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NURS 572 Pharm 28

Opioids, nonopioid centrally acting analgesics

MOA opioid agonists activate Mu (--> resp dep) and Kappa (--> psychotomimetic, diuretic)
strong opioids given oral, IM, rectal (3) morphine, hydromorphone, oxymorphone
very short acting opioids (2) meperidine, remifentanyl
meperidine uses/ADRs labor/delivery, neurotoxic metabolite (avoid drug), anticholinergic (watch tachy)
remifentanyl break through pain, short acting, metab by plasma esterases
long-acting opioids (2) methadone, levorphanol
methadone uses pain, maintenance, detox
levorphanol class long acting opiate agonist
chronic pain opioids (3) fentanyl, alfentanil, sufentanyl
routes of admin fentanyls inj, ITS, transdermal, lozenge, lollipop, buccal, nasal spray
moderate efficacy opioids (3) codeline, oxycodone, hydrocodone
codeine combo, very limiting SEs n/v
oxycodone alone or combo
hydrocodone combo only
MOA mixed agonist/antagonist opioids activate either mu/kappa, antagonize the other
benefit/limitation mixed opioids raises resp depr ceiling(+), but pyschotomimetic reactions
name 4 mixed opioids pentazocaine, nalbuphine, butorphanol, buprenorphine
which 2 mixed opioids contraindicated cardiac pts due to increased cardiac load pentazocaine (contains naloxone too), butorphanol
class of nalbuphine mixed opioid
class of buprenorphine mixed opioid with diff actions at mu/kappa
class of penazocaine mixed opioid, oral combo with naloxone, or injection
name 4 opiate antagonists that can lead to withdrawal if pt is opioid tolerant naloxone, naltrexone, methyl-naltrexone, alvimopan
class, use naloxone opioid antagonist. rapid, short acting block mu/kappa. detox/cravings
class, use of naltrexone opioid antagonist. maintenance post detox. doesn't prevent cravings
class, use of alvimpoan only post-op ileus (antagonizes SE of urinary retention). strict controls, in pt only
opioid ADRs that do NOT develop tolerance miosis, consitpation
opioid ADRS where tolerance develops urinary retention, biliary colic, ICP increases, orthostatic hypoTN, emesis, sedation, decreased respirations, cough suppression
MOA non-opioid central acting analgesics weak mu agonist, but either blocks reuptake Ser, Nor or both
class, moa tramadol non opioid centrally acting analgesic blocks reuptake of nor, ser
class, moa tapentadol non opioid centrally acting analgesic blocks reuptake of ser only
Created by: lorrelaws