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Pharm exam 5 chapters > ch 24 highlights > Flashcards

ch 24 highlights Flashcards

1
Q

what cannot be taken with opioids due to the risk of resp depression?

A

Benzos (ie Ativan, Valium, Xanax, Klonopin)

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2
Q

Important teaching when using transdermal patches

A
  • Avoid prolonged exposure to sun
  • Caution against use of heat, heating pads, hot baths, saunas
  • This increases release of drug from patch and can result in overdose and death
  • Clean site with water only prior to application
  • remove hair by clipping not shaving prior to application
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3
Q

How often is Butrans transdermal patch changed out

A

7 days

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4
Q

Yawning
Sneezing
Sweating
are symptoms of

A

Withdrawl

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5
Q

When giving morphine what should you monitor and perform

A
  • monitor respirations
  • encourage physical activity
  • offer fluids
  • palpate lower abd every 4-6 hours to feel bladder for urinary retention
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6
Q

If you have biliary colic, can you take an opiod?

A

no

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7
Q

What pain med is appropriate when you have biliary colic

A

demerol

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8
Q

what opioid is respiratory depression limited beyond a certain dose

A

Pentzocine

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9
Q

transmucosal fentanyl is approved for what patient population

A

18 years old and older with breakthrough cancer pain who are already taking opioids around the clock

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10
Q

if you need to change products with a transmucosal fentanyl, can you use the same dosing?

A

no, due to differences in bioavailability

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11
Q

Blackbox for codeine

A

In the liver, about 10% of each dose of codeine undergoes conversion to morphine, the active form of codeine. The enzyme responsible is CYP2D6. Among ultra rapid metabolizers which carry multiple copies of the CYP2D6 gene, codeine is unusually effective and has led to death in some children.

Severe toxicity can develop in breastfed infants whose mothers were taking codeine. causes high levels of morphine in breast milk, due to ultra rapid codeine metabolism

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12
Q

What can happen if you give Pentazocine to a pt who is physically dependent on a pure opioid agonist

A

Can precipitate(trigger) withdrawal

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13
Q

Pentazocine withdrawal

A

cramps, fever, anxiety, restlessness

mild, treatment is rarely required

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14
Q

Pentazocine reversal agent

A

Narcan (Naloxone)

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15
Q

Do you see severe resp depression in Butrans

A

no

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16
Q

Can you develop physical dependence on Butrans

A

yes, but symptoms of abstinence are delayed. Peak responses may not occur until 2 weeks after the final dose was taken.

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17
Q

what is combined with Butrans to prevent toxicity

A

Naloxone (narcan)

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18
Q

What do you give for Butrans toxicity

A

cannot readily reverse toxicity once it develops.

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19
Q

what is drug of choice for treating overdose for pure opiod agonist

A

Naloxone (Narcan)

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20
Q

What meds are used for opioid induced constipation

A

Methylnaltrexone
naloxegol
naldemedine

21
Q

what pure opioid antagonist is used for opioid and alcohol abuse

A

Naltrexone (ReVia, Vivitrol) to prevent euphoria

22
Q

what is Embeda

A

a fixed dose combo of morphine and naltrexone designed to discourage morphine abuse

23
Q

What would you be concerned for if a pt was taking tramadol and a MAOI

A

hypertensive crisis

24
Q

What would you be concerned for if a pt was taking tramadol and SSRI/SNRI, tricyclic antidepressants, MAOIs, triptans

A

Serotonin syndrome

25
Q

what opioids cause QT prolongation

A

Butrans and Methodone

26
Q

opioid that causes less constipation than other opioids

A

Tapentadol (Nucynta)

27
Q

what drug should never be administered to a person who is physically dependent on a pure opioid agonist

A

Pentazocine (Talwin)

Buprenorphine (Butrans)

28
Q

opioid side effects

A 
resp depression
constipation
orthostatic hypotension
urinary retention
emesis
sedation
neurotoxicity
29
Q

symptoms of opioid tox

A

delirium
agitation
myoclonus
hyperalgesia

30
Q

what schedule is codeine

alone
combo preps
cough med

A

alone its a schedule II

combo preps are a schedule III

cough is schedule V (antitussive dose is 10mg)

31
Q

codeine blackbox

A

in the liver 10% undergoes conversion to morphine. The enzyme is CYP2D6….there are ultrarapid metabolizers that carry multiple copies of this enzyme. has led to death

32
Q

oxycodone (OcyContin) is schedule

A

II

33
Q

Hydrocodone products such as vicodin, lortab, Vicoprofen are all schedule

A

II

34
Q

blackbox for hydrocodone

A

Products that contain acetaminophen are associated with hepatotoxicity

35
Q

Tapentadol is a

A

moderate to strong opioid agonist

36
Q

what class

Pentazocine (Talwin)
Buprenorphine (Butrans)

A

Agonist-antagonist opioid

37
Q

Pentazocine (Talwin) and resp depression

A

resp depression is limited. Beyond a certain dose, no further depression occurs

38
Q

switching from a pure opioid agonist to Pentazocine (Talwin)

A

a pt who is physically dependent on a pure opioid agonist, pentazocine can precipitate withdrawal

39
Q

physical dependence for Buprenorphine (Butrans)

A

Physical dependence develops but symptoms of abstinence are delayed. Peak responses may not occur until 2 weeks after final dose was taken

40
Q

Buprenorphine (Butrans) and tox

A

pretreatment with narcan can prevent tox, however this med binds very tightly to its receptors and cannot be readily displaced by narcan.

41
Q

Buprenorphine (Butrans) is a schedule

A

III

42
Q

drug of choice for treating overdose with a pure opioid agonist

A

Naloxone (narcan)

43
Q

meds used for opioid induced constipation for chronic pain pt who are not responding to standard laxative therapy

A

opioid antagonists

Methylnaltrexone (Relistor)

Naloxegol (Movantik)

Naldemedine (symproic)

44
Q

opioid antagonists used for constipation should be used with caution in pat taking

A

CYP3A4 inhibitors

45
Q

pure opioid antagonist used for opioid and alcohol abuse

A

Naltrexone (ReVia, Vivitrol)

goal is to prevent euphoria if abuser takes an opioid

46
Q

combo drug designed to discourage morphine abuse

A

Morphine/naltrexone (Embeda)

47
Q

Non opioid centrally acting analgesic

A

Tramadol

48
Q

drug interactions for tramadol

A

intensify responses to CNS depressants (alcohol, benzodiazepines)

MAOI - hypertensive crisis

SSRI - serotonin syndrome

49
Q

tramadol is a schedule

A

IV

Pharm exam 5 chapters (15 decks)

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