Week 3 Opiods

Question 1

Morphine

Answer 1

low oral to parenteral ratio b/c high 1st pass metabolism- low analgesic effect- give parenterally; relieves breathing difficulty caused by pulmonary edema w/ LT ventricular heart failure; decreases: anxiety, cardiac load, venous load; 4-5 hours

Question 2

Fentanyl

Answer 2

strong opiod agonist- low O/P ratio- P450 metablism

Question 3

Codeine (Dextromethorphan)

Answer 3

partial mu opioid agonist- high O/P ratio- metabolized into morphine-then its effective- CYP2D6 metabolized; acts by reducing the cough reflex when given @ doses that will not cause analgesia- Dextromethorphan has less addictive properties & less constipation; 3-4 hours

Question 4

Hydrocodone

Answer 4

Partial mu opioid agonist- medium O/P ratio; give orally-reasonable analgesic action; 4-6 hours

Question 5

Oxycodone

Answer 5

partial mu opioid agonist; medium o/p ratio; 3-4 hours

Question 6

Pt who has tolerance to opioids cant overcome these side effects

Answer 6

miosis and constipation

Question 7

Morphine & Oxycodone

Answer 7

chronic & severe pain, not best for sharp, intermittent pain- hospice care: fixed-interval admin w/ reg dose

Question 8

Fentanyl

Answer 8

transdermal patch given over long periods if slow GI transit occurs from oral sustained release; buccal for short breakthrough pain; decrease respiratory rate; opioid choice for adjunct anesthesia; used before anesthesia & surgery for sedative, anxiety reducing & analgesic properties; used if a need exists to minimize the risk of cardiovascular depression; 1-1.5 hours

Question 9

Methadone

Answer 9

synthetic w/ equi-anelgesic potency to morphine

maintenance in rehab programs; withdrawal symptoms less severe; 4-6 hours

Question 10

Meperidine

Answer 10

less severe respiratory depression, constipation, biliary colic & urinary retention
strong anti-muscarinic effects- tachycardia is a contraindication; used to prevent shivering- actions on Alpha-2 adrenoceptor subtypes; 2-4 hours

Question 11

Codeine & Hydrocodone

Answer 11

Partial agonists; pathological cough suppression; often combined w/ other drugs like aspirin or acetaminophen; can antagonize strong agonists

Question 12

Loperamide or Diphenoxylate

Answer 12

peripheral neuropathic pain; action @ at mu opioid receptors while lacking CNS effects; used for diarrhea- has selective actions in the GI tract- poor solubility properties thus useful for parenteral routes

Question 13

Tramadol

Answer 13

very weak opioid agonist; inhibits serotonin & norepinephrine reuptake; treatment for chronic pain

Question 14

Buprenorphine + naloxone

Answer 14

maintenance for heroin addicts; long lasting- avoids 1st pass metabolism; kappa antagonist & partial mu agonist- resistant to naloxone reversal; 4-8 hours

Question 15

Butorphanol

Answer 15

kappa opioid agaonist & partial mu agonist; greater sedation than nalbuphine & buprenorphine; treats severe pain- migraine or labor; not reversed w/ naloxone if overdose; 3-4 hours