Opioids - Iszard Flashcards Preview

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Flashcards in Opioids - Iszard Deck (33)
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1
Q
morphine
codeine
hydrocodone
hydromorphone
levorphanol
oxycodone
oxymorphone
buprenorphine
nalbuphine
butorphanol
naloxone
heroin
A

phenanthrenes

2
Q

pentazocine
diphenoxylate
loperamide

A

benzomorphans

3
Q

meperidine
fentanyl
sufentanil
ramifentanil

A

phenylpiperidines

4
Q

methodone

propoxyphene

A

diphenylheptanes

5
Q

what are the opioid agonists? (9)

A
morphine
hydromorphine
meperidine
fentanyl
codeine
oxcodone
hydrocodone
propoxyphene
6
Q

what are the mixed agonist/antagonists? (4)

A

pentazocine
nalbuphine
buprenorphine
butorphanol

7
Q

what are the opioid antagonists? (2)

A

naloxone

naltrexone

8
Q

what are the concerns related to opioid adverse effects?

A
  • CNS depression
  • constipation
  • hypotension -> use caution in pt w/hypovolemia*
9
Q

what is the black box warning of opioids?

A

serious, life-threatening respiratory depression may occur

10
Q

what are the indications of opioid therapy?

A
  • MI
  • sickle cell crisis
  • post-op
  • trauma
  • cancer
  • kidney stones
  • back pain
  • epidural anesthesia
  • antitussive
  • antidiarrheal (loperamide)
11
Q

which opioid receptor subtype shows this affinity:

- endorphins > enkephalins > dynomorphins

A

mu

12
Q

which opioid receptor subtype shows this affinity:

- enkephalins > endorphins and dynomorphins

A

delta

13
Q

which opioid receptor subtype shows this affinity:

- dynomorphins&raquo_space; endorphins and enkephalins

A

kappa

14
Q

methadone is a full agonist for which receptor?

A

mu

15
Q

naltrexone and nalmefene inhibit which receptor?

A

mu

16
Q

buprenorphine is a partial agonist for which receptors?

A

kappa and delta

17
Q

naltrexone is a partial agonist for which receptor?

A

kappa

18
Q

nalmefene is a partial agonist for which receptor?

A

kappa

19
Q

what are the dampening effects of opioids?

A
  • depresses pain sensation (analgesic)

- depresses respiratory and cough centers (antitussive)

20
Q

what are the stimulant effects of opioids?

A
  • antinociceptive system (analgesic)
  • smooth musculature of stomach and bowel (antidiarrheal)
  • ureter, bladder, sphincter
21
Q
  • respiratory depression
  • nausea/vomiting
  • pruritus
  • urticaria
  • constipation
  • urinary retention
  • delirium
  • sedation
  • myoclonus
  • seizures
A

acute adverse effects of opioid use

22
Q
  • hypogonadism
  • immunosuppression
  • increased feeding
  • increased GH secretion
  • withdrawal effects
  • tolerance/dependence
  • abuse/addiction
  • hyperalgesia
  • impairment while driving
A

chronic effects of opioid use

23
Q

what are the minimal effects of opioid use?

A
  • miosis
  • constipation
  • convulsion
24
Q

what is the one moderate effect of opioid use?

A

bradycardia

25
Q

what are the serious effects of opioid use?

A
  • analgesia
  • euphoria
  • mental clouding
  • sedation
  • respiratory depression
  • antidiuresis
  • nausea/vomiting
  • cough suppression
26
Q

what are the effects of opioid use with sedative-hypnotics?

A

increased CNS depression, especially respiratory depression

27
Q

what are the effects of opioid use with antipsychotic agents?

A

increased sedation

  • variable effects on respiratory depression
  • accentuation of cardiovascular effects (antimuscarinic and a-blocking actions)
28
Q

what are the effects of opioids with monoamine oxidase inhibitors?

A

relative contraindication to all opioid analgesics d/t high incidence of hyper-pyrexic coma
- HTN has also been reported

29
Q

this drug is an opioid agonist indicated for the management of pain not responsive to non-narcotic analgesics
- contraindicated in pts with bronchial asthma or upper airway obstruction, or respiratory depression

A

morphine sulfate

warnings: respiratory depression, CNS toxicity, don’t use with CNS depressants (alcohol)
adverse rxns: sedation, lightheadedness, dizziness, nausea, vomiting, constipation

30
Q

this drug is indicated for treatment of opioid dependence and is preferred for induction

  • can be abused in a similar manner to other opioids
  • significant respiratory depression and death have occurred, especially when given intravenously in combination with benzodiazepines and other CNS depressants
A

buprenorphine

31
Q

what are the drug interactions of buprenorphine?

A

monitor patients starting or ending CYP34 inhibitors for potential over/under-dosing
- use caution with benzos or other CNS depressants

32
Q

pure opioid antagonist that competes and displaces opioids at opioid receptor
- used for complete or patial reversal of opioid overdose or opioid depression (respiratory depression)

A

nalozone

NOTE: causes the release of catecholamines, which may precipitate acute withdrawal or unmask pain in those who regularly take opioids

33
Q

pure opioid antagonist

  • cyclopropyl dervative of oxymorphone similar to naloxone and nalorphine
  • acts as competitive antagonist at opioid receptor, showing highest affinity for mu receptors
A

naltrexone

NOTE: pts who have been treated with naltrexone may respond to lower opioid doses than previously used -> could result in potentially life-threatening opioid intoxication
- may also precipitate symptoms of acute withdrawal in opioid-dependent patients