Opoids, NSAIDS, Acetaminophen

Question 1

What receptors do opioids act on?

Answer 1

Mu, Kappa, Delta

Question 2

What are mu receptors for?

Answer 2

kind of everything

Question 3

what are Kappa receptors for?

Answer 3

sleepiness, pain relief, slowing down the gut

Question 4

What are delta receptors for?

Answer 4

we don’t really know

Question 5

Effects of Opioids

Answer 5

Analgesia, respiratory depression, sedation, euphoria, physical dependence, decreased gut motility

Question 6

What is the most dangerous effect of Opioids?

Answer 6

respiratory depression

Question 7

How do pure agonists work

Answer 7

bind to activate receptors

Question 8

How do pure antagonists work

Answer 8

bind to receptors and block them

Question 9

what is the main cause of death from opoids?

Answer 9

decreases the sensitivity of respiratory center in the brain causing a build up of CO2

Question 10

What can increase respiratory depression?

Answer 10

when mixed with other cns depressants ie: alcohol, benzos, muscle relaxers, gabapentin

Question 10

You will build a tolerance to all but what 2 things?

Answer 10

constipation, miosis

Question 11

Physical dependence

Answer 11

happens to anyone using opioids for 2 or more weeks

Question 11

what is the general rule for cross tolerance?

Answer 11

reduce equanlgesic dose by 25-50%

Question 12

First signs of with drawl

Answer 12

yawning, rhinorrea, sweating

Question 13

progressing withdrawl

Answer 13

anorexia, irritability, tremor

Question 14

Severe withdrawl symptoms,

Answer 14

violent sneezing, cramps, NV, weakness, diarrhea, muscle spasms

Question 15

Morphine drug class

Answer 15

Pure agonist

Question 16

What route is the worst for morphine and why?

Answer 16

Oral; because absorption varies

Question 17

Who needs special dosing with morphine?

Answer 17

older pts need doses decreased by 33%; can accumulate with low renal function

Question 18

Other agonists related to morphine (4)

Answer 18

Codeine, Hydromorphone, Hydrocodone, Oxycodone

Question 19

What is essential for codeine?

Answer 19

CYP2D6

Question 20

what is CYP2D6?

Answer 20

enzyme that breaks down fat soluble drugs in the liver

Question 21

Why does codeine work?

Answer 21

because 15% of it gets turned into morphine

Question 22

Tramadol

Answer 22

half opioid agonist, half antidepressant

Question 23

What receptor does Tramadol bind to?

Answer 23

Mu receptor

Question 24

What does tramadol block?

Answer 24

the reuptake of serotonin and epinephrine

Question 25

who would tramadol benefit

Answer 25

People experiencing nerve pain

Question 26

Mixed agonist-antagonist

Answer 26

lower risk for respiratory depression and abuse

Question 27

what is an analgesic ceiling

Answer 27

they can only provide so much relief

Question 28

what drug class has an analgesic ceiling?

Answer 28

mixed agonist-antagonist

Question 29

Buprenophrine drug class

Answer 29

mixed

Question 30

what side effects are to mixed aginist-antagonists?

Answer 30

psychotomimetic- hallucinations and dysphoria

Question 31

what can mixed drug class cause?

Answer 31

opioid withdrawl

Question 32

Antagonists (central acting)

Answer 32

OD and abuse deterrent- Naloxone

Question 33

Antagonists (peripheral)

Answer 33

treatment of opioid related constipation: methylnaltrexone

Question 34

NSAIDS

Answer 34

inhibit central and peripheral prostaglandin synthesis

Question 35

what stimulates COX 2

Answer 35

process of injury

Question 36

What NSAIDS are non specific to Cox 1 or 2

Answer 36

ibuprofen, meloxicam, naproxen, diclofenac

Question 37

What NSAID is specific to COX2

Answer 37

celoxib

Question 38

What is the highest risk of NSAID use?

Answer 38

GI bleeding and ulcers

Question 39

Why do NSAIDS cause gi bleeds?

Answer 39

because they inhibit prostaglandins so the stomach lining isnt protective against the acid

Question 40

What is decreased especially if someone is dehydrated or taking an ace inhibitor?

Answer 40

Renal function

Question 41

Why do NSAIDS lower platelet fxn?

Answer 41

makes them less able to stick together, easy bruising and bleeding

Question 42

Cardiac toxicity (NSAID)

Answer 42

only related to COX2

Question 43

Who is at high risk for GI bleeds with NSAID use

Answer 43

people with a history, on aspirin, warfarin, steroids, over the age of 65

Question 44

Treatment for GI bleeds with NSAID use

Answer 44

concurrent PPI use, change to celoxib

Question 45

Ketorolac

Answer 45

max of 5 day use in all forms, has dose adjustments for people over the age of 65 and that weigh less than 50 kg

Question 46

Contraindications of Ketorolac

Answer 46

prior or active ulcer, advanced renal disease, high bleeding risk, concurrent aspirin use, NSAID or probenecid (gout drug)

Question 47

Acetaminophen

Answer 47

inhibits central prostaglandin synthesis- does not work outside the brain

Question 48

what does acetaminophen not help with

Answer 48

swelling

Question 49

what toxic substance does acetaminophen get turned into when metabolized by the liver?

Answer 49

NAPQI

Question 50

What is acetaminophen the biggest cause of

Answer 50

acute liver failure