Exam I: Narcotic Analgesics Flashcards
Opiate vs Opioid - original meaning although opioid is now used to reference both.
Opiate - Compounds naturally occurring in the botanical opium poppy (ie. Morphine, codeine)
Opioid - Synthetic or semi-synthetic compounds that are structurally similar to morphine (agonists)
Pharmacological effects and side effects of full or partial opioid agonists.
- Analgesia
- Euphoria/Dysphoria
- Resp depression
- Sedation - CNS depression
- Miosis - Pupillary constriction - pin-point pupils
- Reduced GI motility - constipation
Name 4 moderate/low opioid agonists.
- Codeine
- Oxycodone
- Hydrocodone
- Benzhydrocodone
Name 3 opioid Mixed Agonists/Antagonists and partial Agonists.
- Buprenorphine (CIII),
- Butorphanol (CIV),
- Pentazocine
Name 3 opioid antagonists.
- Naloxone
- Naloxegol
- Naltrexone
Tramadol and Tapentadol are opioid agonists or antagonists.
Weak agonists
Types of pain that narcotic analgesics relieve?
- Severe acute pain (Use IR)
- Non-cancer chronic pain, if NSAIDs do not work (Use ER)
- Chronic cancer pain (Use ER)
- Neuropathic pain
What are some therapeutic applications of narcotics other than analgesia? (4)
- Adjunct to general anesthesia
- Palliative sedation - numb pain, anxiety, depression
- Antidiarrheals - slows GI motility
- Antitussives - suppress cough reflex in brain
Name the OTC medication that uses an opioid agonist to treat diarrhea. What side effect does an overdose have for this drug?
Loperamide Hydrochloride (Imodium A-D®)
Can cause a fatal arrhythmia in high doses
Name the opioid antitussives. (3)
- Codeine
- Hydrocodone
- Dextromethorphan
“Opioid use disorder” is considered a medical illness.
True/False
True
There is also a genetic component of opioid addiction
Define what stupor is in reference to its effect on people with opioid use disorder.
A state of near-unconsciousness or insensibility. Trouble detecting stimuli.
What is PDMP?
Prescription Drug Monitoring Programs (PDMPs)
Tracks every controlled substance dispensed. Available to healthcare providers and law enforcement personnel.
What schedule drugs are reported in NJ-PDMP?
How often do outpatient pharmacies have to report to NJ-PDMP?
Is this a HIPAA violation?
C-II to C-V
Report information at least twice a week
Not a HIPAA violation
Schedule I drugs
Illegal
Heroin, marijuana
Schedule II drugs
High potential for abuse, severe psychological or physical dependence
Adderall, cocaine, oxycodone, codeine alone
Schedule III drugs
Moderate to low potential for physical and psychological dependence
APAP with codeine, ketamine, testosterone
Schedule IV drugs
Low but significant potential for abuse and low risk of dependence
Xanax, Valium, Tramadol
Schedule V drugs
Lower potential for abuse than Schedule IV
Guaifenesin and Codeine (Robitussin AC), Pregabalin (Lyrica)
An NPI can be omitted if a DEA number is present on the script.
True/False
False
Must include DEA number + NPI number of the prescriber. NJ state blanks include a serial number.
Quantity limits of CII drugs in NJ
30 day supply max
QID for 30 days (120 units)
What regulation did the DEA implement in 2017 for opioid naive patients?
Opioid naïve patients with acute non cancer pain receive a max 5 day supply.
For more, they will need to set an appointment with their provider.
Name 3 CII drugs more potent than morphine.
- Fentanyl
- Hydromorphone
- Oxycodone
What do abuse-deterrent opioid formulations prevent?
Prevent patients from crushing or using medication in a way it was not prescribed.
What three ways can an opioid be made abuse-deterrent?
- Resist crushing/breaking
- Resist dissolving - viscous gel if mixed with water/alcohol
- Release an opioid antagonist (like naloxone) if drug is used in any other way but po
IR opioid is preferred for?
Preferred for acute pain to prevent tolerance
Usually q6-q8 for breakthrough pain
ER opioid preferred for?
Chronic pain only
Maintain pain relief through the day
Characteristics of transdermal opioids. (2)
- Controlled release - long acting
2. Longer onset of action - takes a while to build a therapeutic level in the blood
Two dosage forms of transmucosal opioids. How are they different.
- Sublingual - does directly into the bloodstream. Bypasses the liver for fast absorption.
- Buccal - Absorbed through the cheek, fast acting but not long lasting
Warning for pregnant patients taking an opioid.
Category C
Can cause neonatal opioid withdrawal syndrome
Contraindications for opioid use.
- Patients with significant respiratory depression
- Patients with bronchial asthma
- Patients with convulsive disorders
- Addiction-prone patients
- Treatment of diarrhea
Drugs to avoid when taking opioids due to respiratory depression.
- Alcohol
- Benzodiazepines (-pam i.e. clonazepam, alprazolam etc.)
- Tranquilizers or barbiturates (-bital i.e. butalbital, amobarbital, phenobarbital)
- Monoamine oxidase inhibitors (antidepressants)
Name 3 enzyme inhibitor drugs that can cause DDIs with opioids.
- Clarithromycin
- Ketoconazole (anti-fungal)
- Calcium channel blockers (ie. Diltiazem, verapamil) – blood pressure and heart rate control
Opioids experience DDIs with what pharmacological class of drugs? Why?
Liver enzyme inducers or inhibitors
Opioids are metabolized by liver enzymes
What is The New Jersey “Overdose Prevention Act” of 2013 on naloxone dispensing?
Naloxone remains a prescription drug, but a pharmacy can give out naloxone without a prescription if they have a standing order (physician supplies a standing order for a pharmacy)
Naloxone vs Naltrexone
A. Naloxone
Can only be administered via parenteral methods (no po)
Reverse opioid OD
B. Naltrexone
Can be administered po, IM
Not for opioid OD rescue
Cotreats alcohol withdrawal and opioid use disorder.
Can be used in conjunction with methadone as a detox agent.
Naloxegol (Movantik® ) - opioid antagonist indication.
For treating “OIC” (opioid induced constipation) in patients with chronic non-cancer pain
Similar to naloxone but it does not cross the BBB
Methylnaltrexone Bromide (Relistor®) - opioid antagonist indication.
Acts quickly to reduce constipation
Can stimulate a bowel movement within 30 min of administration
Alvimopan (Entereg®) - opioid antagonist indication.
For post-operative ileus [intestinal obstruction due to loss of peristalsis]
Given to a patient after gastrointestinal surgery
(Duragesic®) Fentanyl transdermal system - can be flushed down the toilet.
True/False
True
This is the only drug that can be flushed down the toilet for disposal
Tramadol is a dual analgesic narcotic. What does this mean?
In addiction to analgesic effects, it also stimulates serotonin levels
