Block 3 materials (Opioids Drug abuse) Flashcards
Butorphanol
MOA:
Clinical uses:
Adverse effects:
Mixed opioid agonist-antagonist
MOA:
κ-opioid receptor agonist & μ-opioid receptor partial agonist.
Nasal formula
Clinical uses:
Severe pain (i.e migraines & labor)
Adverse effects:
1) Respiratory depression (less than full opioid agonists)
2) Withdrawal symptoms if used with a full agonist (not easily reversed with naloxone
Mixed opioid agonist-antagonist
MOA:
κ-opioid receptor agonist & μ-opioid receptor partial agonist.
Clinical uses:
Severe pain (i.e migraines & labor)
Adverse effects:
1) Respiratory depression (less than full opioid agonists)
Butorphanol
Pentazocine
MOA:
Clinical uses:
Adverse effects:
Mixed opioid agonist-antagonist
MOA:
κ-opioid receptor agonist & weak μ-opioid receptor antagonist/partial agonist.
Clinical uses:
1) Analgesia for moderate-severe pain
Adverse effects:
1) Opioid withdrawal symptoms if taking a full opioid agonist (due to competition for opioid receptors)
Mixed opioid agonist-antagonist
MOA:
κ-opioid receptor agonist & weak μ-opioid receptor antagonist/partial agonist.
Clinical uses:
1) Analgesia for moderate-severe pain
Adverse effects:
1) Opioid withdrawal symptoms if taking a full opioid agonist (due to competition for opioid receptors)
Pentazocine
Tramadol
MOA:
Clinical uses:
Adverse effects:
MOA:
A very weak opioid agonist that inhibits the reuptake of norepinephrine & serotonin
Clinical use:
Chronic pain
Adverse effects:
1) Seizures (reduced threshold)
2) Serotonin syndrome
MOA:
A very weak opioid agonist that inhibits the reuptake of norepinephrine & serotonin
Clinical use:
Chronic pain
Adverse effects:
1) Seizures (reduced threshold)
2) Serotonin syndrome
Tramadol
Opioids full agonists
MOA:
Clinical uses:
Adverse effects:
Maintenance vs intoxication
Morphine (oxymorphone & hydromorphone), Heroin (diacetylmorphine), & Meperidine
(all long acting)
Fentanyl, Codeine (oxycodone & hydrocodone), & Methadone
MOA:
Full agonists at opioid receptors
μ (β-endorphin),
δ (enkephalin), & κ (dynorphin)
They close presynaptic Ca2+ channels & open postsynaptic K+ channels to reduce synaptic transmission & inhibit the release of ACh, Norepi, 5-HT, Glutamate, & Substance P.
Clinical uses:
1) Analgesia
2) Euphoria
3) Sedation
4) Cough suppressants (Codeine)
Adverse effects:
1) Constipation (all)
2) Bacteremia, HEP B & C, HIV (Heroin)
3) Miosis (all except Meperidine = mydriasis)
4) Resp & CNS depression
5) Dependence
6) Biliary colic (sphincter of Oddi spasms)
Maintenance:
Methadone, Buprenorphine, Clonidine, Naltrexone
Intoxication : Naloxone
Morphine (oxymorphone & hydromorphone), Heroin (diacetylmorphine), & Meperidine
(all long acting)
Fentanyl, Codeine (oxycodone & hydrocodone), & Methadone
MOA:
Full agonists at opioid receptors
μ (β-endorphin),
δ (enkephalin), & κ (dynorphin)
They close presynaptic Ca2+ channels & open postsynaptic K+ channels to reduce synaptic transmission & inhibit the release of ACh, Norepi, 5-HT, Glutamate, & Substance P.
Clinical uses:
1) Analgesia
2) Euphoria
3) Sedation
4) Cough suppressants (Codeine)
Adverse effects:
1) Constipation (all)
2) Bacteremia, HEP B & C, HIV (Heroin)
3) Miosis (all except Meperidine = mydriasis)
4) Resp & CNS depression
5) Dependence
6) Biliary colic (sphincter of Oddi spasms)
Maintenance:
Methadone, Buprenorphine, Clonidine, Naltrexone
Intoxication : Naloxone
Full opioid agonists
Opioid neurons :
Originate:
Project to:
Receptors:
Origin:
Arcuate nucleus
Projection:
Ventral Tegmental Area & Nucleus accumbens
Receptors:
μ (β-endorphin): “SACRUM”
- Sedation
- Analgesia
- Constipation
- Resp depression
- truncal Rigidity
- eUphoria
- Miosis
δ (enkephalin):
- Spinal analgesia
- Modulation of hormone & neurotransmitter release
κ (dynorphin): “DCA”
- Dysphoria
- Constipation
- Analgesia
Ketamine
MOA:
Clinical uses:
Adverse effects:
NMDA antagonist (PCP analog)
MOA:
Inhibits excitation by glutamate at NMDA receptors to decrease neural conduction
AVOID in HTN & Ischemic heart disease
Clinical uses:
1) Analgesia
2) Amnesia & Catatonia in conscious patients
3) Cardiovascular stimulation (bronchodilation, elevated BP & HR)
Adverse effects:
1) Dissociative anesthesia
2) Increased intracranial pressure
3) Emergence reactions (reduced with Midazolam)
NMDA antagonist (PCP analog)
MOA:
Inhibits excitation by glutamate at NMDA receptors to decrease neural conduction
AVOID in HTN & Ischemic heart disease
Clinical uses:
1) Dissociative Analgesia
2) Amnesia & Catatonia in conscious patients
3) Cardiovascular stimulation (bronchodilation, elevated BP & HR)
Adverse effects:
1) Dissociative anesthesia
2) Increased intracranial pressure
3) Emergence reactions (reduced with Midazolam)
Ketamine
Intoxication with _________ in High doses causes:
impaired motor function, High BP
Ketamine
Amantadine
MOA:
Clinical uses:
Adverse effects:
NMDA receptor antagonists (antiviral)
MOA:
Blocks muscarinic receptor to increase dopamine release & reduce its uptake
Clinical uses:
1) Parkinson disease
2) Influenza virus A
3) Reduce levodopa induced dyskinesias toxicity
(peripheral edema, livedo reticularis, & ataxia)
Adverse effects:
1) Insomnia
2) Dizziness/Confusion
3) Ankle edema
4) Atropine-like symptoms
5) Livedo reticularis
NMDA receptor antagonists (antiviral)
MOA:
Blocks muscarinic receptor to increase dopamine release & reduce its uptake
Clinical uses:
1) Parkinson disease
2) Influenza virus A
3) Reduce levodopa induced dyskinesias toxicity
(peripheral edema, livedo reticularis, & ataxia)
Adverse effects:
1) Insomnia
2) Dizziness/Confusion
3) Ankle edema
4) Atropine-like symptoms
5) Livedo reticularis
Amantadine
Barbiturates & Ethanol
MOA:
Clinical uses:
Adverse effects:
Phenobarbital & Pentobarbital
MOA:
Facilitates GABA(A) action by increasing the duration of Cl- channel opening to reduce neuron firing
AVOID in patients with porphyria
Clinicals:
Sedative (anxiety, seizures, & insomnia)
Adverse effects:
1) Respiratory & Cardiovascular depression
2) Severe CNS depression (worse with alcohol)
3) Dependence
4) Drug interactions (induces CYOP450)
Phenobarbital & Pentobarbital
MOA:
Facilitates GABA(A) action by increasing the duration of Cl- channel opening to reduce neuron firing
AVOID in patients with porphyria
Clinicals:
Sedative (anxiety, seizures, & insomnia)
Adverse effects:
1) Respiratory & Cardiovascular depression
2) CNS depression (worse with alcohol)
3) Dependence
4) Drug interactions (induces CYOP450)
Barbiturates
Benzodiazepines
MOA:
Clinical uses:
Adverse effects:
OD:
Alprazolam, Chlordiazepoxide, Diazepam, Lorazepam, Midazolam, Oxazepam & Triazolam
MOA:
Facilitates GABA(A) action by increasing the frequency of Cl- channel opening & reducing REM sleep
Give LOT for patients with liver disease
Clinicals:
1) Anxiety, Panic disorders, Spasticity, & Status epilepticus (Diazepam, Lorazepam, Midazolam)
2) Eclampsia & supervised withdrawal (Chlordiazepoxide, Diazepam)
3) Night terrors
4) Sleep walking
5) General anesthetic
Adverse effects:
1) Dependence
2) CNS depression with alcohol or Barbs
3) Respiratory depression (less than Barbs)
4) Anterograde amnesia
OD:
treat with Flumazenil
Alprazolam, Chlordiazepoxide, Diazepam, Lorazepam, Midazolam, Oxazepam & Triazolam
MOA:
Facilitates GABA(A) action by increasing the frequency of Cl- channel opening & reducing REM sleep
Give LOT for patients with liver disease
Clinicals:
1) Anxiety, Panic disorders, Spasticity, & Status epilepticus (Diazepam, Lorazepam, Midazolam)
2) Eclampsia & supervised withdrawal (Chlordiazepoxide, Diazepam)
3) Night terrors
4) Sleep walking
5) General anesthetic
Adverse effects:
1) Dependence
2) CNS depression with alcohol or Barbs
3) Respiratory depression (less than Barbs)
4) Anterograde amnesia
OD:
treat with Flumazenil
Benzodiazepines
Buprenorphine
MOA:
Clinical uses:
Adverse effects:
MOA: Opioids partial agonists
Partial μ opioid receptor agonist &
κ / δ receptor antagonists
Buprenorphine binds with high affinity but low activity at the receptor
Combined with Naloxone
Clinical uses:
1) Analgesia (combined with naloxone to prevent abuse)
2) Wean patients off full opioid agonists
(while avoiding withdrawal from sudden termination of opioids)
Adverse effects:
1) Opioid withdrawal
2) Resp & CNS depression (not as severe)
MOA: Opioids partial agonists
Partial μ opioid receptor agonist &
κ / δ receptor antagonists
Buprenorphine binds with high affinity but low activity at the receptor
Combined with Naloxone
Clinical uses:
1) Analgesia (combined with naloxone to prevent abuse)
2) Wean patients off full opioid agonists
(while avoiding withdrawal from sudden termination of opioids)
Adverse effects:
1) Opioid withdrawal
2) Resp & CNS depression (not as severe)
Buprenorphine
Opioids mixed agonists-antagonists
MOA:
Clinical uses:
Adverse effects:
Nalbuphine & Pentazocine
MOA:
Mostly k agonists & mu antagonists
Clinical uses:
1) Spinal analgesia
2) Dysphoria
Adverse effects:
1) Withdrawal
Nalbuphine & Pentazocine
MOA:
Mostly k agonists & mu antagonists
Clinical uses:
1) Spinal analgesia
2) Dysphoria
Adverse effects:
1) Withdrawal
Opioids mixed agonists-antagonists
Opioid antagonists
MOA:
Clinical uses:
Naloxone, Naltrexone, & Methylnaltrexone
MOA:
Antagonize all opioid receptors
Clinical uses:
IV (reverse respiratory depression)
Oral (reduce alcohol & opiate cravings)
Opioid induced constipation
Naloxone, Naltrexone, & Methylnaltrexone
MOA:
Antagonize all opioid receptors
Clinical uses:
IV (reverse respiratory depression)
Oral (reduce alcohol & opiate cravings)
Opioid induced constipation
Opioid antagonists
MOA:
Anticholinergic activity AVOID IN MI!!!
Clinical uses:
Used to reduce shivering after Halothane anesthesia [by its action on a2 receptor]
Adverse effects:
Tachycardia
Pethidine
Pethidine
MOA:
Clinical use:
Adverse effect:
MOA:
Anticholinergic activity AVOID IN MI!!!
Clinical uses:
Pethidine is used to reduce shivering after Halothane anesthesia [by its action on a2 receptor]
Adverse effects:
Tachycardia
Nicotine
Intoxication:
Withdrawal:
Treatment options:
Intoxication:
Restlessness
Withdrawal:
Irritability
Anxiety
Restlessness
Reduced concentration
Increased appetite
Rx:
Nicotine patch/gun
Bupropion
Varenicline
Intoxication:
Restlessness
Withdrawal:
Irritability
Anxiety
Restlessness
Reduced concentration
Increased appetite
Rx:
Nicotine patch/gun
Bupropion
Varenicline
Nicotine
Cocaine
MOA:
Intoxication:
Withdrawal:
Treatment options:
MOA:
Long-acting Monoamine transporter inhibitor that blocks Dopamine, Norepi, & 5HT reuptake
Intoxication:
Acute
- Impaired judgment
- Mydriasis
- Diaphoresis
- Hallucinations
- Paranoia
- Angina/sudden cardiac death
Chronic
- Perforated nasal septum
Withdrawal:
1) Restlessness
2) Hunger
3) Severe depression
4) Sleep disturbance
Treatments:
1) Benzodiazepines
2) Beta or mixed alpha beta blockers
(HTN & heart)
MOA:
Long-acting Monoamine transporter inhibitor that blocks Dopamine, Norepi, & 5HT reuptake
Intoxication:
Acute
- Impaired judgment
- Mydriasis
- Diaphoresis
- Hallucinations
- Paranoia
- Angina/sudden cardiac death
Chronic
- Perforated nasal septum
Withdrawal:
1) Restlessness
2) Hunger
3) Severe depression
4) Sleep disturbance
Treatments:
1) Benzodiazepines
2) Beta or mixed alpha beta blockers
(HTN & heart)
Cocaine
Amphetamine/Methamphetamine
MOA:
Intoxication:
Withdrawal:
MOA:
Indirectly inhibits reuptake of NE & DA from a mobile pool (considered weak MAO inhibitors)
Intoxication:
- Euphoria/Grandiosity/Paranoia
- Mydriasis
- Hyper-alertness/Insomnia
- HTN/Cardiac arrest
- Fever/Seizures
- Fractured teeth
Withdrawal:
Nonspecific CRASH
- Depression
- Increased appetite
- Vivid nightmares/disturbances
Treatments:
1) Benzodiazepines (agitations & seizures)
MOA:
Indirectly inhibits reuptake of NE & DA from a mobile pool (considered weak MAO inhibitors)
Intoxication:
- Euphoria/Grandiosity/Paranoia
- Mydriasis
- Hyper-alertness/Insomnia
- HTN/Cardiac arrest
- Fever/Seizures
- Fractured teeth
Withdrawal:
Nonspecific CRASH
- Depression
- Increased appetite
- Vivid nightmares/disturbances
Treatments:
1) Benzodiazepines (agitations & seizures)
Amphetamines/methamphetamiens
CNS stimulants
MOA:
Clinical uses:
Adverse effects:
Methamphetamines/amphetamines, & Methylphenidate
MOA:
Increase catecholamines in the synaptic cleft (esp norepi & dopamine)
Clinical use:
ADHD
Narcolepsy
Binge-eating disorder
Adverse effects:
1) Nervousness/Agitation/Anxiety
2) Tachycardia/HTN
3) Insomnina
4) Anorexia
5) Tics
6) Bruxism