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