457 review

Question 1

which receptor is responsible for most of the opioids’ analgesic effects

Answer 1

mu- resp dep, reduced GI motility, euphoria, physical dependencev (MERP)

Question 2

which opioid receptor does not contribute to physical dependence

Answer 2

kappa

Question 3

what are the natural opioids

Answer 3

morphine codeine

Question 4

codeine morphine equivalents

Answer 4

200mg cod=30mg morph

Question 5

codeine metabolism

Answer 5

2d6 to morphine

Question 6

tramadol action

Answer 6

mu agonist (way less vs morphine), seratonin and NE agonist. Less effective vs morph and more SE and worry about SS/increased seizure risk. 2d6 met, lower risk of addiction

Question 7

oxycod vs morphine

Answer 7

1.5x stronger (20 oxy=30morph)

Question 8

morphine vs hydromorph for renal dysfx

Answer 8

hydro better. morphine is met to 2 metabolites; m6=active analgesic, m3= not analgesic and accumulates in renal dysfx which can lead to tox

Question 9

most likely to get hsitamine response with this opioid

Answer 9

morphine

Question 10

hydromorph vs morph

Answer 10

5x more potent (1g hydro=5g morphine)

Question 11

fentanyl vs morph

Answer 11

100x more potent in terms of daily equivalents (25mcg/hr=100mg oral morphine per day). dose q72h in patch

Question 12

which two opioid SE do patients not develop tolerance to

Answer 12

constipation miosis

Question 13

how long does it take for tolerance to sedation of opioids

Answer 13

begins in 2-4, may take up to 10

Question 14

where does pain relief with opioid therapy seem to plateau

Answer 14

200mg morphine equivalents per day-over this there is also an increased risk of all cause mortality

Question 15

what is considered opioid success in terms of pain improvement

Answer 15

improved fx or at least 30% reduction in pain intensity (assess with 11 point ie 0-10 rating scale)

Question 16

calculate the percent change in pain

Answer 16

raw change (ie baseline-endpoint)/baseline x100

Question 17

what is a failed opioid trial

Answer 17

failed after 2-3 dose titrations to achieve analgesia or misuse/abuse/addiction

Question 18

how to switch opioids

Answer 18

if previous dose is high (200 or more morphine equiv), start at 50% or less of previous opioid dose and convert to morphine equiv. If low, start at 60-75% previous dose and do as above

Question 19

how much more potent are IV/SC formulations of opioids vs their oral counterparts

Answer 19

generally accepted they are 2x as potent

Question 20

what should prn doses of opioids be

Answer 20

take 10% of total oral daily dose scheduled and add it on

Question 21

rate of opioid tapers

Answer 21

can vary from 10% of total daily dose qd to 10% q1-2 weeks. Once 1/3 original dose is reached, slow taper to one half or less the previous rate