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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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