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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 31 - Opioids > Flashcards

Chapter 31 - Opioids Flashcards

1
Q

What chemical mediators are released with tissue injury?

A

-bradykinin
-histamine
-substance P
-prostaglandins
-serotonin
-leukotrienes

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2
Q

Opiod

A

any drug, natural or synthetic, that has actions similar to morphin

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3
Q

Opiate

A

term that applies only to compounds present in opium

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4
Q

Which 3 peptide families have opioid-like properties?

A

-enkephalins
-endorphins
-dynorphins

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5
Q

What are Mu opioid receptors?

A

receptors that are the MOST important for opioids - involve analgesia, respiratory depression, euphoria, sedation, physical dependence

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6
Q

What are kappa opioid receptors used for?

A

analgesia and sedation

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7
Q

What receptor is responsible for underlying psychomimetic effects?

A

kappa receptors

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8
Q

Which receptor type does not interact with opioids?

A

delta

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9
Q

What receptors do pure opioid agonists interact with?

A

Mu and kappa

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10
Q

What effects do pure opioid agonists produce?

A

-analgesia
-euphoria
-sedation
-respiratory depression
-physical dependence
-constipations

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11
Q

What drugs are pure opioid agonists?

A

morphine and codeine

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12
Q

What drugs are agonist-antagonist opioids?

A

-pentazocine
-nalbuphine
-butorphanol
-buprenorphine

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13
Q

What effect do agonist-antagonist opiods have when administered alone?

A

analgesia

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14
Q

What do agonist-antagonist opiods do with pure agonists?

A

antagonize analgesia

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15
Q

All opiods are measures against what drug??

A

morphine

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16
Q

How does morphine act?

A

mimics actions of endogenous opioid peptides primarily at Mu receptors

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17
Q

What are the adverse effects of morphine?

A

-**respiratory depression
-constipation
-urinary retention
-drowsiness
-orthostatic hypothension
-emesis
-miosis
-cough suppression
-tolerance and dependence
-brain fog

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18
Q

WHAT IS A MAJOR COMPLICATION OF OPIOIDS?

A

RESPIRATORY ARREST

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19
Q

Who is most susceptible to resp. depression from morphine?

A

infants and elderly

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20
Q

What is the onset of IV morphine?

A

7 mins

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21
Q

What is the onset of IM morphine?

A

30 min

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22
Q

What is the onset of subQ morphine?

A

up to 90 mins

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23
Q

How long does morphine last?

A

4-5 hrs

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24
Q

Spinal morphine injection may be ______________

A

delayed

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25
Q

What contributes to constipation from morphine?

A

-suppressed propulsive contractions
-intensified non-propulsive contractions
-increased anal sphincter tone
-inhibited secretion of fluids into lumen

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26
Q

What is the tx for morphine induced constipation?

A

-activity
-fibre and fluid intake
-stimulant laxatives
-stool softeners
-polyethylene glycol

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27
Q

How does morphine cause orthostatic hypotension?

A

blunts baroreceptor reflex by causing vasodilation

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28
Q

How does morphine cause urinary retention?

A

-increase tone in bladder sphincter
-increased tone in detrusor muscle
-suppresses awareness of bladder stimuli

29
Q

How does morphine suppress cough?

A

-acts on receptors in medulla to suppress reflex
-secretions accumulate in airway

30
Q

What does patient teaching about coughing post-morphine occur?

A

cough reflex is suppressed, secretions must be cleared at regular intervals

31
Q

How does morphine produce emesis?

A

-direct stimulation of chemoreceptors in medulla
-rxn. greatest with initial dose
-more common in recumbent patients

32
Q

How does morphine elevate ICP?

A

-reduced respirations increases CO2 in blood that dilates cerebral vasculature

33
Q

Euphoria

A

exaggerated sense of well-being caused by Mu receptor activation

34
Q

Dysphoria

A

sense of anxiety and unease

35
Q

When does dysphoria occur?

A

when morphine is taken in the absence of pain

36
Q

How do you avoid sedation with morphine?

A

-smaller doses more often
-use opioids with short half-lives

37
Q

Miosis

A

pupillary constriction

38
Q

How do pupils appear with morphine toxicity?

A

pinpoint pupils

39
Q

What are risk factors for neurotoxicity caused by morphine?

A

-renal impairment
-pre-existing cognitive impairment
-prolonged opioid use

40
Q

How is neurotoxicity managed with morphine use?

A

hydration and dose reduction

41
Q

Is morphine lipid soluble?

A

not really, doesn’t cross BBB easily

42
Q

What AEs does morphine tolerance develop to?

A

-analgesia
-euphoria
-sedation
-respiratory depression
-NOT CONSTIPATION OR MIOSIS

43
Q

What are the initial morphine withdrawal symptoms that start 10hrs after the last dose?

A

-yawning
-rhinorrhea
-sweating

44
Q

What are the subsequent symptoms of morphine withdrawal?

A

-violent sneezing
-weakness
-nausea
-vomiting
-diarrhea
-abdominal cramps
-bone and muscle pain
-muscle spasms
-kicking movements

45
Q

How long does morphine withdrawal last if untreated?

A

7-10 days

46
Q

What is the classic triad of morphine TOXICITY?

A

-coma
-respiratory depression
-pinpoint pupils

47
Q

What is the treatment for morphine toxicity?

A

ventilation support and NALOXONE (narcan)

48
Q

2 guidelines for morphine?

A

-monitor vitals
-give on fixed schedule

49
Q

How many times more potent is fentanyl than morphine?

A

80-100x

50
Q

___% of codeine is converted to morphine via CYP2D6

A

10

51
Q

What strength are codeine, oxycodone, and hydrocodone?

A

moderate to strong opioid agonists

52
Q

What kind of opioid is Buprenorphine?

A

an agonist-antagonist opioid

53
Q

How is buprenorphine administered?

A

-7 day patch
-SL tabs

54
Q

Why is Buprenorphine used over other drugs?

A

substance use replacement therapy because it works differently

55
Q

How does buprenorphine act?

A

as a partial agonist at Mu receptors and antagonist at kappa receptors

56
Q

What effect does buprenorphine provide?

A

analgesic effects (like morphine) with less respiratory depression

57
Q

What is an adverse effect of buprenorphine?

A

prolonged QT interval

58
Q

When are opioid antagonists used?

A

-treatment of OD
-constipation relief
-reversal of post-op effects
-reversing neonatal respiratory depression
-addiction management

59
Q

What is naloxone (narcan)?

A

a reversal agent for opioids

60
Q

What receptors does naloxone work at?

A

Mu and Kappa

61
Q

What opioid antagonist is used more often to treat addiction?

A

naltrexone - prevents euphoria if user takes an opioid

62
Q

What is methylnaltrexone (antagonist) used to treat?

A

opioid-induced constipation

63
Q

How do non-opioid centrally acting analgesics act?

A

relieve pain in a way unrelated to opioid receptors

64
Q

Do non-opioid analgesics have the same risks?

A

no respiratory depression or abuse

65
Q

What are the 2 non-opioid analgesics?

A

tramadol and tramacet (tramadol and acetaminophen)

66
Q

What receptors do tramadol and tramacet work at?

A

NE and 5-HT (serotonin)

67
Q

Tramadol and tramacet are ___________ analogues

A

codeine

68
Q

What are the side effects of tramadol and tramacet?

A

-sedation
-dizziness
-headache
-dry mouth
-constipation

69
Q

When should tramadol and tramacet not be used?

A

high suicide risk pts

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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