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ATTH 5100 > Chapter 8: Drugs To Treat Pain - Opioid Analgesics > Flashcards

Chapter 8: Drugs To Treat Pain - Opioid Analgesics Flashcards

1
Q

Name a low potency opioid.

A

Codeine

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2
Q

Name a medium potency opioid.

A

Morphine

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3
Q

Name an opioid.

A
  • hydrocodone
  • oxycodone
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4
Q

Name a extremely high potency opioid.

A

Fentanyl

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5
Q

Name an illegal opioid.

A

Heroin

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6
Q

Name an opioid antagonist.

A

Naloxone

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7
Q

Prescribers should consider opioid therapy only if…

A

The expected benefits for both pain and function are anticipated to outweigh the risks to the patient

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8
Q

If opioids are used, they should be combined with _______ therapy and _______ _______ therapy, as appropriate.

A
  • nonpharmacologic
  • nonopioid pharmacologic therapy
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9
Q

Opioid drugs act by binding to _____ _____, primarily located in the ______, the _______ ______ _____, and the _______ _____.

A
  • opioid receptors
  • CNS
  • peripheral nervous system
  • gastrointestinal tract
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10
Q

Onset of analgesic effect for oral opioids:

A

45 min

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11
Q

Peak effect of oral opioids usually occurs when?

A

1-2 hours after administration

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12
Q

Name some symptoms of opioid addiction or opioid use disorder.

A
  • inability to control opioid use
  • uncontrollable cravings
  • drowsiness
  • changes in sleep habits
  • weight loss
  • frequent flulike symptoms
  • decreased libido
  • lack of hygiene
  • changes in exercise habits
  • isolation from family and friends
  • stealing from family, friends, or businesses
  • new financial difficulties
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13
Q

What is Norco, Lortab, or Vicodin?

A

Combination of hydrocodone and acetaminophen

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14
Q

What is Percocet?

A

Oxycodone and acetaminophen

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15
Q

What is vicoprofen?

A

Hydrocodone and ibuprofen

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16
Q

The extended release (ER) form of all opioids should be used only for ______ _____ and is dosed ….

A
  • chronic pain
  • around the clock rather than on an as-needed basis
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17
Q

What is opioid-induced constipation?

A

Reduction of spontaneous bowel movement from baseline to typically < 3 bowel movements per week after commencing opioid therapy.

18
Q

What reverses the constipation associated with opioids?

A

Peripherally Acting Mu-Opioid Receptor Agonists (PAMORA)

19
Q

What happens when you combine opioids and benzodiazepines or sleep hypnotics?

A
  • significant sedation
  • respiratory depression
  • coma, death
  • should be avoided, especially when driving
20
Q

What are the 3 primary FDA opioid warnings?

A
  1. Risk of addiction, abuse, and misuse.
  2. Life-threatening respiratory depression.
  3. Risks from concomitant use with benzodiazepines or other CNS depressants.
21
Q

What effects does codeine have?

A
  • low-potency opioid analgesic
  • antitussive
22
Q

What is the onset of action, peak effect, duration, bioavailability, and half life of codeine?

A
  • onset of action: 0.5-1 hr
  • peak effect: 1-1.5 hr
  • duration: 4-6 hr
  • bioavailability: 53%
  • half life: 3 hr
23
Q

How is codeine metabolized and excreted?

A
  • hepatic
  • urine, feces
24
Q

What is equianalgesic?

A
  • the standard against which new analgesics are measured
  • morphine
25
Q

What are congeners?

A

Semisynthetic derivatives

26
Q

What effect does morphine have?

A

Medium-potency opioid analgesic

27
Q

Routes of administration for morphine:

A
  • oral (IR, ER)
  • rectal
  • IV
  • IM
  • SQ
28
Q

What is the onset of action, peak effect, duration, bioavailability, and half-life of morphine?

A
  • onset of action: ~30 min (patient dependent)
  • peak effect: 1 hour
  • duration: patient dependent
  • bioavailability: 17-33% (first pass effect limits oral bioavailability)
  • half life: 2-4 hr
29
Q

How is morphine distributed?

A
  • skeletal muscle, liver, kidneys, lungs, intestinal tract, spleen, and brain
  • binds to opioid receptors in the CNS and periphery (eg. GI tract)
30
Q

How is morphine metabolized and excreted?

A
  • hepatic
  • urine and feces
31
Q

When is morphine indicated?

A
  • for management of pain severe enough to require daily, around-the-clock, long-term opioid treatment
  • alternative treatment options are inadequate
32
Q

Name 2 synthetic derivatives of morphine. They are widely used in combination with _______.

A
  • oxycodone
  • hydrocodone
  • acetaminophen
33
Q

Hydrocodone is approximately equipotent to ______, with an onset of action of ______ min, duration of ______ hours, and a serum half life of about ______ hours.

A
  • oxycodone
  • 10-30 min
  • 4-6 hours
  • 4 hours
34
Q

Fentanyl is ____ times more potent than morphine.

A

100

35
Q

Fentanyl is most widely used for….

A

Intraoperative and periprocedural analgesia

36
Q

Time to peak analgesic effect after IV administration of fentanyl vs morphine.

A
  • ~ 5 min
  • ~ 15 min
37
Q

What routes of administration are preferred when using fentanyl for chronic pain management?

A
  • poorly absorbed in the GI tract
  • transdermal or buccal administration methods preferred
38
Q

Transdermal fentanyl patches (Duragesic) provide sustained release for _____ hours. However, factors promoting increased absorption such as _______, _____ ______, can lead to overdosage and increased side effects.

A
  • 48-72 hours
  • fever, moist heat
39
Q

The transdermal patch fentanyl is indicated only for what type of patients?

A
  • opioid-tolerant patients
  • patients who have been on 60 mg of morphine/day or an equianalgesic dose of another opioid for at least a week
40
Q

How does Naloxone work?

A

Binds competitively to opioid receptors but does not produce an analgesic or opioid side-effect response. Used to reverse the toxic effects of opioid agonists.
- can completely or partially reverse opioid depression (including respiratory depression)

41
Q

How much Naloxone can be administered how often?

A

2 mg every 2 or 3 minutes

ATTH 5100 (13 decks)

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