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Flashcards in T5 Deck (25):
1

morphine

Strong Analgesic (μ agonist)
10mg subQ -good for sev. pain
IV doses lower
sedation/mental clouding (OD)
anxiety relief
euphoria
nausea (stim. CRTZ)
resp. depression *death* (can tx resp. distress in pulm. edema)
pupil constriction
anti-cough
histamine rel. (use benadryl, naloxone)
lower seizure threshold
endocrine disturbs.
sm. musc effects (constipa., reten, bronchoconstr., inc. biliary press.)
CV effects (hypotension, cut. vasodilation, inc. CSF press.)
skel musc. regidity
immunosuppression

2

codeine

Strong Analgesic (μ agonist)
weaker than morphine
antitussive (lower dose) *but can rel. histamine-->aggrav. asthma, etc.

3

fentanyl (Sublimaze)

Strong Analgesic (μ agonist)
patch or IV
short-term, fx
stronger than morphine-100 ug is typ. dose
(Duragesic) for chronic pain
fentanyl plus droperidol (Innovar): neuroleptic analgesia

4

heroin

Strong Analgesic (μ agonist)
acetylated morphine-more potent and euphoric (4-6 hrs)
today much higher purity
inj., snorting, smoking (easier for novice DU)
Afghanistan
"black tar" from Mexico

5

hydrocodone (Vicodin, Lortab, Norco, Zohydro ER, others)

Strong Analgesic (μ agonist)
exs are vicodin: hydrocodone + acetaminophen(inhib. PG prod)
problem: can OD, tox. doses of acetomin. 1st
-Zohydro ER: just hydrocodone, no acetomin.
-antitussive (lower dose)
was Schedule 3-->*now Sch. 2*

6

hydromorphone (Dilaudid, Palladone)

Strong Analgesic (μ agonist)
like morphine, more potent
IV, oral

7

meperidine (demerol)

Strong Analgesic (μ agonist)
-almost discarded, still around
1/10th potency of morphine, will see doses up to 100 mg
oral, IV
mod-sev. pain, obstetrics (dec. resp depression? NO)
"urban legend" advantages: less sm. musc effects? NO
*short-acting* buildup of normeperidine-->**seizures** w/ repetitive tx, NOT for chronic pain

8

methadone (dolophine)

Strong Analgesic (μ agonist)
less euphoric and longer duration (12-24 hrs) than heroin or morphine
can be taken orally
-tx of heroin addxn
tricky dosing
"methadone substitution": for drug pt is dependent on, then tapered
"methadone maintenance": addiction tx as disease, medicated chronically w. methadone
-can function, just switching?
-can only be dispensed by licensed methadone clinics! not readily available for heroin tx
-good pain relieving drug but underused bc of stigma
Schedule 2: can prescribe for pain

9

oxycodone (Percodan, Percocet, OxyContin, Oxecta)

Strong Analgesic (μ agonist)
more powerful than hydrocodone
combo prod. w/ acetomin. (percocet)
or w/ ASA
Oxycontin: sustained release just opioid for chronic sev. pain (12-24 hrs) used to get high-snort "hilbilly heroin": appalachia, reformulated so "gummy mess" can't grind up
w/ etOH: "dose dumping"-->OD

10

oxymorphone (opana)

Strong Analgesic (μ agonist)
-pulled in 70s (drug users)
marked as having lower abuse potential-false

11

pentazocine (talwin)

Partial Agonist and Mixed Agonist/Antagonist Analgesic
not full u activity, k agonist, some pain relief, not as much for severe pain
less abuse potential (still there!)
u antagonists at high doses-->w.drawal symptoms
dysphoric rxns
*Talwin NX*: form. w/ nalaxone (antag!) to reduce chance of IV abuse
nalaxone metabolized on 1st pass in liver-doesn't reach systemic
if injected, both in system

12

*buprenorphine* (Buprenex, Sabutrex, Suboxone)

Partial Agonist and Mixed Agonist/Antagonist Analgesic
-replacement for methadone for opioid addxn, more readily available, less abuse potential
Suboxone: + nalaxone
*maintenance: "office based" tx of opioid dependence* not enrolled in methadone clinic, doc is certified

13

butorphanol (Stadol)

Partial Agonist and Mixed Agonist/Antagonist Analgesic

14

tramadol (Ultram)

Partial Agonist and Mixed Agonist/Antagonist Analgesic
-weak u agonist, less intense "buzz", no high, dec. abuse pot.(still abused, Schedule 4)
inhibits reup. of NE and serotonin, (like tricycl. antidepr)
neuropathic pain

15

apentadol (Nucynta)

Partial Agonist and Mixed Agonist/Antagonist Analgesic

16

naloxone (Narcan, Evzio)

opioid antagonist
-opioid OD, IV, inj.

17

schedule 2... only ??? day supply
same for schedule 3 except..

30
can refill!

18

naltrexone (ReVia, Vivitrol)

opioid antagonist
-longer acting, oral: 12-24 hrs
not as good for opioid addiction
HCW: tempted to use drugs
dec. etOH craving
can inc. pain!

19

methylnaltrexone (Relistor)

opioid antagonist

20

alvimopan (Entereg)

opioid antagonist
-opioid induced constipation

21

naloxegol (Movantik)

opioid antagonist
-opioid-ind. constipation

22

opioid combo preps

Codeine/Acetaminophen (Tylenol with Codeine and generic preparations.
Codeine/Aspirin (Empirin and generics)
Hydrocodone/Acetaminophen (Vicodin, Norco, Lortab, others)
Hydrocodone/Ibuprofen (Vicoprofen)
Oxycodone/Acetaminophen (Percocet, Percodan, Tylox, and others)
*concern: liver toxicity

23

Tapentadol (Nucynta)

??
Schedule 2

24

opioid w/drawal

craving for drug
anxiety, hostility, insomnia, yawning, rhinorrhea, hyperventilation
dilation of pupils
GI hypermotility (diarrhea, nausea, vomiting, cramping)
hypertension, tachycardia
"goose flesh", chills, sweating
hyperalgesia, muscle aches GI pain

25

clonidine

suppress autonomic symps of opioid/etOH withdrawal