CNS Meds: Opioid Flashcards
Recall the receptors stimulated by opiates
Mu receptor
Kappa receptor
Explain the effects that opiates have when MU receptors are activated
- producing analgesia
- sedation
- euphoria
- respiratory depression
- physical dependence
- decreased GI motility (–> leads to pretty bad constipation)
Explain the effects that opiates have when Kappa receptors are activated
- producing analgesia
- sedation
- some GI decreased motility
Explain the mechanism of pure opioid agonist
activate both mu and kappa receptors
classified into strong/moderate opioids
List 10 examples of strong opioid agonists
Alfentanil
Fentanyl*
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Oxymorphone
Remifentanil
Sufetanil
List 4 examples of moderate to strong opioids
Codeine
Hydrocodone
Oxycodone
Tapentadol
Recall the classic triad of signs of opioid overdose
- Coma
- Respiratory depression
- pinpoint pupils !!!
Explain how a patient treated with naloxone may respond if they are opioid dependent
Patients with significant physical dependence on opioids will have an immediate withdrawal response
Symptoms of opioid withdrawal are horrible!
- dysphoria and insomnia
- weird yawning
- rhinorrhea
- pupillary dilation, lacrimation (tearing)
- piloerection (hairs bristling)
- muscle aches
- nausea, vomiting, diarrhea
- fever and sweating
Explain the routes in which naloxone can be administered
- Intranasal
nose spray into one nostril –> effects in a few minutes - IV or IM
effects will only last for 1-couple hours –> will need to give additional doses
Recite legal and illegal high-potency opioid agonists (which naloxone can reverse)
legal: fentanyl, methadone, dilaudid, norco, lorcet
illegal: heroin (non-prescribed)
List drugs naloxone does not reverse
- benzodiazepines (diazepam, alprazolam, midazolam, clonazepam, estazolam)
- stimulants (amphetamines, cocaine, methamphetamines)
- sedatives (phenobarbital)
- alcohol
Define “analgesics”
Analgesics are drugs that relieve pain without causing loss of consciousness
Recall the drug that is used as the “gold standard” to determine opioid potency
morphine
Identify the most potent legal opioid medication
Fentanyl
List adverse effects of opioid medication
- respiratory depression
- constipation, emesis
- urinary retention
- orthostatic hypotension (due to vasodilation)
- ## miosis
Recall which drug class may exacerbate the urinary retention and constipation symptoms associated with opioid use
anticholinergic drugs
Explain why caution should be used with administering an opioid to a patient with a head injury
If a patient has respiratory depression due to opioids, hypercapnia (elevated CO2) will cause vasodilation –> risk of increased ICP –> brain damage
Identify 2 patient populations that are particularly sensitive to opioids
- infants (immature blood brain barriers)
- pregnancy or labor
(opioids inhibit uterine contractions and slow down fetus respiration)
List 2 long-term side effects associated with opiate use
- opioid tolerance = a reduced responsiveness to an opioid agonist; the need to use increasing doses to achieve the desired effect
develops to analgesia, euphoria, sedation, and respiratory depression
**does not develop to constipation or miosis
- physical dependence = the need for opioids to avoid withdrawal symptoms
List the routes in which fentanyl can be delivered
IV or IM
transdermal patch
transmucosal spray, tablet. etc.
intranasal
Describe precautions that should be taken with meperidine administration
- only used short-term
(greater than 48 hours –> build of toxic metabolite called normeperidine –> seizures) - should not be used with MAOIs
(lead to life-threatening serotonin syndrome
Explain why opioids are sometimes prescribed with other over-the-counter analgesics
- in combination with non-opioids like aspirin and acetaminophen –> combination therapy produces better pain relief than with monotherapy
-
Describe how the formulation of oxycontin (controlled release oxycodone) was changed in recent years for safety
The old formulation Oxycontin OC was easy to crush –> high overdose risks
The newer formulation is called Oxycontin OP and is more difficult to crush, won’t easily dissolve in water/alcohol
List 2 indications for hydrocodone
Hydrocodone: very common prescription in the US
- taken as antitussive (hydrocodone + antihistamines and nasal decongestant)
- taken for pain relief (hydrocodone + acetaminophen or ibuprofen)
