Pharm - Opioids

Question 1

name the benzomorphans

Answer 1

• pentazocine
• diphenoxylate
• loperamide

Question 2

name the phenylpiperidines

Answer 2

• meperidine
• fentanyl
• sufentanil
• ramifentanil

Question 3

name the diphenylheptanes

Answer 3

• methadone

- propoxyphene

Question 4

name the opioid agonists

Answer 4

• morphine
• hydromorphine
• methadone
• meperidine
• fentanyl
• codeine
• oxycodone
• hydrocodone
• propoxyphene

Question 5

name the mixed opioid agonist/antagonist (partial agonists)

Answer 5

• pentazocine
• nalbuphine
• buprenorphine
• butorphanol

Question 6

name the opioid antagonists

Answer 6

• naloxone

- naltrexone

Question 7

MOA opioids

Answer 7

bind to opioid receptors in the CNS causing inhibition of ascending nerve pathway, altering the perception of and response to pain and producing generalized CNS depression

Question 8

compare onset of action between oral and IV opioids

Answer 8

oral: 30 mins
IV: 5-10 mins

Question 9

compare duration between:

• immediate release
• extended release
• epidural/intrathecal
• suppository

Answer 9

• immediate release: 3-5 hours
• extended release: 8-24 hours
• epidural/intrathecal: up to 24 hours
• suppository: 3-7 hours

Question 10

3 main adverse effects of opioids

Answer 10

• CNS depression
• constipation
• hypotension

Question 11

constipation (as an adverse effect of opioid use) is particularly problematic in what patients

what preventative measures can be taken to reduce potential for constipation

Answer 11

patients with unstable angina and patients post-MI

stool softeners, increased fiber

Question 12

hypotension (as an adverse effect of opioid use) is particularly concerning in what patients

Answer 12

hypovolemic patients, CV disease, circulatory shock, or pts on other drugs that exaggerate hypotensive effects (phenothiazines, general anesthetics)

Question 13

what is the black box warning for opioids

Answer 13

serious, life-threatening, or fatal respiratory depression may occur

carbon dioxide retension

Question 14

compare potency of opioids

Answer 14

least:
- hydrocodone
- oxycodone
- methadone
- oxymorphone
- hydromorphone
- butorphanol
- buprenorphine
- fentanyl
most:

Question 15

other than pain relief indications for opioids, what are some additional indications

Answer 15

• adjunct to general anesthesia
• epidural anesthesia
• palliative care
• antitussive
• antidiarrheal

Question 16

compare affinities to endogenous opioids peptides for the mu receptor

Answer 16

endorphins > enkaphalins > dynorphins

Question 17

compare affinities to endogenous opioids peptides for the delta receptor

Answer 17

enkephalins > endorphins and dynorphins

Question 18

compare affinities to endogenous opioids peptides for the kappa receptor

Answer 18

dynorphins&raquo_space; endorphins and enkaphalins

Question 19

what receptors does methadone work on

Answer 19

full agonist on mu receptor

Question 20

what receptors does buprenorphine work on

Answer 20

partial agonist to all receptors

Question 21

what receptors does naltrexone work on

Answer 21

• antagonist to mu

- partial agonist to kappa

Question 22

what receptors does nalmefene work on

Answer 22

• agonist to mu

- partial agonist to kappa

Question 23

what is the only listed drug to work on delta receptors

Answer 23

buprenorphine

Question 24

describe the stimulant effects of opioids

Answer 24

analgesic: stimulates vagal centers, chemoreceptors, antinociceptive system
antidiarrheal: spastic constipation, works on ureter, bladder

Question 25

describe the dampening effects of opioids

Answer 25

analgesic: decreased pain sensation and mood alertness antitussive: decreases respiratory center, cough center, emetic center

Question 26

list the acute adverse effects of opioid use

Answer 26

- respiratory depression - N/V - pruritis - urticaria - constipation - urinary retention - delirium - sedation - myoclonus - seizures

Question 27

list the chronic adverse effects of opioid use

Answer 27

- hypogonadism - immunosuppression - increased feeding - increased GH secretion - withdrawal effects - tolerance, dependence - abuse, addiction - hyperalgesia - impairment while driving

Question 28

specific side effects to oxycodone

Answer 28

CNS: hallucinations, confusion, fainting, dizziness Eyes: swelling, redness MSK: seizures Skin: hives, rash Respiratory: difficulty breathing

Question 29

what drug-drug interactions can occur with opioids

Answer 29

1) w/ sedatives/hypnotics --> increased CNS depression, particularly respiratory 2) antipsychotics --> increased sedation 3) MOAIs --> hyperpyrexic coma, hTN

Question 30

indications for morphine sulfate

Answer 30

opioid agonist indicated for management of pain not responsive to non-narcotic analgesics

Question 31

contraindications to morphine sulfate

Answer 31

bronchial asthma or upper airway obstruction

Question 32

AEs of morphine sulfate

Answer 32

- respiratory depression - CNS toxicity - CNS depression - sedation - light-headedness - dizziness - N/V - constipation

Question 33

indications for buprenorphine

Answer 33

treatment of opioid dependence and is preferred for induction

Question 34

AEs buprenorphine

Answer 34

- headache - N/V - hyperhidrosis - constipation - withdrawal - insomnia - pain

Question 35

drug interactions buprenorphine

Answer 35

monitor pts starting or ending CYP3A4 inhibitors or inducers for potential over or under dosing

Question 36

MOA naloxone

Answer 36

pure opioid antagonist that competes and displaces opioids at opioid receptor site

Question 37

indications naloxone

Answer 37

for the complete or partial reversal of opioid depression induced by natural and synthetic opioids also for diagnosis of suspected or known acute opioid overdosage

Question 38

warnings/precautions naloxone

Answer 38

acute opioid withdrawal: naloxone causes release of catecholamines which may precipitate acute withdrawal or unmask pain

Question 39

MOA naltrexone

Answer 39

pure opioid antagonist; cyclopropyl derivative of oxymorphone; competitive antagonist at opioid receptor sites with high affinity for mu receptors

Question 40

indications naltrexone

Answer 40

treatment of alcohol use disorder blocks effects of exogenously administered opioids

Question 41

warnings/precautions naltrexone

Answer 41

- accidental opioid OD (pts on naltrexone may respond to lower opioid doses than previously used, so using opioids again could cause OD) - acute opioid withdrawal

Question 42

indications loperamide other than pain relief

Answer 42

used to treat diarrhea