8. Opioids

Question 1

Overdose rates were highest among people aged 25-54, higher in whites, american indian or alaskans than black/ hispanic, men were more likely to die from overdose, the MC drugs involved include oxycodone, hydrocodone, and?

Answer 1

Methadone

Question 2

All of the following are what chemical class of opioids?
morphine
codeine
hydrocodone
hydromorphone
levophanol
oxycodone
oxymorphone
buprenorphine
nalbuphine
naloxone
heroin

Answer 2

Phenanthrenes

Question 3

All of the following are what chemical class of opioids?
pentazocine
diphenoxylate
loperamide

Answer 3

Benzomorphans

Question 4

All of the following are what chemical class of opioids?
Meperidine
Fentanyl
Sufentanil
Famifentanil

Answer 4

Phenylpiperidines

Question 5

All of the following are what chemical class of opioids?
Methadone
Prpoxyphene

Answer 5

Diphenylheptanes

Question 6

All of the following are what functional class of opioids?
morphine
hydromorphine
methadone
meperidine
fentanyl
codeine
oxycodone
hydrocodone
propoxyphene

Answer 6

Complete Opioid Agonists

Question 7

All of the following are what functional class of opioids?
Pentazocine
Nalbuphine
Buprenorphine
Butorphanol

Answer 7

Partial/Mixed opioids agonists

Question 8

All of the following are what functional class of opioids?
naloxone
naltrexone

Answer 8

Opioid Antagonists

Question 9

Opioids general mechanism of action is they bind to opioid receptors in the CNS causing inhibition of ascending pain pathways, altering the preception of and response to pain, producing a generalized?

Answer 9

CNS Depression

Question 10

Onset of action of opioids depends on administration- oral 30 minutes, IV-5-10 minutes. Duration depends on patient and type of medication, immediated release 3-5hrs, ER 8-24 hours, epidural 24 hours, suppository ?

Answer 10

3-7 hours

Question 11

Side affects associated with opioids include CNS depression, hypotension, consitpation**MC- give preventative stool softener, and has a black box warning for serious life threatening or fatal?

Answer 11

respiratory depression (monitor closely during initiation/ dose escalation)

Question 12

Compared to morphine, opioids are much more potent, hydrocodone oxycodone are only slightly stronger as compared to what, which is 100X the strength of morphine?

Answer 12

Fentanyl

Question 13

Opioids are used for pain management in both acute and chronic pain, such as MI, sickle cell crisis, post op procedures, trauma, cancer, kidney stones and even?

Answer 13

Back pain

Question 14

Opioids are also used as an adjunct to general anesthesia, epidural anesthesia, palliative care, antitussive for cough, and antidiarrheal such as?

Answer 14

Loperamide

Question 15

Match the opioid receptor with its correct affinity...
Endorphins > enkephalins > dynorphins
enkephalins > Endorphins > dynorphins
Dynorphins >> Endorphins > Enkephalins
Delta
Kappa
Mu

Answer 15

Mu =  Endorphins > enkephalins > dynorphins
Kappa = Dynorphins >> Endorphins > Enkephalins
Delta = enkephalins > Endorphins > dynorphins

Question 16

A full opioid agonist will fully activate Mu receptor, partial agonists will partial activate all three opioid receptors, and Naltrexone and nalmefene do what?

Answer 16

are antagonists at the Mu receptor however are partial agonists at kappa and delta- used for alcohol and opioid addiction

Question 17

Stimulant effects of opioids are analgesic at chemoreceptors of area postrema oculomotor center and antinociceptive, other stimulat effects occur include ureter/ bladder/ bladder sphincter as well as smooth m. stomach and bowel causes?

Answer 17

Antidiarrheal or constipation

Question 18

Dampening effects of opioids at their receptors include pain sensation/mood alertness= analgesic, and it also affects the emetic center (causing N/V) and the respiratory and cough center which leads to its?

Answer 18

antitussive qualities

Question 19

At increasing rates of a full agonist (methadone) the opioid effect continues to increase exponentially, a partial agonist plateaus after a certain amount, what about an antagonist?

Answer 19

Naloxone** he likes completely blocks opioids and can even throw them off their receptor

Question 20

There is a safety margin between normal treatment with morphine for pain (decreased perception), but once enough is given- or an overdose, what occurs?

Answer 20

respiratory depression and DEATH

Question 21

There is a high degree of tolerance that is caused by opioids including analgesia, euphoria/dysphoria, mental cloduing, sedation, respiratory depression, antidiuresis, N/V and?

Answer 21

cough suppression

Question 22

There are moderate degrees of tolerance that develop to some of the effects of the opioids which include bradycardia, and minimal or no degrees or tolerance to the effects include miosis, convulsions and?

Answer 22

Constipation

Question 23

Acute* adverse effects of opioid use includes resp depression, N/V, pruritus, urticaria, constipation, urinary retention, delirium, myoclonus, and what else?2

Answer 23

sedation

seizures

Question 24

Chronic* adverse effects of opioids include hypogandism, immunosuppression, increased feeding, inc. GH secretion, withdrawal, tolerance and dependence, abuse/addiction, and what other 2?

Answer 24

hyperalgesia

impairment while driving

Question 25

general side effects of opioids include hallucinations, confusion, fainting, dizziness, swelling of tongue/lips, hives, rash, troubled breathing/slowed breathing, seizures, hoarsness, swelling throat, cant swallow, and what in the face and eyes?

Answer 25

Swelling of the face and eyes (as well as swelling in hands feet ankles legs)

Question 26

Opioids with sedative-hypnotic drugs increases central nervous system depression (**resp depression). Opioid with what causes increased sedation, effects on respiratory depression and accentuation of CV effects?

Answer 26

Antipsychotic agents

Question 27

Opioids with what inhibitors is a relative contraindication to all opioid analgesics because of the high incidence of hyperpyrexic coma*, hypertension is also seen?

Answer 27

Monoamine Oxidase Inhibitors

Question 28

What opioid is a pure opioid antagonist that competes and displaces opioids at the opioid receptor sites, used for opioid overdose- complete or partial reversal of opioid depression induced by natural and synthetic opioids?

Answer 28

Naloxone

SE: acute opioid withdrawal due to release of catecholamines which can unmask pain

Question 29

What is a pure opioid antagonist- a cyclopropyl derivative of oxymorphone similar in structure, it acts as competitive antagonist at opioid receptor sites, with highest affinity for MU?

Answer 29

Naltrexone

Question 30

Naltrexone is used in treatment of alcohol use disorder, and for the blockade of the effects of exogenously administered opioids.. SE include accidental overdose bc patients who had been treated w naltrexone will have a lower response to opioids, and what other side effect?

Answer 30

acute opioid withdrawal, may precipitate symptoms of acute withdrawal in opioid dependent patients, such as pain, hypertension, sweating, agitation, and irritability

(neonates = shill cry/failure to feed)

Question 31

What is used to treat diarrhea and can also decrease amount of drainage in patients with ostomies, if overdosed, naloxone is given as an antidote, vital signs must be monitored for recurrence of symptoms of drug overdose for 24 hours?

Answer 31

Loperamide

Question 32

What is an opioid agonist indicated for the management of pain not responsive to non-narcotic analgesics, contraindicated in people allergic, in bronchial astham or upper airway obstruction, respiratory depression in absence of resuscitiative equipment?

Answer 32

Morphine Sulfate

SE: sedation, lightheadedness, dizziness, N/V, constipation

Question 33

Morphine Sulfate must be given carfully to avoid dosing errors due to confusion between different concentrations* and between mg/ml, causes resp depression, CNS toxicity, and may increase the risk of?

Answer 33

respiratory depression with other CNS depressants

Question 34

What is indicated for the treatment of opioid dependence and is preferred for induction ( a withdrawal med), resp depression and death may occur via IV or in combo w benzos/alch?

Answer 34

Buprenorphine

Question 35

Buprenorphine has side effects including headache, N/V, hyperhidrosis, consitpation, withdrawal, insomnia and pain, and patients must be monitored starting or ending what inhibitors or induces, for potential over and under dosing?

Answer 35

CYP3A4 inhibs/inducers (processed by this)