Moderate and other opioid agonists

Question 1

Moderate opioid agonists - 3 drugs

Answer 1

Codeine
Hydrocodone
(Propoxyphene - removed)

Question 2

Moderate opioid agonists - adm

Answer 2

Oral with nonopioid analgesic. High dose cause intolerable side effects.

Question 3

Moderate opioid agonists - indications

Answer 3

Mild to moderate pain

Alleviate or prevent coughing.

Question 4

Codeine - MOA

Answer 4

Most of the therapeutic effect is caused by metabolism to morphine.

Question 5

Explain the different effect of codeine and hydrocodone in different patients.

Answer 5

Most of therapeutic effect caused by metabolism to morphine. Pts deficient in CYP2D6 have little pain relief. Pts who are ultra-rapid metabolizers may have a higher peak, and cause intoxication of fetus/infant if pregnant/nursing.

Question 6

Other opioid agonists

Answer 6

Tramadol
Tapentadol 
Dextromethorphan 
Diphenoxylate
Loperamide

Question 7

Tramadol - MOA

Answer 7

Dual-action analgesic: agonist at μ receptors and inhibits neuronal reuptake of serotonin and norepinephrine.
Analgesic effect is only partially inhibited by opioid antagonists.

Question 8

Tramadol - indications

Answer 8

Moderate pain.

Chronic pain syndromes

Question 9

Tramadol - side effects

Answer 9

Lowers seizure threshold

Increased risk of suicidal thoughts and behaviors.

Question 10

Tapentadol - MOA

Answer 10

Acts on μ receptors and inhibit NE reuptake.

Question 11

Dextromethorphan - indications

Answer 11

Antitussive (little analgesic effect).

Used with quinidine for psuedobulbar affect in neurodegenerative disease.

Question 12

Opioids used for diarrhea

Answer 12

Diphenoxylate and loperamide.