Mehl. Opioids for usmle Flashcards
Opioids receptors.
Mu (μ) and kappa (k) are most well-studied, although delta (d) and NOP forms exist.
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Opioids receptors.
Mu agonism is responsible for ????
Most of the classic effects of opioids – i.e., analgesia, euphoria, respiratory depression, and dependence.
Opioids receptors. Agonism results in ……?
Agonism results in inhibition of neuronal firing and neurotransmitter release via opening of K+ channels and closing of Ca2+ channels.
Opioids receptors. kappa responsible for what?
Kappa has analgesic effects but can also produce dysphoria.
Opioids can cause ???CP3
respiratory depression, miosis, and constipation
Opioid withdrawal cause what symptoms?
Opioid withdrawal can cause flu-like symptoms, irritability, piloerection, and yawning.
Morphine. for what pain?
Gold standard opioid; used for moderate to severe pain.
Morphine. USMLE wants you to know that morphine is “metabolized into …?
active metabolites that accumulate.”
This is NBME answer for how overdose can occur in patients who use self-controlled pumps, since it can take time to work, so patient uses too much.
Morphine. Patients who are in severe pain can sometimes have ,…?
hypertension as a result. Surgery Q has morphine as answer for how to control BP post-op.
Morphine. f patient has history of opioid abuse but has severe pain, e.g., due to trauma, …. what to do?
do not withhold using opioids. Always treat pain fully.
Codeine. for what reason used?
Less potent than morphine; used for mild to moderate pain; in many antitussives
Oxycodone. combined with what?
Potent opioid often combined with acetaminophen.
Oxycodone. USMLE wants you to know that oxycodone/acetaminophen combo is preferred …..????
Preferred initially in patients who are post-op. Do not just jump to morphine.
Fentanyl.
Potent synthetic opioid with high abuse potential.
Meperidine. Potent opioid with high abuse potential.
I’ve noticed NBME likes this opioid for malingering Qs, where they’ll say, e.g., a 47- year-old man comes into the ER in severe pain requesting meperidine.
Dextromethorphan. used for what?
Opioid used in antitussives.
Dextromethorphan. often cause what adverse?
Common cause of delirium from over-the-counter cold meds.
Loperamide, eluxadoline. used for what?
Opioids used for diarrhea-predominant irritable bowel syndrome
Loperamide, eluxadoline. addictive potential?
Low addictive potential.
Loperamide, eluxadoline.
The fact that opioids cause constipation as an adverse effect “is a good thing” in the setting of wanting to help limit diarrhea in IBS.
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Buprenorphine. what receptors and how?
Mu partial agonist and kappa antagonist.
Buprenorphine. what inhibition can cause what?
The kappa antagonism can help cause less dysphoria. NBME Q floating around somewhere wants you to know it has the kappa effects
Tramadol. what is unique MOA?
Unique MOA where it is weak mu opioid agonist + also an SNRI.
Unique MOA where it is weak mu opioid agonist + also an SNRI.???
Tramadol
Mu partial agonist and kappa antagonist.
The kappa antagonism can help cause less dysphoria. NBME Q floating around somewhere wants you to know it has the kappa effects.
Buprenorphine.
Potent opioid often combined with acetaminophen.?
Oxycodone
ess potent than morphine; used for mild to moderate pain; in many antitussives.?
Codeine
I’ve noticed NBME likes this opioid for malingering Qs???
Meperidine
Opioid used in antitussives. actually 2 of them?
Codeine;Dextromethorphan
Methadone. receptors?
Long-acting full mu opioid agonist that is used for opioid/heroin withdrawal.
Methadone. Reduces opioid cravings.
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Long-acting full mu opioid agonist that is used for opioid/heroin withdrawal.???
Methadone
Opioid receptor antagonists. 3?
Naloxone; Naltrexone; Suboxone
Opioid receptor antagonists. Naloxone. used when?
Opioid receptor antagonist used for acute overdoses
Opioid receptor antagonists. Naltrexone. used for what?
Opioid receptor antagonist used for alcohol dependence (i.e., ̄ alcohol cravings).
Opioid receptor antagonists. Naltrexone. in what cases apart alcohol?
Can also be used for opioid dependence in patients who are already detoxified in order to prevent relapse (i.e., by blocking opioid receptors, if the patient abuses any opioids, he/she won’t feel the euphoric effects).
Opioid receptor antagonists. Suboxone. Buprenorphine + naloxone combo given orally for??
opioid addiction in those who have high risk of abuse, or those who have already abused methadone.
Opioid receptor antagonists. Suboxone.
Buprenorphine’s partial agonist effects at mu receptors help with???
cravings, but….
Opioid receptor antagonists. Suboxone.
Buprenorphine’s partial agonist effects at mu receptors help with cravings, but the naloxone is added so that if the patient …..??
crushes the suboxone and injects it, the naloxone will antagonize the opioid receptors and cause withdrawal symptoms.
However, when taken orally, the naloxone has negligible effect due to poor oral bioavailability.
Alcohol abuse drugs. Disulfiram. blocks what?
Blocks acetaldehyde dehydrogenase
Alcohol abuse drugs. Disulfiram. mechanism/CP?
If patient drinks while on the drug, he/she will experience flushing + severe discomfort, thereby disincentivizing any form of drinking.
Alcohol abuse drugs. Acamprosate. mechanism?
Acamprosate decreases alcohol withdrawal cravings by modulating glutamatergic activity.
Alcohol abuse drugs. prie acamprosate buvo:
Alcohol inhibits NMDA glutamate receptor activity, where chronic alcoholism causes upregulation of NMDA receptors and excessive glutamate transmission and excitotoxicity upon withdrawal.
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Alcohol abuse drugs. Naltrexone. As mentioned above, opioid receptor antagonist that ̄ alcohol cravings.
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