement of propensive muscle

Question 10

True or False:
Urine retention, increased biliary pressure, and decrease intestinal motility are effect of use of opioids?

Answer 10

True

Question 11

True or False: opioids can interfere with cardiovascular system, causing postural hypotension and cutaneous vasodilation (both of which are due to histamine release)

Answer 11

True

Question 12

Why is morphine less potent orally?

Answer 12

First pass effect

Question 13

Can morphine cross the BBB?

Answer 13

Yes

Question 14

What patients should be given opioids with caution?

Answer 14

-Immunocompromised (immunosuppresion)
-Asthmatics (bronchoconstriction - histamine release)
-Recent head injury (increase CSF)
-Seizure prone (lower seizure threshold)

Question 15

Drug interactions with morphine?

Answer 15

1) CNS depressants (additive effect)
2) MAO inhibitors (coma/hyperpyrexia)
3) Speedball

Question 16

Triad symptoms for opioid overdose?

Answer 16

1) pinpoint pupil
2) depressed rate of respiration
3) CNS depression

Question 17

Treating opioid OD?

Answer 17

• Ventilation (admin O2-but may remove hypoxic drive)
• Narcotic antagonist (Narcan)

Question 18

True or False: Opioids can be used to treat moderate to severe pain, as adjunct to anesthesia, as anti-tussives, or dyspnea of left heart failure

Answer 18

True

Question 19

How does morphine compare to codeine?

Answer 19

Codeine is effective when administered orally (morphine is not)
Codeine is less potent - it is a weak opioid agonist

Question 20

Morphine dosage?

Answer 20

30-60 mg PO
10 mg SC/IM

Question 21

In most patients, codeine is metabolized to ___

Answer 21

morphine

Question 22

Uses of morphine?

Answer 22

1) Anti-tussive
2_analgesic

Question 23

People with CYP2D6 are more likely to overdose on _____

Answer 23

codeine

Question 24

Why is meperidine not an appropriate treatment for chronic pain?

Answer 24

Build up of normepedrine can lead to seizures

Question 25

When heroin enters the brain, what does it become?

Answer 25

Morphine + 2 acetyl groups

Question 26

How does duration of action vary when methadone is used as analgesic vs. for opioid addiction?

Answer 26

-Analgesic: 4-6 hrs -Opioid addiction: 12-24 hrs

Question 27

____ can be used to treat breakthrough pain, supplement in surgical anesthesia, and transdermally for chronic pain

Answer 27

Fentanyl

Question 28

How can opioid combination preparations cause liver damage?

Answer 28

-At high doses, may have toxic doses of acetaminophen, aspirin, or ibuprofen

Question 29

What drug class has less abuse potential, compared to opioids?

Answer 29

Mixed agonist-antagonists

Question 30

How does pentazocine act?

Answer 30

High doses: mu-antagonist Normally: -mu receptor (partial agonist) -kappa receptor (agonist)

Question 31

Although pentazocine is less effective for severe pain, it is also less likely to do what two thing? What is it more apt to caues?

Answer 31

1) respiratory depression 2) potential for dependence more likely to cause CNS stimulation

Question 32

Why does the Talwin NX include both pentazocine and naloxone?

Answer 32

Naloxone decreases chance of IV abuse (stops person from getting high)

Question 33

Buprenorphine is a ___ agonist that acts at __ receptors

Answer 33

partial; mu

Question 34

Main use of buprenorphine?

Answer 34

Reduce drug cravings in addicts

Question 35

What two partial agonists have abuse deterrent formulations?

Answer 35

-Buprenorphine -Talwin NX

Question 36

What is the primary agent of office based treatment of opioid addiction?

Answer 36

Buprenorphine

Question 37

___ is a weak agonist that inhibits synaptic re-uptake of NE and serotonin, can be used to treat mild to moderate pain

Answer 37

Tramadol

Question 38

While Tapentadol is similar to Tramadol, how is it unalike? Alike?

Answer 38

Tapentadol has stronger mu activity and more effective than tramadol at treating pain (also more abuse potential) -Both inhibit uptake of 5-HT and NE

Question 39

Naltrexone is a long-acting ____ that treats primary ______

Answer 39

antagonist etoh abuse

Question 40

Two drawbacks of naltrexone?

Answer 40

1) Hepatotoxicity risk 2) Supppppper long acting (like 3-4 weeks long!)

Question 41

What two drugs can be given to treat/prevent constipation from opioid use?

Answer 41

-Naloxegol (opioid antagonist - chronic; outpatient setting; less sytemic effects) -Methylnaltrexone (for serious constipation resulting from higher doses)

Question 42

True or False: Features of acute withdraw include: dilation of pupils, HTN, tachy, goose flesh, yawning, sweating

Answer 42

True

Question 43

Why does one feel bad when they withdraw?

Answer 43

Person becomes depleted of endorphins and enkephalins

Question 44

Which is fatal: opioid or alcohol withdraw?

Answer 44

ETOH

Question 45

Before beginning naltrexone, an opioid addict must first ___

Answer 45

be detoxified

Question 46

Is Naloxone