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Pharmacology > CNS Meds: Opioid > Flashcards

CNS Meds: Opioid Flashcards

1
Q

Recall the receptors stimulated by opiates

A

Mu receptor

Kappa receptor

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2
Q

Explain the effects that opiates have when MU receptors are activated

A
  • producing analgesia
  • sedation
  • euphoria
  • respiratory depression
  • physical dependence
  • decreased GI motility (–> leads to pretty bad constipation)
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3
Q

Explain the effects that opiates have when Kappa receptors are activated

A
  • producing analgesia
  • sedation
  • some GI decreased motility
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4
Q

Explain the mechanism of pure opioid agonist

A

activate both mu and kappa receptors

classified into strong/moderate opioids

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5
Q

List 10 examples of strong opioid agonists

A

Alfentanil
Fentanyl*
Hydromorphone
Levorphanol
Meperidine

Methadone
Morphine
Oxymorphone
Remifentanil
Sufetanil

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6
Q

List 4 examples of moderate to strong opioids

A

Codeine
Hydrocodone
Oxycodone
Tapentadol

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7
Q

Recall the classic triad of signs of opioid overdose

A
  1. Coma
  2. Respiratory depression
  3. pinpoint pupils !!!
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8
Q

Explain how a patient treated with naloxone may respond if they are opioid dependent

A

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

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9
Q

Explain the routes in which naloxone can be administered

A
  • 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
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10
Q

Recite legal and illegal high-potency opioid agonists (which naloxone can reverse)

A

legal: fentanyl, methadone, dilaudid, norco, lorcet

illegal: heroin (non-prescribed)

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11
Q

List drugs naloxone does not reverse

A
  • benzodiazepines (diazepam, alprazolam, midazolam, clonazepam, estazolam)
  • stimulants (amphetamines, cocaine, methamphetamines)
  • sedatives (phenobarbital)
  • alcohol
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12
Q

Define “analgesics”

A

Analgesics are drugs that relieve pain without causing loss of consciousness

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13
Q

Recall the drug that is used as the “gold standard” to determine opioid potency

A

morphine

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14
Q

Identify the most potent legal opioid medication

A

Fentanyl

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15
Q

List adverse effects of opioid medication

A
  • respiratory depression
  • constipation, emesis
  • urinary retention
  • orthostatic hypotension (due to vasodilation)
  • ## miosis
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16
Q

Recall which drug class may exacerbate the urinary retention and constipation symptoms associated with opioid use

A

anticholinergic drugs

17
Q

Explain why caution should be used with administering an opioid to a patient with a head injury

A

If a patient has respiratory depression due to opioids, hypercapnia (elevated CO2) will cause vasodilation –> risk of increased ICP –> brain damage

18
Q

Identify 2 patient populations that are particularly sensitive to opioids

A
  1. infants (immature blood brain barriers)
  2. pregnancy or labor
    (opioids inhibit uterine contractions and slow down fetus respiration)
19
Q

List 2 long-term side effects associated with opiate use

A
  1. 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

  1. physical dependence = the need for opioids to avoid withdrawal symptoms
20
Q

List the routes in which fentanyl can be delivered

A

IV or IM
transdermal patch
transmucosal spray, tablet. etc.
intranasal

21
Q

Describe precautions that should be taken with meperidine administration

A
  • 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
22
Q

Explain why opioids are sometimes prescribed with other over-the-counter analgesics

A
  • in combination with non-opioids like aspirin and acetaminophen –> combination therapy produces better pain relief than with monotherapy

-

23
Q

Describe how the formulation of oxycontin (controlled release oxycodone) was changed in recent years for safety

A

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

24
Q

List 2 indications for hydrocodone

A

Hydrocodone: very common prescription in the US

  1. taken as antitussive (hydrocodone + antihistamines and nasal decongestant)
  2. taken for pain relief (hydrocodone + acetaminophen or ibuprofen)

Pharmacology (20 decks)

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