11. Opiods Flashcards
What health professional is the largest prescriber of opiods to children <19
OMS
Women between the ages of - at at greater risk of dying from a prescription analgesic overdose
45-54
Women between the ages of - are at a greater risk of attending an emergency room for perscription analgesics
25-45
(Men/women) Are more likely to doctor shop
women
What factors have contributed to the current opioid epidemic
- Drastic increase in the number of scripts written
- Greater social acceptance (doctor gave it to me so it must be ok)
- Aggressive marketing
What age ranges see the most deaths from opioid overdose
20-39
OD deaths are greater in (whites/blacks) and (males/females)
White males
T/F OD deaths are about equal in the suburbs and the citiy
t- this is not an inner city issue only
T/F most OD deaths are a result of heroin alone
f- most are fentanyl related
How often does NYS mandated training need to be done and who needs to do it
- Poeple with DEA numbers
- Once every 3 years
- Covers 8 topics
Analgesics (opiod and non-opiod) are used in what three clinical scenarios
- Acute pain- most common
- Non-cancer chronic pain- most problematic
- Cancer chronic pain
Define acute pain
- Lasts less than 12 weeks
- Related to tissue damage
- Is expected to improve with healing
What information should be obtained regarding a patient’s pain history
PQRSTU
- P= palliative and precipitating factors
- Q= Quality and Quantity
- R= Region and radiating
- S= Severity
- T= Time and temporal factors
- U=Understanding
What are the different mechanisms of pain and describe them
- Neuropathic pain= dysfunction with the somatosensoty nervous system
- Inflammatory
- Mechanical/ compressive
- Neuromuscular
T/F The first line of treatment for neuropathic pain is an opiod
t- opioid should never be first line treatment regardless of the mechanism of pain
What are the four different approaches to intercepting (managing) pain
Initiation
- Peripheral nerve
- NSAIDs
Transmission
- Peripheral Nerve to SC
- LA
Integration
- SC to brain
- Opiods
Modulation
- Descending pathways that modulate pain pathways
- TCAs
What are the different non-pharmacologic strategies to treating pain
- Behavior management
- Psychic therapy (ice, heat, positioning, streatching)
- Self management
- Biofeedback
- Hypnotherapy
Give examples of NSAIDs in the acetic acid family
-Diclofenac and etodoloc
Give examples of NSAIDs in the Oxicam family
piroxicam and meloxicam
Name NSAIDs in the fenamates family
mefanamic acid
Name NSAIDs in the Naphyhylakanones family
nabumetone
Describe the expression of COX 1 and 2
1= Always (constituitively) 2= inducible (by inflammatory cells, growth factors and tumor promoters)
Role of COX 1
- Hemostasis (platelet funciton)
- Gi protection
- Renal function
What drugs have a ceiling effect
NSAIDs- NOT opioids
T/F NSAIDs are effective in treating acute and chronic pain
t
What NSAIDs have lower risks of GI bleeding
Ibprofen and naproxen
Adverse effects of non-selective NSAIDs
- Gastric irritation
- Reversible platelet inhibition
- Renal impairment
Describe the difference between the terms
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
Define the following terms
-Abuse
Misuse or over use of a controlled substance
Define the following terms
-Addiction
Prolonged uncontrollable need for a habit forming substance that can cause symptoms of withdrawl
Define the following terms
-Dependence
Physical and psycological
- Physical= results from abrupt discontinuation
- Psychological= compulsion to use driven by mental factors “wanting the rush”
Define the following terms
-Tolerance
decreased response to a drug
Define the following terms
-Withdrawl
Uncomfortable symptoms that develop when a person stops taking a drug for which there is dependence
Indications for opiod use
- Moderate to severe pain
- Sedation/GA
- Cough suppression
- Diarrhea treatment
- Anxiety
- Opioid dependence
What are the four types of opiods and give examples
Natural
-Codeine, morphine
Semi-synthetic
-Heroin, oxycodone, and hydrocodone
Synthetic
-Fentanyl, mederidine, buprenordorphine
Endogenous
-Endorphins
Describe the pharmacologic properties of opioids (effect of opioids on body)
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
What are the short acting opioids
codeine and hydrocodone
What are the extended release opioids
morphine and oxycodone
What are the long lasting opioids
Methadone and fentanyl
T/F Opiods have a ceiling effect
f
Treatment for acute pain _day supply of opioids is sufficient and should never be greater than _ days
3 days… 7 days
First line treatment for acute pain is
non-pharmacologic therapy
What does PMP stand for
Perscription monitoring program
For the test to determine an individuals risk for developing an opioid dependence what are the numbers for mild, moderate, and high risk
Mild= 0-3
Moderate=4-7
High 8+
T/F Since the implementation of the PMP there has been a reduction in the number of opioid perscriptions
t
T/F Most physicians explain to the patients how to properly dispose of unused opiods
f
Chronic pain has persisted for at least how long
3-6 months
T/F When behavioral practices and non-opioids have not been effective at reducing the patient’s pain opioids should be used
t
T/F OPioids have improved function and provided pain relief in non-cancer chronic pain patients
F- insufficient evidence
What must be done first before opioids are perscribed
- Screening for dependence risk
- PMP
Average number of days of use before dependence is
9 days (only takes one dose for some
Drug seeking behaviors are
- 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
What are things we can do to prevent addiction
- 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
