Chapter 6

Question 1

Dried juice from the unripe seed capsules of the opium poppy

Answer 1

Opium

Question 2

Mechanism of action of opium

Answer 2

Enkephalins
Endorphins
Dynorphins

Question 3

Important recepters for opium include:

Answer 3

Mu
Kappa
Delta

Question 4

Pharmacokinetics of opioids

Answer 4

ADME

• absorption
• distribution
• metabolism
• excretion

Question 5

Pharmacologic effects of opioid

Answer 5

Analgesia
Sedation and euphoria
Cough suppression
GI effects
Adverse reactions

Question 6

Sedation and euphoria of opioid

Answer 6

k-recepter stimulation
Potentiate analgesic effect; relieve anxiety
Additive with other CNS depressants
Remove pain; euphoria results

Question 7

Cough suppresion of opiods

Answer 7

Depressive cough center in medulla

Antitussive effect requires lower dose

Question 8

GI effects of opiods

Answer 8

Increases the smooth muscles tone

Decreases GI’s propulsive contractions and motility

Question 9

Adverse effect respiratory depression from opiods

Answer 9

Cause of death with overdose
Elderly - decrease in pulmonary ventilation
Reduced ventilation produces vasodialation
Vasodilation results in intracranial pressure
Mask CNS diagnostic symptons
Hyperthyroidism
Hypothyroidism

Question 10

Adverse reactions: Nausea and Emesis

Answer 10

Constipation
Miosis
Urinary retention & antiduretic effect
CNS effects

Question 11

What are the CNS effects when associated to the adverse reaction of nausea and emesis

Answer 11

Anxiety
Restlessness
Nervousness
Dysphoria

Question 12

Adverse reactons: Cardiovascular effects

Answer 12

Biliary tract constriction
Histamine release
Pregnancy and nursing considerations

Question 13

What are the pregnancy and nursing considerations

Answer 13

FDA pregnancy category C - morphine, codeine
Infant born to addict
Depressed respiration
Withdrawal symptons

Question 14

Allergic reactions to opiods

Answer 14

Dermatologic

• Skin rashes
• Urticaria
• Contact dermatitis

Question 15

Formulated with sodium bisulfate

Answer 15

Some brands of opiod analgesic combinations - be aware of sulfite hypersensitivity

Question 16

Drug interactions with opiods

Answer 16

Sedation
Respiratory depression
Interact with monoamine oxidase (MAO) inhibitors
Interact with antipsychotic agents such as chlorpromazine

Question 17

What are the two signs of addiction

Answer 17

Craving

Loss of ability to stop using and loss of ability to control amount

Question 18

Chronic administration

Answer 18

Tolerance occurs except to miosis and constipation
Habituation
Dependence

Question 19

Adverse reactions: Addiction

Answer 19

Degree of addiction potential is proportional to analgesic strength
Dependent on the drug’s ability to produce euphoria and reduce anxiety
Length of administration
Development of tolerence

Question 20

Treatment for opiod addiction

Answer 20

Substituting oral opiod for infectable form
Cold turkey - abrupt withdrawal
Methadone maintence
Adminstering naltrexone (Trexan)

Question 21

Morphine

Answer 21

Prototype opiod
Parenterally - postoperative pain in hospitalized puts
Orally - treatment of terminal illnesses
Sustained-released tablets - outpatient use in terminally ill

Question 22

Oxycodone + aspirin =

Answer 22

Percodan

Question 23

Oxycodone + acteminophen =

Answer 23

Percocet, Tylox

Question 24

Hydrocodone

Answer 24

Hydrocodone > hydromorphone
Hydrocodone + ibuprofen
Hydrocodon + actemeninophen
Hydrocodone ER

Question 25

Codeine

Answer 25

Meperidine (Demerol)
Hydromorphone (Dilaudid)
Methadone (Dolophine)
Fentanyl family

Question 26

Naloxone (Narcan)

Answer 26

Opiod antagonist

Treating agonist or mixed opioid overdoses

Question 27

Full agonist/Reuptake inhibitors: Tramadol (Ultram)

Answer 27

u-Opioid agonist action
Inhibition of repute of norepinephrine and serotonin
No federal scheduling yet; Schedule IV in many states

Question 28

Account for 40.2% of RX for patients age 18-30 years

Answer 28

Analgesics