| Question | Answer |
| define narcotic | |
| define miois | constrict pupils |
| define dysphoria | uneasy, anxiety |
| define antitussive | cough suppressant |
| key features of opiod | Act on the CNS to decrease reaction (response) to pain
Physiologically addictive over time with regular use
Used for moderate to severe pain |
| Briefly explain the mechanism of action of opioid analgesics | Bind to receptors in the CNS (brain and spinal cord)
Alter reaction to pain |
| Identify 3 opioid receptors and explain their relationship to the pharmacologic effect and adverse reactions associated with
opioids. | |
| mu | analgesia,
respiratory depression,
physical dependence,
euphoria,
sedation,
constipation |
| kappa | analgesia,
sedation,
miosis,
dysphoria |
| delta | analgesia |
| Identify different forms of administration for opioids | Opioids can be taken orally in tablet form or through a transdermal patch. Can be injected, snorted or smoked.
Some in a nasal spray. |
| discuss the pharmacokinetics | Absorption
Absorbed well orally
Also absorbed from lungs, oral/nasal mucosa, and skin
Distribution
First-pass effect if taken orally
Pass the placenta |
| What is the onset and duration of opiods | Onset =within 1 hr.
Duration=4-6 hrs |
| discuss pharmacologic effects | Analgesia
Sedation-at usual doses and additive effects with alcohol
Euphoria- occurs at large does or if pain is removed
Cough suppression-
Gastrointestinal effects- reduces motility and contractions |
| Pharmacologic effects & adverse reactions
related and proportional to drug strength | |
| Adverse reaction | respiratory depression
cause vasodilation
intercranial pressure
nausea
constipation
miosis
urinary retention
xerostomia |
| if allergic to codeine, avoid | Morphine
Hydromorphone (Dilaudid)
Hydrocodone (Vicodin)
Oxycodone (percodan, percocet) |
| how can opiods affect pregnancy | can be used
May prolong labor or cause fetal respiration depression near term. |
| never get a tolerance to | pinpoint pupils
constipation |
| what is the most potent opioid | hydromorphone (dilaudid) |
| Which opioid is most commonly used | morphine |
| list 5 strong analgesic | hydromorphone
morphine
methadone
meperdine
fentanyl |
| list intermediate analgesic | oxycodone |
| list 2 weak analgesic | hydrocodone
codeine mixtures |
| high 1st pass effect
most abused drug in medical personnel | merpidine (dermol) |
| Fentanyl combined with _____) allow a patient:
to feel no pain
remain awake
will not move during a procedure
(nasal intubation, bronchoscopy, cardiac catheterization) | Droperidol |
| Most used opioid in dentistry | codeine
Combined with acetaminophen (Tylenol # 3)
Used in cough syrup as antitussive |
| What schedule is a codeine alone?
What schedule is a codeine mixture? | 2
3 for mixture |
| Used as replacement drug for heroin and other opioids
Given to addicts orally
Gradually weaned off
Little euphoria
Sufficient strength to prevent withdrawal symptoms
It is also used for methadone maintenance | methadone |
| what schedule is tramadol (not as pain effective) | 4 |
| purpose of mixed opioids | used for treating addiction and pain |
| describe NALTREXONE | Used for treatment of addiction to opioids or alcohol
Given orally |
| describe Naloxone (narcan) | Overdose treatment for opioids
pure antagonist at all 3 receptors
will competitively inhibit opioids
Reverses CNS and respiratory depression
Administered parenterally (injection/nasal) |
| List symptoms of opioid overdose
how to treat? | Major symptom- respiratory depression
Pinpoint pupils (miosis)
Narcon |
| addiction | |
| Discuss ways to identify a drug addict | Requests a specific pain medication
Cancels dental appointments because will be out of town for days but wants Rx
Complains of pain for days after minor procedure
Claims a low pain threshold
Moves from office to office
Needs refill with no pain |
| Identify symptoms associated with abrupt opioid withdrawal | Yawning
Lacrimation
Perspiration
Rhinorrhea
Goosebumps (piloerection)
Nausea &vomiting
Chills & tremors
Tachycardia |
| Opioids are used in dentistry to manage pain if NSAIDS are contraindicated or not effective.
Most dental pain can be managed with NSAIDS
Not indicated for chronic dental pain due to addictive potential. | |
| Identify opioid related drugs that should be included on the emergency cart | Opioid overdose:
-Naloxone (Narcan)
Pain from a heart attack:
-Morphine
-Meperidine |
| Name the drugs associated with neuroleptanalgesia | droperidol+fentanyl |
| State the opioid and nonopioid components of the following: | |
| Percodan | aspirin+oxydone |
| Percocet | apap+oxycodone |
| Vicodin | |
| Tylenol #3 | apap+codeine |
| What does agonists treat? | pain, diarrhea, cough |
| What should you recommend an addict for pain relief? | NSAID |
