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Opioids
Pharmacology
| Question | Answer |
|---|---|
| What are analgesics? | Drugs that relieve pain without causing loss of consciousness |
| What is an opioid? | Any drug, natural or synthetic, that has actions similar to morphine. |
| What are the 3 families of endogenous opioid peptides? | Enkephalins, endorphins, and dynorphins |
| What are the 3 opioid receptors? | Mu, kappa, and delta |
| Which of the three opioid receptors do opioid analgesics not interact with? | Delta |
| What are responses to activation of mu receptors? | Analgesia, respiratory depression, euphoria, and sedation |
| Which of the opioid receptors are related to physical dependence? | Mu |
| Which receptor, if activated, may underlie pyschotomimetic effects? | Kappa |
| Which receptors do pure opioid agonists activate? | Mu and kappa |
| What are the 2 groups of pure opioid agonists? | Strong opioid agonists and moderate to strong opioid agonists |
| What is the prototype drug for strong opioid agonists? | Morphine |
| What is the prototype drug for moderate to strong opioid agonists? | Codeine |
| What are 4 agonist-antagonists opioids? | Pentazocine, nalbuphine, butorphanol, and buprenorphine |
| True or False: Pure opioid agonists and pure opioid antagonists produce the same effects. | False |
| What is the primary use for pure opioid antagonists? | Reversal of respiratory and CNS depression caused by opioid overdose |
| What is the prototype drug for pure opioid antagonists? | Naloxone (Narcan) |
| What is the source of morphine? | From the seedpod of the poppy plant |
| What is the principal indication for morphine? | Relief of moderate to severe pain |
| How does morphine relieve pain? | By mimicking the actions of endogenous opioid peptides, primarily at mu recpetors |
| What is the most serious adverse effect of morphine? | Respiratory depression |
| How long can morphine-related respiratory depression last? | 4-5 hours |
| How long does it take respiratory depression to begin after an IV injection? | 7 minutes |
| Which route of administration for morphine has the longest delay in onset of respiratory depression? | If given in spinal injection |
| How can opioid induced constipation be managed without pharamacologic measures? | Physical activity, increased intake of fiber and fluids, and enemas |
| What is a prophylactic drug for opioid induced constipation? | Senna |
| How often should patients be educated to void in order to manage urinary retention caused by morphine? | Every 4 hours |
| Why can morphine be given post op? | For cough suppression |
| What is a symptom of biliary colic induced by morphine? | Epigastric distress |
| What is a good alternative to morphine if it causes biliary colic? | Meperidine |
| When is the emetic reaction of morphine greatest? | With the initial dose |
| Is dysphoria caused by morphine common among patients in pain? | No |
| What are S/S of neurotoxicity induced by morphine? | Delirium, agitation, myoclonus, and hyperalgesia |
| How should neurotoxicity induced by morphine be managed? | With hydration and dose reduction |
| How is morphine inactivated? | By hepatic metabolism |
| Should a PO dose of morphine be higher than IV, IM, and subQ? | Yes |
| What characterizes morphine tolerance? | Euphoria, analgesia, and sedation |
| Does cross tolerance exist among opioid agonists? | Yes |
| How long does physical dependence of opioids take to form? | Can occur after 20 days |
| What are initial S/S of abstinence syndrome? | Yawning, rhinorrhea, and sweating. |
| How does abstinence syndrome progress from its initial signs and symptoms? | Anorexia, tremor, irritability, and gooseflesh followed by violent sneezing, weakness, N/V, diarrhea, abdominal cramps, bone and muscle pain, and kicking movements |
| How long does the onset of abstinence syndrome take? | 10 hours after the final dose |
| How can abstinence syndrome be managed? | Withdraw opioids gradually |
| How does morphine toxicity present? | Coma, respiratory depression, and pin point pupils |
| How do you treat morphine toxicity? | Ventilatory support and Narcan |
| How much stronger is Fentanyl than morphine? | 100 times |
| How much of each dose of codeine is converted to morphine in the liver? | 10% |
| What two drugs are combined with codeine? | Aspirin and acetaminophen |
| What drugs are oxycodone combined with? | Aspirin, acetameninophen, and ibuprofen |
| What is the most widely prescribed drug in the US? | Hydrocodone |
| What ist he usual dose of hydrocodone? | 5 mg |
| Which opioid causes less constipation than traditional opioids? | Tapentadol |
| What is the prototype drug for agonist-antagonists opioids? | Pentazocine (Talwin) |
| Which agonist-antagonists opioid is commonly used during labor? | Nalbuphine |
| How often should pain assessment be performed if a patient is prescribed opioids? | Before administration and 1 hour after |
| Should opioids be on a fixed schedule or ordered PRN? | Fixed schedule |
| What is a disease process characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm? | Addiction |
| How many PCA devices are currently available? | 1 |
| What is the most commonly used drug for a PCA? | Morphine |
| What is REMS? | Risk Evaluation Mitigation Strategy |
| What is the objective of REMS? | To reduce injuries and death from prescription opioids and to reduce abuse |
| True or False: Without an opioid present, Narcan can still produce effects. | False |
| How is Narcan eliminated? | By hepatic metabolism |
| Why can Narcan not be used orally? | Because of rapid first-pass interaction |
| What are the 4 nonopioid centrally acting analgesics? | Tramadol, clonidine, ziconotide, and dexmedetomidine |
Created by:
shrewsbury_sd
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