Analgesics And sedatives Pt 3: Opioids

Question 1

True of False: all opioids are controlled substances

Answer 1

True af

Question 2

List the opioids that are full mu agonists

Answer 2

1. Morphine
2. Oxymorphine
3. Hydromorphine
4. Methadone
5. Fentanyl
6. Remifentanil

Question 3

List the full mu antagonists

Answer 3

1. Naloxone (narcan) - REVERSAL AGENT for opioid overdose

Question 4

List the opioids that are partial mu agonists

Answer 4

Buprenorphine (ceiling effect)

Question 5

List the opioids that are mixed agonist-antagonists

Answer 5

1. Butorphanol
   - kappa agonist, mu antagonist

Question 6

What opioids are considered “special opioids”?

Answer 6

1. Tramadol
2. Hydrocodone

Question 7

3 types of opioid receptors?

Answer 7

Mu, kappa, delta

Question 8

Endogenous opioids that bind to mu receptors?

Answer 8

Endorphins, endomorphins

Question 9

Main effects of binding on Mu receptors?

Answer 9

Analgesia > sedation
- resp, CV depression, and GI hypomotility

Question 10

Main effects of binding on kappa receptors?

Answer 10

Sedation > analgesia
- less resp, CV, and GI effects

Question 11

If you want more of an analgesic effect than sedation, you want to choose an opioid that binds to _____ receptor

Answer 11

Mu

Question 12

If you want more of a sedative effect than analgesic effect, you want to choose an opioid that binds to _____ receptor

Answer 12

Kappa

Question 13

What is the MOA for opioid agonists?

Answer 13

Activation of mu-opioid receptors

Question 14

CRI admin is preferred with short acting opioids like ___________

Answer 14

Fentanyl and remifentanil

Question 15

Opioid bioavailability decreases with _______ route of administration

Answer 15

Oral

Question 16

What endogenous opioid binds to kappa receptors?

Answer 16

Dynorphin

Question 17

Which receptor is the most common and most affected by opioid drugs?

Answer 17

Mu

Question 18

Where do Opioid agonists inhibit neurotransmission?

Answer 18

Dorsal horn of spinal cord and opioid receptors in the periphery and brain

Question 19

Opioids are most commonly administered by _______ route of admin

Answer 19

IV or IM

Question 20

Regarding species differences, what is IMPT to know about how opioids are metabolized?

Answer 20

Metabolized by conjugation to glucuronic acid

Cats are deficient, so opioids are metabolized more slowly (stays in body longer)

Question 21

______ agonism produces the most sedative effects

Answer 21

Kappa

Question 22

Do opioids cross specialized barriers?

Answer 22

Yes, BBB and placenta

*adverse effects on fetus

Question 23

Which opioids can be used as an antitussive?

Answer 23

1. Butorphanol (mixed agonist/antagonist)
2. Hydrocodone (full mu agonist)

Question 24

__________ can be used as an emetic to induce vomiting in dogs

Answer 24

Apomorphine IV

TOXIC TO CATS

Question 25

What CNS signs can be seen with opioid agonists?

Answer 25

CNS depression (dogs, monkeys, humans)

CNS stimulation (cats, horses, ruminants, pigs)

Question 26

Hyperthermia is a clinical effect from opioid agonists that can be seen in __________ (species)

Answer 26

Cats
Ruminants
Horses

Question 27

Hypothermia is a clinical effect from opioid agonists that can be seen in __________ (species)

Answer 27

Dogs, rabbits monkeys

Question 28

What side effects are associated with opioid agonists and the respiratory system?

Answer 28

Dose dependent respiratory depression

• lowers resp drive leading to HYPOVENTILATION

-panting can be seen

Question 29

What side effects are associated with opioid agonists and the cardiovascular system?

Answer 29

Centrally mediated bradycardia and hypotension due to vasodilation