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Anesthesia > 11. Opiods > Flashcards

11. Opiods Flashcards

1
Q

What health professional is the largest prescriber of opiods to children <19

A

OMS

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2
Q

Women between the ages of - at at greater risk of dying from a prescription analgesic overdose

A

45-54

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3
Q

Women between the ages of - are at a greater risk of attending an emergency room for perscription analgesics

A

25-45

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4
Q

(Men/women) Are more likely to doctor shop

A

women

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5
Q

What factors have contributed to the current opioid epidemic

A
  • Drastic increase in the number of scripts written
  • Greater social acceptance (doctor gave it to me so it must be ok)
  • Aggressive marketing
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6
Q

What age ranges see the most deaths from opioid overdose

A

20-39

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7
Q

OD deaths are greater in (whites/blacks) and (males/females)

A

White males

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8
Q

T/F OD deaths are about equal in the suburbs and the citiy

A

t- this is not an inner city issue only

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9
Q

T/F most OD deaths are a result of heroin alone

A

f- most are fentanyl related

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10
Q

How often does NYS mandated training need to be done and who needs to do it

A
  • Poeple with DEA numbers
  • Once every 3 years
  • Covers 8 topics
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11
Q

Analgesics (opiod and non-opiod) are used in what three clinical scenarios

A
  • Acute pain- most common
  • Non-cancer chronic pain- most problematic
  • Cancer chronic pain
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12
Q

Define acute pain

A
  • Lasts less than 12 weeks
  • Related to tissue damage
  • Is expected to improve with healing
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13
Q

What information should be obtained regarding a patient’s pain history

A

PQRSTU

  • P= palliative and precipitating factors
  • Q= Quality and Quantity
  • R= Region and radiating
  • S= Severity
  • T= Time and temporal factors
  • U=Understanding
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14
Q

What are the different mechanisms of pain and describe them

A
  • Neuropathic pain= dysfunction with the somatosensoty nervous system
  • Inflammatory
  • Mechanical/ compressive
  • Neuromuscular
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15
Q

T/F The first line of treatment for neuropathic pain is an opiod

A

t- opioid should never be first line treatment regardless of the mechanism of pain

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16
Q

What are the four different approaches to intercepting (managing) pain

A

Initiation

  • Peripheral nerve
  • NSAIDs

Transmission

  • Peripheral Nerve to SC
  • LA

Integration

  • SC to brain
  • Opiods

Modulation

  • Descending pathways that modulate pain pathways
  • TCAs
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17
Q

What are the different non-pharmacologic strategies to treating pain

A
  • Behavior management
  • Psychic therapy (ice, heat, positioning, streatching)
  • Self management
    • Biofeedback
    • Hypnotherapy
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18
Q

Give examples of NSAIDs in the acetic acid family

A

-Diclofenac and etodoloc

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19
Q

Give examples of NSAIDs in the Oxicam family

A

piroxicam and meloxicam

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20
Q

Name NSAIDs in the fenamates family

A

mefanamic acid

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21
Q

Name NSAIDs in the Naphyhylakanones family

A

nabumetone

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22
Q

Describe the expression of COX 1 and 2

A 
1= Always (constituitively)
2= inducible (by inflammatory cells, growth factors and tumor promoters)
23
Q

Role of COX 1

A
  • Hemostasis (platelet funciton)
  • Gi protection
  • Renal function
24
Q

What drugs have a ceiling effect

A

NSAIDs- NOT opioids

25
Q

T/F NSAIDs are effective in treating acute and chronic pain

A

t

26
Q

What NSAIDs have lower risks of GI bleeding

A

Ibprofen and naproxen

27
Q

Adverse effects of non-selective NSAIDs

A
  • Gastric irritation
  • Reversible platelet inhibition
  • Renal impairment
28
Q

Describe the difference between the terms

A

Narcotic= legal term

Opiate= naturally occuring alkaloid found in the opium poppy

Opioid= medicate term describing any substance that binds the opioid receptor and produces psychologic effects

29
Q

Define the following terms

-Abuse

A

Misuse or over use of a controlled substance

30
Q

Define the following terms

-Addiction

A

Prolonged uncontrollable need for a habit forming substance that can cause symptoms of withdrawl

31
Q

Define the following terms

-Dependence

A

Physical and psycological

  • Physical= results from abrupt discontinuation
  • Psychological= compulsion to use driven by mental factors “wanting the rush”
32
Q

Define the following terms

-Tolerance

A

decreased response to a drug

33
Q

Define the following terms

-Withdrawl

A

Uncomfortable symptoms that develop when a person stops taking a drug for which there is dependence

34
Q

Indications for opiod use

A
  • Moderate to severe pain
  • Sedation/GA
  • Cough suppression
  • Diarrhea treatment
  • Anxiety
  • Opioid dependence
35
Q

What are the four types of opiods and give examples

A

Natural
-Codeine, morphine

Semi-synthetic
-Heroin, oxycodone, and hydrocodone

Synthetic
-Fentanyl, mederidine, buprenordorphine

Endogenous
-Endorphins

36
Q

Describe the pharmacologic properties of opioids (effect of opioids on body)

A

Nmonic MORPHINES

  • M= Miosis (pin-point pupils)
  • O=Orthostatic hypotension
  • R= Respiratory depression
  • P=Physical dependence
  • H=Histamine release
  • I= Increased intracranial pressure
  • N= Nausea
  • E= Euphoria
  • S= Sedation
37
Q

What are the short acting opioids

A

codeine and hydrocodone

38
Q

What are the extended release opioids

A

morphine and oxycodone

39
Q

What are the long lasting opioids

A

Methadone and fentanyl

40
Q

T/F Opiods have a ceiling effect

A

f

41
Q

Treatment for acute pain _day supply of opioids is sufficient and should never be greater than _ days

A

3 days… 7 days

42
Q

First line treatment for acute pain is

A

non-pharmacologic therapy

43
Q

What does PMP stand for

A

Perscription monitoring program

44
Q

For the test to determine an individuals risk for developing an opioid dependence what are the numbers for mild, moderate, and high risk

A

Mild= 0-3
Moderate=4-7
High 8+

45
Q

T/F Since the implementation of the PMP there has been a reduction in the number of opioid perscriptions

A

t

46
Q

T/F Most physicians explain to the patients how to properly dispose of unused opiods

A

f

47
Q

Chronic pain has persisted for at least how long

A

3-6 months

48
Q

T/F When behavioral practices and non-opioids have not been effective at reducing the patient’s pain opioids should be used

A

t

49
Q

T/F OPioids have improved function and provided pain relief in non-cancer chronic pain patients

A

F- insufficient evidence

50
Q

What must be done first before opioids are perscribed

A
  • Screening for dependence risk

- PMP

51
Q

Average number of days of use before dependence is

A

9 days (only takes one dose for some

52
Q

Drug seeking behaviors are

A
  • Last appointment at end of day
  • Arrive without an appointment
  • Allergic to NSAIDs
  • Only certain drugs are effective
  • Unusual stories of lost or stolen scripts
  • Unwilling to give permission to obtain medical history
  • Request refills sooner than expected
  • Won’t need treatment
53
Q

What are things we can do to prevent addiction

A
  • Talk to patient’s about risks of opioids
  • Prescrib the lowest effective dose and only in quantiity needed
  • NSAIDs
  • Use long lasting local (bupivicaine, etidocaine
  • Avoid combination therapy with alcohol and benzos

Anesthesia (12 decks)

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