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Pharmacology > Exam 4: Opioid Analgesics-Part 2 > Flashcards

Exam 4: Opioid Analgesics-Part 2 Flashcards

1
Q

Desired Clinical Effects of Opioid Drugs…KNOW THIS, OWN IT: Potent _______….Sedation and ________…..______ suppression

A

analgesic…euphoria….cough

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2
Q

Desired Clinical Effects of Opioid Drugs…KNOW THIS, OWN IT: GI effects- _______ smooth muscle tone, _____ propulsion and motility, used for treatment of _______.

A

increases….decreases….diarrhea

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3
Q

Adverse Reactions: Physical _______

A

addiction

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4
Q

Adverse Reactions: _______ depression (____ related)…dcreases brainstem sensitivity to _____.

A

respiratory…dose….CO2

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5
Q

Adverse Reactions: Opioids directly stimulate the chemoreceptor trigger zone the in medulla to produce ______ and _______. BUT don’t worry, regular, repeated dosing prevents this by depressing its center (floor of fourth ventricle).

A

nausea and vomiting

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6
Q

Adverse Reactions: this reason is why opiods are given to stop diarrhea (off label)…

A

MAD constipation yo

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7
Q

Adverse Reactions: pinpoint pupils (scientifically named ______)… this is a diagnostic for addiction.

A

Miosis

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8
Q

Adverse Reactions: When on opioids, the production of _____ is stimulated and there for you retain urine, this can be an issue if the pt has _______ problems already.

A

ADH….prostate

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9
Q

Adverse Reactions: Opioids can occasionally stimulate _____ effects: anxiety, restlessness, nervousness, dysphoria

A

CNS

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10
Q

Adverse Reactions of Opioid Drugs-Cardiovascular: _______ the vasomotor center and stimulates the vagus nerve so at high doses you can get _____tension, _______cardia, and syncope.

A

depress….HYPOtensino….tom Bradycardia

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11
Q

Adverse Reactions of Opioid Drugs-Biliary tract _______

– Biliary colic (watch in patients with gallstones)

A

constriction

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12
Q

Adverse Reactions of Opioid Drugs: ________ release! causing itching and urticaria…

A

histamine

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13
Q

Adverse Reactions of Opioid Drugs-Pregnancy and lactation….______ labor; depress fetal _______ if given near term…..Infants born to addicts have marked depressed respiration and experience withdrawal….Cross into _______…..morphine and codeine=FDA Pregnancy category “___”

A

prolong….respiration….breast milk…“C”

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14
Q

Adverse Reactions of Opioid Drugs–Severity of side effects is proportional to ______.

A

efficacy… HA I bet you thought it would be potency

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15
Q

Adverse Reactions of Opioid Drugs–Overdose: Major symptom: ________ depression, Pinpoint pupils, Coma, Treated with antagonist = ________

A

respiratory…naloxone

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16
Q

Adverse Reactions of Opioid Drugs-Withdrawl: Occurs after abrupt discontinuance of drug….Yawning, lacrimation, perspiration, rhinorrhea, gooseflesh and piloerection (“_______”), irritability, nausea, vomiting, tachycardia, tremors, chills

A

“cold turkey”

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17
Q

Hypersensitivity Reactions to Opioids–Most are ________ – Skin rashes, urticaria…Differentiate from symptoms caused by histamine release (itching)..If true allergy, avoid…..Some preparations contain _________ (allergy to sulfites)

A

dermatologic…sodium bisulfite

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18
Q

Clinical indications- Dentistry: ________ & ________, in medicine-those two AND _______, _______.

A

Analgesia, sedation….cough suppression and diarrhea

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19
Q

Opium = dried juice obtained from unripe seed capsules of poppy plant (Paparer somniferous)…25% of the dried juice consists of the ______: morphine, codeine

A

alkaloids

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20
Q

Heroin is a ________ morphine product.

A

synthesized

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21
Q

Please name the 8 PURE agonists

A

1.morphine 2. oxycodone(percocet) 3.hydrocodone(vicodin) 4.codeine 5.dihydrocodeine 6.propoxyphene (withdrawn) 7.meperidine 8.fentanyl (most potent)

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22
Q

What is the mixed agonist/antagonist that is Equally as potent as morphine?

A

METH-a-done

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23
Q

What schedule is Methadone?

A

II (mixed agonist/antagonist for detox/chronic pain)

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24
Q

Methadone inhibits _______ pain pathways.

A

ascending

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25
Q

Methadone produces generalized _____ depression.

A

CNS

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26
Q

Mathadone has SUPERIOR ______ efficacy.

A

oral

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27
Q

Methadone has a ____ duration of action.

A

long (6 to 12 hours)

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28
Q

Methadone was initially used as a maintenance regimen for ______ abuse = FDA approved detoxication and maintenance programs & ______ therapy.

A

heroine..chronic pain

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29
Q

When you hear pure antagonist, think of the _______!!!! (reversing some of the negative effects of opioids.

A

Antidote

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30
Q

KEEP a drug of this type in the dental offices that administer sedation to reverse effects…its effects occur in ___ to ___ MINUTES and last for ___-___ hours…What are 2 examples of this?

A

A pure antagonist..1 to 2 minutes….1 to 4 hours….nal-ox-one & nal-trex-one

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31
Q

Which one is used for alcohol abstinence..naltrexone or naloxone?

A

naltrexone

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32
Q

Naloxone (Narcan)…In dental office, IV to reverse overdose of _______ and _______ (sedation).

A

fentanyl and meperidine

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33
Q

What is the PROTOTYPE Pure Agonist?

A

Morphine

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34
Q

Morphine- Acts like internal _______/_______.

A

enkephalins/endorphins

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35
Q

Morphine- ______ mediated receptor function.

A

G-protein

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36
Q

Morphine- Decreased ___________ in pain

pathways and it acts ______.

A

neurotransmitter…centrally

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37
Q

What is the most widely used route of administration for morphine?

A

IM

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38
Q

Oral morphine is ______ absorbed….Not used in _______

A

poorly….dentistry

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39
Q

Morphine has the ______ ring structure = which is ___ sided…Needed to bind to opiate (___) receptor

A

Piperidine…6….mu

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40
Q

What is the most widely abused opiate in hospital personnel? WHY?

A

Mep-er-id-ine (Dem-erol)…Does not cause MIOSIS (masks the pinpoint pupils

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41
Q

Meperidine (Demerol) is an Excellent analgesic, but its _______.

A

addictive

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42
Q

Meperidine (Demerol) does not have mitosis, but does display _______, which is an atopine effect.

A

My-dri-asis

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43
Q

Meperidine (Demerol)-synthetic or natural?…How much sedation/euphoria compared to morphine/heroin?

A

synthetic.. Not as much sedation and euphoria as

with morphine or heroin

44
Q

Meperidine (Demerol)…What are the 2 primary side effects?

A
  1. Nausea 2.Respiratory Depression
45
Q

How is meperidine (Demerol) mainly used in dentistry?

A

IV sedation

46
Q

meperidine (Demerol)-Not as _______ as fentanyl, Not as much risk for ________ as with fentanyl

A

potent…respiratory depression

47
Q

meperidine (Demerol)- has a ______ margin of safety with a ___ mg dose, administered via _______.

A

wider..25 mg..IV

48
Q

meperidine (Demerol)-can be given ______ for moderate to severe pain, ____-____ mg every 4 hours as needed (so ___ hours of duration)

A

orally…50-100mg…4

49
Q

What is one of the most frequently prescribed opioids in dentistry?

A

codeine!

50
Q

Codeine-Not used as ____- agent in dentistry = moderate efficacy, but many _______ side effects…used in combination products with ________ or ________.

A

sole…GI…acetaminophen or aspirin

51
Q

Codeine-has 1/__ the potency of morphine, so 10 mg of morphine = ____ mg of codeine

A

1/6th….60 mg codeine

52
Q

Codeine-What is the OPTIMUM dose?..if exceeded no greater ________ effect, but more _______!

A

60 mg…analgesic…side effects

53
Q

Oral morphine is poorly absorbed, so we use ________, given orally, instead. BUT, there is risk for _______.

A

codeine…addiction

54
Q

Codeine is indicated for _______ to moderately ______ pain…not indicated for _______ pain!

A

moderate to moderately severe…severe!

55
Q

What is the drug of choice for cough suppression?

A

Codeine

56
Q

Codeine, rather typical side effects like nausea, dizziness, constipation, hypersensitivity, but _______ is an odd one.

A

excitability

57
Q

Codeine dosing- __ to __ mg every 4-6 hours…#1=__ mg, #2=___ mg, #3= __ mg, #4=___ = 60 mg

A

15-60mg every 4-6 hours….#1=8mg (OTC in Canada!! Yay Canada!)….#2=15mg….#3=30mg….#4=60mg

58
Q

What is the MOST WIDELY prescribed codeine product by dentists? What schedule is it?

A

Tylenol #3-300 mg acetaminophen and 30mg codeine..schedule 3

59
Q

This is a good product for tension headaches!- C-III
• butalbital 50 mg (barbiturate) • aspirin 325 mg
• caffeine 40 mg

A

Ms. Fior-in-al with Codeine

60
Q

What drug is 3 times more potent than codeine, has low incidence of side effects, and is typically assoc with acetaminophen?

A

HydroCodone

61
Q

What type of drug is Vicodin?

A

Hydrocodone (5mg) + Acetaminophen (500 mg)

62
Q

What kind of drug is Lorcet/Lortab?

A

Hydrocodone (5mg) + Acetaminophen (500mg)

63
Q

What does the term “CET” wedged into a drug name indicate?

A

That it has aCETaminophen!!

64
Q

What is in our New Drug, Norco? What is a great FDA approved benefit? How does it still work?

A

10mg of hydrocodone and 325 mg acetaminophen..FDA likes the less amount of acetaminophen to guard against acute liver damage…works with a bit higher opiate dose

65
Q

What is Vicodin’s brand new schedule?

A

C-II, thanks DEA…

66
Q

What are 2 examples of hydrocodone + ibuprofen? (hint they have some part of ibuprofen in their names)

A
  1. Vico-Profen 2. Ibu-done
67
Q

In hydrocodone + ibuprofen, the ibuprofen dose stays consistent at ____ mg…but many clinicians want to it the ibuprofen ceiling, so they will add ___ mg.

A

200mg…supplement with 200 more mg to get the 400 mg ceiling

68
Q

Dihydrocodeine has the same efficacy/potentcy as _______, so its no more effective then ________.

A

codeine..Tylenol #3

69
Q

What is an example of dihydrocoeine?

A

Synalgos DC (dihydrocodeine, aspirin, caffeine)

70
Q

What is AS potent as morphine and is HIGHLY addictive? There for it is more potent then ______, which means more ______.

A

Oxycodone…codeine…side effects

71
Q

What is the schedule for Oxycodone? How is it usually paired in dentistry?

A

C-II…usually combined with an NSAID

72
Q

What are the 3 oxycodone drugs that have oxycodone and acetaminophen/aspirin/ibuprofen?

A

PercoCET (acetamin), Percodan(aspirin), RoxiCET (acetamin), Combunox (ibu)

73
Q

What is the NEW drug with oxycodone and ibuprofen? How much of each?

A

COMB-UN-OX.. 5 mg oxycodone, 400 mg ibuprofen

74
Q

Combunox-Short term management of acute,

moderate-to-_____ dental pain, Use for __-__ days only, ______ available

A

severe….3-5 days..generic

75
Q

fentanyl is ____ times more potent than morphine! AND ____ times more potent then meperidine.

A

100 times!!!….500 times

76
Q

In dentistry, fentanyl is used for __________ only*, via which 3 ways?

A

conscious sedation…via IV, transdermal, or a LOLLIPOP

77
Q

What is the great dental opiate not scheduled by DEA (May be scheduled in certain states)…for moderate to moderately-severe pain

A

tram-a-dol

78
Q

Tramadol-Use for ≤___ days for acute dental pain

A

5

79
Q

Tramadol-Binds to ____ opiate receptors in CNS, which inhibits ________ pain pathways, altering perception of and response to pain

A

mu….ascending

80
Q

Tramadol-Also inhibits the reuptake of ________ and ________….

A

norepi and serotonin

81
Q

What is a brand name for tramadol?

A

Ultram

82
Q

tramadol-Immediate release given 50-100 mg every 4 to 6 hours, not to exceed ____ mg/day = titrate up

A

400 mg/day

83
Q

tramadol-a rare complication:_________ and it is also associated with ________.

A

are complication = anaphylaxis…..Associated with seizures

84
Q

PLEASE DONT CRUSH YOUR tramadol!!!!!!!Rapid release and absorption of extended release formulation if broken, crushed or chewed can lead to potentially lethal ________.

A

overdose

85
Q

Ultracet is a combination of _______ and _______. What ingredient dictates the max daily dose?

A

acetaminophen (325 mg ) and tramadol (37.5 mg)…acetaminophen dictates

86
Q

What is our kick ass NSAID that provides analgesia at the opioid level? Therefore its indicated for moderate to _______ dental pain

A

ket-or-olac (Tor-a-dol)…severe

87
Q

ket-or-olac (Tor-a-dol)- SHORT term use, less than or equal to ___ days of use.

A

5 days

88
Q

ket-or-olac (Tor-a-dol)- since its an NSAID, watch for ______ and _______ complications.

A

bleeding…GI

89
Q

Prescribing Considerations-Most patients are better managed with _______ (anti- inflammatory effect)

A

NSAIDs

90
Q

Prescribing Considerations- Start with ________ preparations (containing codeine or hydrocodone)

A

combination

91
Q

Prescribing Considerations- Only prescribe stronger opioids for ______ periods of time, then switch to something else

A

SHORT

92
Q

Prescribing Considerations- rescribe ______ quantities without ______.

A

SMALL….REFILLS

93
Q

Prescribing Considerations- should be straight forward, but prescribe only if patient has received _________.

A

dental treatment

94
Q

Prescribing Considerations- If _____ persists, bring patient back for evaluation and local treatment

A

pain

95
Q

Prescribing Considerations- If patient demands more drugs, refer to a _______ (chronic pain). Because it is managed differently!

A

pain clinic

96
Q

Key Points to Remember- Opiates are ________ substances in the US

A

scheduled

97
Q

Key Points to Remember-We write for limited quantities due to the potential for ________
– **Limit use to ___-___ days (acute pain only)

A

addiction…3 to 5 days

98
Q

Key Points to Remember-__________ with ________ is most widely used opiate agent for the management of dental pain (Vicodin or Lorcet)

A

hydrocodone with acetaminophen

99
Q

Key Points to Remember-Of the codeine preparations, _______ is the most widely prescribed in dentistry

A

Tylenol #3

100
Q

Key Points to Remember-________ with __________ is used to treat the more SEVERE degrees of pain

A

oxycodone with acetaminophen

101
Q

Key Points to Remember- __________ is useful for patients with a history of CODEINE ALLERGY.

A

meperidine (Demerol)

102
Q

Key Points to Remember- ______ and _________ (Dilaudid) are NOT indicated as analgesics in ANY dental situation!

A

morphine…hydromorphone

103
Q

Key Points to Remember- Whenever possible, an ______ is preferred to a opiate agent for pain management
– Opiates do not reduce ________, which is the most common etiology for dental pain
– Treating inflammation will reduce _____

A

NSAID….inflammation…pain

104
Q

Key Points to Remember- All opiates will cause _______ in most patients, ________ is another common complaint

A

nausea…constipation

105
Q

Key Points to Remember- _______ patients: use caution – NSAIDS and GI bleeding– Aspirin and hemorrhage– Opiates and constipation– Opiates and CNS effects = disorientation, falling– Liver and renal function = start lowest dose, titrate up

A

Elderly

106
Q

LAST BUT NOT LEAST- please rank the opiates by potency (from highest to lowest) (7)

A

1.fentanyl 2.morphine 3.oxycodone (tie w/morphine) 4.meperidine 5.hydrocodone 6.codeine 7.dihydrocodeine (tie w/morphine)

Pharmacology (23 decks)

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