opioids part 2

Question 1

What should nurses assess with opioid use?

Answer 1

Pain rating, respirations, vital signs, constipation.

Question 2

What are key precautions for morphine use?

Answer 2

Respiratory issues, pregnancy, labor/delivery, head injury.

Question 3

What drugs interact with opioids?

Answer 3

CNS depressants, anticholinergics, hypotensives, MAOIs, other opioids.

Question 4

What is the classic triad of opioid toxicity?

Answer 4

Coma, respiratory depression, pinpoint pupils.

Question 5

What is the treatment for opioid overdose?

Answer 5

Ventilator support and naloxone (Narcan).

Question 6

How much stronger is fentanyl compared to morphine?

Answer 6

100 times stronger.

Question 7

What are the 3 routes of fentanyl administration?

Answer 7

Parenteral (surgery), transdermal patch, transmucosal (lozenge, buccal, sublingual).

Question 8

How strong and fast is alfentanil?

Answer 8

¼ as strong as fentanyl but 4 times faster.

Question 9

How strong is sufentanil compared to fentanyl and morphine?

Answer 9

5–10x stronger than fentanyl (500x morphine).

Question 10

What is remifentanil used for?

Answer 10

Ultra-short-acting pain control.

Question 11

What’s a major concern with meperidine (Demerol)?

Answer 11

Short half-life and toxic metabolite accumulation.

Question 12

What is methadone used for?

Answer 12

Pain and opioid addiction.

Question 13

What is hydromorphone (Dilaudid) used for?

Answer 13

Often used as PCA, more rapid onset than morphine.

Question 14

What are side effects of Dilaudid vs. morphine?

Answer 14

Less nausea, more orthostatic hypotension.

Question 15

What is oxymorphone (Opana) used for?

Answer 15

Pain/sleep before/during surgery or childbirth.

Question 16

What is levorphanol (Levo-Dromoran)?

Answer 16

A strong opioid used for moderate to severe pain.

Question 17

How are moderate-to-strong opioid agonists similar to morphine?

Answer 17

They cause analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis.

Question 18

Are the effects of moderate-to-strong agonists reversible with naloxone?

Answer 18

Yes.

Question 19

How do moderate-to-strong opioid agonists differ from morphine?

Answer 19

Less analgesia and respiratory depression, slightly lower abuse potential.

Question 20

What is codeine used for?

Answer 20

Pain and cough suppression.

Question 21

How is codeine usually administered?

Answer 21

Orally, alone or with aspirin/acetaminophen.

Question 22

How much codeine equals 325 mg of acetaminophen in analgesic effect?

Answer 22

30 mg of codeine.

Question 23

What are some formulations of oxycodone?

Answer 23

Oxaydo, Roxicodone (immediate), OxyContin, Xtampza ER (extended).

Question 24

What are the uses for immediate vs. extended-release oxycodone?

Answer 24

Immediate: breakthrough pain; Extended: chronic pain.

Question 25

What was the issue with original OxyContin formulation?

Answer 25

Could be crushed and snorted/injected for abuse.

Question 26

What was done to reduce OxyContin abuse?

Answer 26

A 2010 reformulation made it harder to crush and non-dissolvable for injection.

Question 27

What is the most widely prescribed drug in the U.S.?

Answer 27

Hydrocodone.

Question 28

What is hydrocodone commonly combined with?

Answer 28

ASA, acetaminophen (Lortab), or ibuprofen (Vicodin).

Question 29

What is tapentadol (Nucynta) comparable to?

Answer 29

Oxycodone in analgesic effect.

Question 30

What benefit does tapentadol have over oxycodone?

Answer 30

Less constipation.

Question 31

How do agonist-antagonist opioids work?

Answer 31

They are agonists at kappa receptors and weak antagonists at mu receptors.

Question 32

What are the routes for pentazocine (Talwin)?

Answer 32

IV, IM, SubQ.

Question 33

What else can pentazocine be used for besides pain?

Answer 33

Obstetric pain, anesthesia adjunct.

Question 34

What are nalbuphine (Nubain) routes and indications?

Answer 34

IV, IM, SubQ; used for pain and as an anesthesia adjunct.

Question 35

What is butorphanol (Stadol) used for?

Answer 35

Pain relief; administered IV or IM.

Question 36

What is buprenorphine's receptor action?

Answer 36

Partial agonist at mu, antagonist at kappa.

Question 37

What are buprenorphine’s uses?

Answer 37

Moderate-severe pain (IM/IV/SL); opioid withdrawal/dependence (transdermal, SL).

Question 38

When is naloxone (Narcan) used?

Answer 38

For acute opioid intoxication, postoperative opioid reversal, and neonatal resuscitation.

Question 39

What is the most serious medical concern in opioid overdose?

Answer 39

Respiratory depression.

Question 40

How should naloxone be administered in an overdose?

Answer 40

In small repeated doses until withdrawal symptoms appear.

Question 41

What must be done in addition to giving naloxone?

Answer 41

Maintain a patent airway and have resuscitation equipment ready.

Question 42

What does it mean if naloxone doesn’t reverse symptoms quickly?

Answer 42

The overdose might be due to a non-opioid substance.

Question 43

What happens to a patient after naloxone therapy?

Answer 43

They become more sensitive to opioids.

Question 44

What drugs treat opioid-induced constipation or postoperative ileus?

Answer 44

Alvimopan and methylnaltrexone.

Question 45

Why don’t alvimopan and methylnaltrexone reverse analgesia?

Answer 45

They do not cross the blood-brain barrier.

Question 46

What is naltrexone used for?

Answer 46

Opioid and alcohol abuse.

Question 47

How does naltrexone work in opioid users?

Answer 47

Blocks euphoria but doesn’t stop cravings.

Question 48

What must be true before starting naltrexone therapy?

Answer 48

The patient must be opioid-free.