Opioids/Narcotics

Question 1

What is opium?

Answer 1

Dried juice from the seed-head of the opium poppy

Question 2

What are 3 indications for opium?

Answer 2

analgesia, antitussive (codeine), constipating

Question 3

What year was morphine derived? Who was responsible?

Answer 3

1801 by Morpheus – the greek of dreams!

Question 4

What is an opioid?

Answer 4

Generic term for natural and synthetic substances that bind opioid receptors

Question 5

What are the 3 subtypes of opioid receptors?

Answer 5

Delta, Mu, Kappa

Question 6

How do opioids relieve pain?

Answer 6

receptor agonism by reducing the pain NT

Question 7

what are 7 AEs of opioids?

Answer 7

1. sedation
2. Reduced peristalsis
3. Pruritis (histamine release)
4. Respiratory depression
5. N/V
6. Miosis
7. Peripheral vasodilation (decrease in BP)

Question 8

Why do opioids worsen pancreatic pain? What drug may cause less pain in these patients?

Answer 8

contract sphincter of oddi (increased biliary tree pressure)

Meperidine!

Question 9

What is the anti-dote of opioids? what will you see in patients after giving it?

Answer 9

Naloxone (Narcan)

withdrawal symptoms

Question 10

What is a longer acting form of naloxone that can be used for detox/addiction therapy? How long do you take it? How does it work?

Answer 10

Naltrexone (Vivitrol) - 1-3 days

Reduces euphoria in stable addicts

Question 11

What can Ky EMTs use for opioid ODs in the field?

Answer 11

injection/inhalation of naloxone

Question 12

Are all opioids long or short acting?

Answer 12

They have a broad range -
Remifentanil - short half life with plasma esterase
Methadone - large Vd, half life (take 1x/wk)

Question 13

opioids = ______ inter-pt variability

Answer 13

wide

Question 14

opioids dosage forms?

Answer 14

IV, SQ, TD, Intrathecal, PCA (pump)

Question 15

Morphine is the ____- ______ opioid. How is different from the others?

Answer 15

Gold standard

Water-soluble (hydrophilic)

Question 16

Morphine is used most often in pts with what pain? why?

Answer 16

Chest pain - it reduces sympathetic tone (decrease HR, BP) with little reflex tachycardia

Question 17

How is morphine metabolized?

Answer 17

first-pass effect - after it passes thru the liver, there is very little concentration of the drug left in the blood to enter the systemic circuit.

Question 18

which drug is the most resistant to naloxone?

Answer 18

methadone

Question 19

What does it mean that morphine as an IV:PO ratio of 1:6?

Answer 19

You need to give MORE morphine PO because only some of it will end up in the systemic blood stream. When giving it IV, it does not have the first pass effect, thus needing smaller dose.

Question 20

Meperidine (Demerol) is structurally ________ to MS. It is _____potent than MS.

Answer 20

Dissimilar, less potent

Question 21

How is demerol metabolized? What patients should not take it?

Answer 21

Hepatically – normeperidine

patients with renal failure.. normeperidine will accumulate and cause seizures.

Question 22

meperidine can also increase ____ levels, when combined with antidepressants can lead to a life threatening condition called ________________.

Answer 22

5-ht

Serotonin Syndrome - tremors, sz, hallucinations, death.

Question 23

What is the official name of heroin? How do you imagine heroin? Why does it elicit such potent effects?

Answer 23

Diamorphine
chain of morphines
its highly lipophilic and goes straight to the brain.
highly addictive

Question 24

Why should you avoid meperidine in chest pain alerts?

Answer 24

can cause reflex tachycardia

Question 25

Meperidine is a weak ____________ and has __________ properties.

Answer 25

weak antitussive | antiACh properties

Question 26

Codeine is used more for _______ than pain relief. | For pain above or below the shoulders? What is an example?

Answer 26

cough suppression Above the shoulders - dental pain: Codeine #3 (30 mg Codeine + 300mg APAP)

Question 27

T or F. Most analgesic effects of codeine are from the metabolism to morphine.

Answer 27

T.

Question 28

Oxycodone is a ______-_______ opioid. And is __x more potent that MS. It is highly ________.

Answer 28

semi-synthetic 2x as potent as MS addictive

Question 29

Oxycodone has ____ systemic bioavailability even following oral administration. Meaning, it has ___ first pass.

Answer 29

high | low first pass

Question 30

Oxycodone causes more/less pruritis and mental status change than MS.

Answer 30

less

Question 31

``` Hydrocodone is coformulated with APAP in what 2 drugs? Below or above the shoulder pain? What class is hydrocodone? ```

Answer 31

Vicodin, Lortab Below the shoulders - back pain C2

Question 32

T or F. Hydocodon + APAP is Percocet.

Answer 32

F. Oxycodone + APA = Percocet | Percodan = ASA+Oxy

Question 33

Hydromorphine (Dilaudid) has ___x the potency of MS via PO and ___x the potency via IV.

Answer 33

5x as potent with PO | 8x as potent with IV

Question 34

How is Methadone useful in withdrawl/maintenance of opioid addiction?

Answer 34

It reduces cravings and the euphoric effect of other opioids

Question 35

How long is methadone's duration of action? What does this mean for its reversibility? It is hydro/lipophilic?

Answer 35

15h following a PO dose --large Vd It is hard to reverse! Lipophilic

Question 36

What is a medical AE of methadone?

Answer 36

QT prolongation -- Torsades

Question 37

Fentanyl is long/short acting. What is the relationship with dose and half life?

Answer 37

short | half life increases with dose

Question 38

How potent is fentanyl compared to MS?

Answer 38

100x as potent as MS

Question 39

Why is fentanyl a good transdermal agent? how long does the patch last?

Answer 39

it is highly lipophilic. | replace patch after 72h ($$$)

Question 40

Alfentanil, Remifentanil, Sufentanil have different _______ than fentanyl. Which one has the most rapid on/off? Which one is more potent than F?

Answer 40

onset/duration/potency Remifantanil Sufentanil

Question 41

Tramadol has weak/strong opioid activity? How does it work? Which opioid AE does tramadol cause less of?

Answer 41

weak opioid activity Inhibits reuptake of NE and enhances 5-HT release. resp depression

Question 42

AE of Tramadol? Is it less addictive? What narcotic class is it?

Answer 42

Seizure Equally addictive C4 (moved from C5)

Question 43

Bupenorphine (Butrans patch, Bupenex, Subutex) is used for what? What does it mean that it is paradoxical?

Answer 43

opioid dependence and moderate-severe pain | it acts as a opioid agonist/antagonist -- wean off narcotics

Question 44

What narcotic class is the Butrans patch? How often should you change it?

Answer 44

C3 | change every 7 days

Question 45

Dextromethorphan is used for what?

Answer 45

cough