E1- Opioids Flashcards
Which opioid is most likely to cause N/V?
Injected Morphine
Which opioids are most likely to be used as antitussives?
Codeine and Dextromethophan
Which opioid does not suppress cough?
Meperidine
Do opioids cause mitosis or mydriasis?
Mitosis
What is the only opioid that causes mydriasis?
Meperidine
Which opioid is most likely to cause truncal rigidity
Fentanyl, IV
What are the cardiovascular effects of opioids?
Bradycardia
Decreased BP
What is the only opioid that may cause tachycardia?
Meperidine
What is the GI effect of opioids?
Constipation
What are the GU effects of opioids?
Decreased urine output
Harder to urinate
Harder to pass kidney stones
What is the effect of opioids on the uterus?
Prolong labor
What are the endocrine effects of opioids?
Increases ADH, prolactin, somatotropin
Inhibits LH
Why do some people claim they are allergic to opioids?
Opioids release histamine
Produces flushing, itching sweating
Which opioid is most likely to produce a histamine reaction?
Injected Morphine
What is the effect of opioids on body temperature?
Decreased body temperature
Which opioid is contraindicated in pts with a hx of seizures?
Meperidine
What are SE of opioids?
N/V Constipation Urinary retention Itching/hives Respiratory depression Postural hypotension Restlessness Dysphoria
What can occur with chronic opioid use?
Tolerance
Hyperalgesia
What can decrease tolerance dependence, and hyperalgesia?
NMDA receptor antagonist
What effects of opioids can develop tolerance?
Analgesia Sedation Euphoria N/V Respiratory depression
What effects of opioids do not develop tolerance?
Miosis
Constipation
Seizures
Are pts more likely to become addicted if they are over or under prescribed?
UNDERprescribed
What can be used to reduce symptoms of opioid withdrawal?
Clonidine
Methadone
Buprenorphine
What can cause withdrawal if a pt if dependent on opioids?
Opioid antagonsit
What are some symptoms of opioid withdrawal
Dysphoria Anxiety Insomnia Piloerection Increased BP, HR, temp Muscle aches, twitches
What are signs of opioid OD?
CNS depression
Respiratory depression
Pin point pupils
What is the treatment of opioid OD?
Support respiration Opioid antagonist (Naloxone)
What are the clinical uses of opioids?
Analgesia Acute pulmonary edema Antitussive Diarrhea Anesthesia
What are possible drug interactions of opioids?
Sedative hypnotics
Antipsychotics
MAO inhibitors (Meperidine, Dextromethorphan- but best to avoid all opioids)
CYP2D6 inhibitors (Fluoxetine)
What are contraindications to opioids?
Use of partial agonist with full agonist (cause withdrawal)
Pts with head injuries (increase in intracranial pressure)
Pregnancy
Impaired pulmonary function
function
Impaired hepatic or renal function
What route of administration of Morphine most effective?
More effective when injected than PO due to high first-pass metabolism
Which opioid is more potent than morphine, but less likely to cause itching, and is a good choice for pts with renal dysfunction?
Hydromorphone
Which 2 opioids are Mu agonist?
Methadone
Meperidine
What are the uses of Methadone?
Long-term control of pain (hard-to-treat cases)
Maintenance treatment of addicts
When should Meperidine not be used?
For more than 48hrs, in high doses, or in renal failure due to accumulation of metabolite that can cause seizures
Which opioid causes serotonin syndrome when used with MAOIs?
Meperidine
Fluoxetine inhibits the effects of which opioids?
Codeine, Oxycodone, Hydrocodone (metabolized by CYP2D6)
Is it recommended to prescribe hydrocodone with/without acetaminophen?
WITHOUT
What is being added to Oxycodone and Buprenorphine to prevent their effects if injected?
Naloxone or Naltrexone
What is the MOA of Pentazocine/naloxone?
Kappa receptor agonist, Mu receptor partial agonist
What is the MOA of Buprenorphine?
Mu receptor partial agonist
Which opioid has a ceiling effect to the euphoria leading to a low abuse potential?
Buprenorphine
What is the MOA of Tramadol?
Weak Mu agonist, inhibits NE/5-HT reuptake
What should you not combine Tramadol with? Why?
Antidepressants –> seizures
MAOIs, TCAs, SSRIs –> serotonin syndrome
What should you not combine with Dextromethophan? Why?
MOAIs- –> serotonin syndrome
What is DOC for opioid overdose?
Naloxone
How is Naloxone administerted?
Must be injected (give until pupils dilate)
What is the concern for Naltrexone and alcoholics?
May cause liver toxicity when used chronically
What are the 2 opioid antagonist?
Naloxone
Naltrexone
