Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Exam 4 - opioid analgesics > Flashcards

Exam 4 - opioid analgesics Flashcards

1
Q

The descending pain modulating system projects via the _____ to the spinal cord ____ ____. Contains high concentrations of endogenous _____ _____. It is activated by _____ analgesics like certain kinds of ____.

A 
Medulla
Dorsal horn
Opioid peptides
Opiate
Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Opiates produce analgesia by ____ ____ on the CNS

A

Direct action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name for pain receptors?

A

Nociceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do systemic administration of opiates produce analgesia?

A

By acting at widely distributed sites throughout the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The pain suppression system is controlled by what?

A

Serotonin and also partially enkephalin-mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What 4 things is the pain suppression system activated by?

A
  1. Noxious stimuli
  2. Pain
  3. Psychological factors (including placebos)
  4. Opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do opioid analgesics take place?

A

Analgesia system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The analgesia system is mediated by what 3 things?

A
  1. periaqueductal grey matter (midbrain)
  2. nucleus raphe magnus (medulla)
  3. pain inhibitory neurons (dorsal horn)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Proper name for endogenous morphine?

A

Endorphin - opiate like effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 5 places are endorphins found?

A
  1. GUT
  2. sns
  3. adrenal medullart chromaffin cells
  4. cns (arcuate nucleus hypothalamus, pituitary/nucleus tractus solitarii, visceral afferents from CN VII, IX, X)
  5. pancreatic islet cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F endorphins are involved in blood pressure regulation, temperature regulation, and food intake.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 precursor molecules of endorphins?

A
  1. proenkephalin A
  2. pro-opiomelanocortin (POMC) = B-endorphin
  3. Proenkephalin B (prodynorphin) = dynorphins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Endorphins act via what receptor in the GI tract?

What side effect does this cause?

A

Mu receptor

Side effect = constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_____ mimics opiate activity = weak analgesics

A

Enkephalins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where are enkephalins found in the body?

A

Widely distributed - NT in many brain areas: PAG, RVM, spinal cord laminea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

May be responsible for producing analgesia in placebo responders like _____.

A

Acupuncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What receptors do enkephalins act through?

A

Mu and delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What works through the kappa receptors?

A

Dynorphins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What 3 places are dynorphins found?

A
  1. Spinal cord
  2. through out brain
  3. hypothalamus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Opiate effect depends on what?

A

Site of binding - highly specific = STEREOSPECIFIC

Only levo-isomers have biological activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What receptor is endorphin activated and gives the best pain relief but highest risk for addiction and possible respiratory depression?

A

Mu
(M1- addiction)
(M2 - respiratory depression)

22
Q

Which receptor is enkephalins activated and has an effect on analgesia, emotion, and seizures?

23
Q

Which receptor is dynorphins activated and causes spinal analgesia, miosis, and sedation?

24
Q

What receptor, although no longer classified as an opioid receptor, causes hallucinations, nightmares, anxiety, and tachycardia?

25
Besides mu, delta, and kappa, what opioid receptor provides analgesia effects?
Epsilon
26
Strength of attachment of an opioid drug to its binding site (binding affinity) is proportional to its ______.
Potency
27
What happens with continued exposure of tissues to high concentrations of opioid agonists?
Tolerance - the potency of the drug declines so that progressively higher concentrations are required to produce the same degree of analgesia Characteristic of all opioids Cross tolerance develops as well
28
What are 4 desired clinical effects produced by all opiate drugs?
1. Potent analgesia 2. Sedation and euphoria 3. Cough suppression 4. GI effects (increase smooth muscle tone -> constipation, used as diarrhea tx)
29
There are 15 common adverse effects produced by all opiate drugs. What are they? (Severity of side effect is proportional to efficacy)
1. Physical addiction 2. Respiratory depression 3. Nausea/vomiting 4. Constipation 5. Miosis 6. Urinary retention 7. CNS effects - anxiety, restlessness, nervousness, dysphoria 8. Cardiovascular - postural hypotension, bradycardia 9. Biliary tract constriction - biliary colic 10. Histamine release 11. Pregnancy/lactation - prolong labor, depress fetal respiration, cross breast milk 12. Develop tolerance 13. May cause an adverse reaction 14. Overdoes 15. Withdrawal
30
What are some side effects of withdrawal?
yawning, lacrimation, perspiration, rhinorrhea, gooseflesh/piloerection, irritability, nausea, vomiting, tachycardia, tremors, chills
31
Identify the life-threatening adverse event associated with opiate overdose.
Respiratory depression
32
What are the 2 opiate antagonists?
1. naltrexone (Depade, ReVia, Vivitrol) - oral or IM | 2. naloxone (Narcan) - IV to reverse OD
33
Where is opium from?
Dried juice obtained from unripe seed capsules of poppy plant
34
What are 2 common derivatives of opium used in dentistry?
1. morphine | 2. codeine
35
Arrange these common opioids according to potency, highest to lowest. meperidine, codeine, dihydrocodeine, fentanyl, morohine, hydrocodone.
1. fentanyl = 100x more potent than morphine and 500x more than meperidine 2. morphine = oxycodone 3. meperidine 4. hydrocodone = 3x more than codeine 5. codeine 6. dihydrocodeine = codeine (same efficacy/potency)
36
What is the optimum dose of codeine?
60 mg - no increased effect after this, but increased adverse events
37
What is the most widely prescribed codeine product in dentistry?
Tylenol 3 (3 =30 mg codeine)
38
Codeine is used for moderate to moderately severe pain and what else?
Cough suppression
39
hydrocodone is 3x more potent than codeine, what are 2 examples with acetaminophen?
1. Viodin (5/500 or 7.5/500) | 2. Lorcet/Lortab (5/500 or 7.5/500)
40
What drug uses a lower dose of acetaminophen but is still a strong opiate dose?
Norco | 10 mg hydrocodone with 325 mg acetaminophen
41
Does hydrocodone with ibuprofen have enough enough ibuprofen for an anti-inflammatory response?
No use OTC to supplement
42
Which opioid is highly addictive, as potent as morphine, more potent than codeine, has more side effects, and used to treat severe pain? Know the 4 brand names
oxycodone - schedule 2 1. Percocet 2. Tylox 3. Percodan 4. Roxicet
43
What is the most widely used hydrocodone preparation used by dentists?
hydrocodone with acetaminophen | Vicodin or Lorcet
44
In dentistry, when would you use meperidine (Demerol)?
IV conscious sedation or orally for moderate to severe pain. Not as potent as fentanyl so less risk of respiratory depression but may cause nausea
45
In dentistry, when would you use fentanyl?
Conscious sedation only! Given through IV, transdermal, and lollipop
46
What drug is used for short term acute dental pain (less than 5 days), it inhibits the reuptake of norepinephrine and serotonin, and associated with seizures?
tramadol (Ultram)
47
What drug is used for short term acute dental pain (less than 5 days), is not an opioid but gives relief at that level. Watch for bleeding and GI complications.
ketorolac (Toradol) - NSAID
48
Why are NSAIDs preferred to an opiate for pain management?
Opiates do not reduce inflammation and treating inflammation will decrease pain All opiates have adverse side effects - especially nausea and constipaiton
49
When would you prescribe someone meperidine (demerol)?
For patients with a history of codeine allergy
50
What opioid drugs are almost never prescribed by dentists?
morphine and hydromorphone (Dilaudid)

Pharmacology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions