39 - Opioid analgesics - ha Flashcards
Opioid that provides relief for moderate to severe acute and chronic pain.
Morphine
Pure opioid.
Morphine
In addition to reducing pain, what are other indications for Morphine?
- Induce sleep
- Treat diarrhea
- Relief of dyspnea (pulmonary edema assoc. w/LVF)
- Antitussive
Dangers of morphine:
Respiratory depression
Dependency/Abuse
Severe Hypotension
What should you always prescribe along with Morphine to avoid one of its major side effects?
Laxative
Semisynthetic analogue of morphine AND codeine.
Hydromorphone (Dilaudid)
Semisynthetic analogue of CODEINE.
Hydrocodone (Vicodin)
This is 5x more potent than morphine. It relieves moderate to SEVERE pain.
Hydromorphone (Dilaudid)
Why is hydromorphone an antitussive?
It directly acts on the medulla to suppress cough
Combination of a centrally-acting analgesic (codeine) and peripherally-acting analgesic (acetaminophen).
Tylenol w/Codeine (T3)
Slightly less potent than morphine; relief of mild to moderate pain.
Tylenol w/codeine
When taking T3 or percocet, what should your patient avoid?
Other products that contain acetaminophen! Do not exceed 3000mg per day (per PKM)
Combination of hydrocodone and acetaminophen.
Hydrocodone (Vicodin)
Hydrocodone (Vicodin) is used for what type of pain?
Similar potency as morphine; moderate to severe pain.
This is about 2x as potent as morphine, used in patients tolerant to opioids.
Oxycodone
Semisynthetic derivative of morphine.
Oxycodone
Synthetic opioid structurally UNRELATED to morphine
Meperidine (Demerol)
Why is Meperidine NOT recommended for long-term pain?
It has active metabolic toxic metabolites (normeperidine) which have neurotoxic properties.
In addition to common adverse reactions of opioids, what other SEs are associated with Meperidine?
- anxiety
- tremors
- muscle twitches
- anticholinergic effects
- PUPIL DILATION
- hyperactive reflexes
What is unique about the extra SEs caused by Meperidine?
They cannot be reversed with the administration of naloxone.
This centrally-acting opioid weakly inhibits reuptake of norepinephrine and serotonin, in addition to binding to the mu receptors
Tramadol (ultram)
What type of pain is tramadol used for?
moderate to moderately severe pain
This can cause toxicity when combined with TCAs and SSRIs, possibly leading to serotonin syndrome.
Tramadol
This synthetic opioid is good for both nociceptive and neurogenic pain; works well for chronic pain
Methadone
In addition to common adverse reactions of opioids, what other SEs are associated with Methadone?
- Cardiac arrhythmias
- Torsades de pointes
- Cardiac arrest!
This is well-absorbed orally and has a longer duration of action than morphine.
Methadone
Fentanyl is a centrally-acting opioid that weakly inhibits reuptake of norepinephrine and serotonin, in addition to binding to the mu receptors. What are the differences between this and Tramadol?
- It is a STRONG agonist
- It has a RAPID ONSET and SHORT DURATION (but may take 48hrs to reach steady state)
- May require a break-through drug
Used to induce anesthesia and for analgesia during labor (epidural).
Fentanyl (Duragesic)
Fentanyl (Duragesic) is used for patients with this type of pain.
Fluctuating pain levels (*esp for pts that can’t tolerate oral admin)
What is one of the most common SEs of Hydromorphone (Dilaudid)?
Vomiting
