Ch. 28 Flashcards
1
Q
Opiate
A
- applies only to compounds present in opium
2
Q
Endogenous Opioid Peptides
A
3 families:
- enkephalins
- endorphins
- dynorphins
3
Q
Opioid Receptors
A
Mu receptors: Analgesia, respiratory depression, euphoria, sedation, and physical dependence
Kappa receptors: Analgesia and sedation; kappa activation may underlie psychotometic effects seen with certain opioids
Delta receptors
4
Q
Pure Opioid Agonists
A
- activate mu receptors and kappa receptors
- can produce analgesia, euphoria, sedation, respiratory depression, physical dependence, constipations, and other effects
- morphine: strong opioid agonist and moderate to strong opioid agonists
- codeine: moderate to strong agonists
5
Q
Agonist-Antagonist Opioids
A
- pentazocine, nalbuphine, butorphanol, and buprenorphine
- when administered alone, produce analgesia
- if administered, can antagonize analgesia caused by the pure agonist
- rarely used
6
Q
Pure Opioid Antagonists
A
- Nalozone (Narcan): prototype of the pure opioid antagonists
- antagonists at mu and kappa receptors
- do not produce analgesia or any of the other effects caused by opioid agonists
- reversal of respiratory and central nervous system depression caused by overdose with opioid agonists
- Methylnaltrexone: used to treat opioid-induced constipation
7
Q
Morphine
A
- source: seedpod of the poppy plant
- actions: pain relief, drowsiness, mental clouding, anxiety reduction
- sense of well-being, respiratory depression
- constipation, urinary retention
- orthostatic hypotension, emesis
- miosis, cough suppression
- biliary colic
- tolerance and physical dependence
8
Q
Morphine: Therapeutic Use
A
- relief of pain
- without affecting other senses
- no loss of consciousness
- relieve pain by mimicking the actions of endogenous opioid peptides, primarily at mu receptors
9
Q
Morphine: Adverse Effect- Resp. Depression
A
resp. depression:
- infants and elderly are sensitive
- onset: IV, 7 mins; IM, 30 mins; SubQ, 90 mins; may persist 4-5 hours; spinal injection; delayed for hours
- tolerance to resp. depression can develop
- increased depression with concurrent use of other drugs that have CNS depressant actions
- can compromise patients with impaired pulmonary function
10
Q
Morphine: Constipation
A
- cause: supressed propulsive intestinal contractions, intensified nonpropulsive contractions, increased ton of anal sphincter, and inhibited secretion of fluids into the intestinal lumen
- complications of constipation include fecal impaction, bowel perforation, rectal tearing, and hemorrhoids
- treatment includes physical activity, increased intake of fiber and fluids, stimulant laxatives, stool softeners, and polyethylene glycol
11
Q
Morphine: Othrostatic Hypotension
A
- morphine-like drugs lower bp by blunting the baroreceptor relfex and by dilating peripheral arterioles and veins
- patient teaching: symptoms of hypotension (dizziness) and instructions to sit or lie down if they occur
- hypotension can be minimized by moving slowly when changing from a supine or seated position to an upright position
12
Q
Morphine: Urinary Retention and Hesitancy
A
- increases tone in bladder sphincter
- increases tone in detrusor muscle, thereby elevating pressure within bladder and causing sense of urinary urgency
- may interfere with voiding by suppressing awareness of bladder stimuli
13
Q
Morphine: Cough Supression
A
- acts at opioid receptors in the medulla to suppress cough
- suppression of spontaneous cough ma lead to the accumulation of secretion in airway
- patients should be instructed to actively cough at regular intervals
- codeine-based and hydrocodone-based cough remedies
14
Q
Morphine: Biliary Colic
A
- induces spasm of common bile duct
- epigastric distress to biliary colic
- may intensify rather than relieve pain in patients with pre-existing biliary colic
- meperidine causes less smooth muscle spasm than morphine
15
Q
Morphine: Emesis
A
- promotes nausea and vomiting through direct stimulation of chemoreceptor trigger zone of medulla
- emetic reactions are greatest with initial dose and then diminish
- nausea and vomiting is uncommon in recumbent patients but occur 15%-40% of ambulatory patients
- can be reduced by pretreatment with an antimetic and by having patient remain still
16
Q
Morphine: Elevation of Intracranial Pressure
A
- supressed resp., morphine increases carbon dioxide content of blood, which dilates cerebral vasculuature and causes intracranial pressure to rise
- if resp. is maintained at a normal rate, intracranial pressure will remain normal
17
Q
Morphine: Euphoria/Dysphoria
A
- exaggerated sense of well-being caused by activation of mu receptors
- a sense of anxiety and unease; uncommon among patients in pain, but may occur when morphine is taken in absence of pain
18
Q
Morphine: Sedation
A
- drowsiness and some mental clouding
- avoid hazardous activities
19
Q
Morphine: Miosis
A
- cause pupilary constriction
- toxic doses: pupils constrict to pinpoint size
- bright lights
20
Q
Morphine: Neurotoxicity
A
- delirum, agitation, hyperalgesia
- renal impairment, prolonged high-dose opioid use
- manage: hydration and dose reducation
21
Q
Adverse Effects From Prologned Morphine Use
A
- hormonal changes: declinein cortisol levels, increase in prolactin, decrease in LH and FH, testosterone and estrogen
- altered and suppressed immune function
22
Q
Morphine: Pharacokinetics
A
- admin by several routes
- not very lipid-soluble
- does not cross BBB easily
- only small fraction of each dose reaches site of analgesic action
23
Q
Morphine: Tolerance
A
- increased doses needed to obtain same response
- develops with analgesia, euphoria, sedation, and resp. depression
- cross-tolerance to other opioid agonists
- no tolerance to miosis or constipation develops
24
Q
Morphine: Physical Dependence
A
- abstinence sydnrome with abrupt discontinuation
- about 10 hours after last dose, the intial reaction occurs and includes yawning, rhinorrhea, and sweating
- progressing to sneezing, weakness, nausea, vomiting, diarhea, abdominal crmaps, bone and muscle pain, spasms, and kicking movements
- lasts 7-10 days if untreated
- withdrawl is unpleasent but not lethal
25
Q
Morphine: Drug Interactions
A
- CNS depressants: intesnify sedation and resp. depression
- Anticholinergic drugs
- Hypotensive drugs
- MAO inhibitors
- agonist-anatagonist opiods
- opioid antagonist
26
Q
Morphine: Toxicity
A
- clinical manifestation: classic triad (coma, resp. depression, pimpoint pupils)
- treat: vent support; anatagonist (Narcan)
- guidelines: monitor vital signs before giving, give on a fixed schedule
27
Q
Codeine
A
- 10% converts to morphine in liver
- pain and cough supression
- orally usually
28
Q
Oxycodone
A
- analgesic actions = to those of codeine
- long-acting analgesics
- immediate release
29
Q
Fentanyl
A
- 100x more potent than morphine
30
Q
Dosing Guidelines
A
- assessment of pain: should be evaluated before opioid admin and about 1 hour after
- dosage determination: opioid analgesic must be adjusted to accomodate individual variation
- dosing schedule: as a rule, opioid should be admin on a fixed schedule
- avoiding withdrawal
31
Q
Clinical Use of Opioids
A
- physical dependence: state in which an abstinence sydnrome will occur if the dependence-producing drug is abruptly withdrawn; it is NOT equated with addiction
- abus: drug use that is inconsistent with medical social norms
- addiction: behaviour pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm
32
Q
Patient-controlled analgesia
A
- drug selection and dosage regulations
- comparision of patient-controoled analgesia with traditional intramuscular therapy
- IM painful to patient; cause negative side effects (bruising and hematoma formation)
- patient education and family education
33
Q
Indications for Clinical Use
A
- postoperative pain
- obstetric analgesia
- myocardinal infarction
- head injury
- cancer-related pain
- chronic noncancer pain
34
Q
Opiod Anatagonist: Principle Use
A
- treat opioid overdose and relief of opiod-induced constipation
- reversal of postoperative opioid effects
- reversal of neonatal resp. depression
- management of opiod addiction
35
Q
Pure Opioid Antagonists
A
- Narcan (Naloxone)
36
Q
Naloxone
A
- action: competitive antagonist
- pharmacolgic effects
- pharmacokinetics
- therapeutic uses: reversal of opioid overdose; reversal of postoperative opioid effects; reversal of neonetal resp. depression (during labour and delivery)
37
Q
Naltrexone
A
- pure opiod antagonist
- opioid and alcohol abuse
- opioid abuse: prevents euphoria if abuser takes and opiod
- candidates for treatment must be rendered opioid free before naltrexone is started
- does not prevent craving for opioids
38
Q
Nonopioid Centrally Acting Analgesics
A
- relieve pain by mechanism largely or completely unrelated to opioid receptors
- do not cause resp. depression, physical dependence or abuse
- not regulated under controlled substances act
ex. Tramadol (suicide risk), Clonidine, Ziconotide, Dexmedetomidine
