module 4 opioid agents Flashcards
morphine MOA
mu receptor agonist
- min. effect on Kappa and sigma Rc
morphine AE
nausea myoclonus hallucination pruritis d/t histamine release supraspinal analgesia resp depressin euphoria sedation dec. GI motility pupil constriction
Morphine Contraindication
renal insufficiency: Inc. AE
Morphine administation
PO IM IV SubQ rectal epidural intrathecal
Codeine administration
PO IV IM SubQ Combo with: - APA - guaifenesin - promethazine
Codeine prodrug
active form: morphine
codeine use
antitussive effect without conversion
cough
hydrocodone administration
always combined with - APAP - ASA - ibuprofen - antihistamine PO
hydrocodone use
analgesic
antitussive
oxycodone administration
PO in combination with - APAP - ASA No active metabolites: safer with renal dysfunction
hydromorphone administration
PO IV IM SubQ rectal epidural - semi-synthetic - no major metabolites: safer with renal dysfunction
Methadone administration
PO IV SubQ Long half life no active metabolites: safer with renal dysfunction
methadone use
opioid addiction treatment or maintenance
daily dosed
pain management: 2-3/day
Meperidine administration
PO IV IM rectal epidural intrathecal - synthetic main metabolite: normeperidine - long half life
meperidine use
post-op for shakes/chills
epidural
spinal analgesia ST
meperidine AE
CNS excitation
anxiety
seizures
Meperidine caution
elderly
renal dysfunction
fentanyl administration
IV
transdermal patch (q72h)
transmucosal lozenge
buccal tablets
fentanyl uses
- transdermal for chronic pain: after titration with short acting opioid
- transmucosal for breakthrough pain
Fentanyl precautions
80-100X more potent than morphine
buprenorphine administration
SL
parenteral
Has a ceiling effect
buprenorphine MOA
partial agonist
- can precipitate withdrawal s/s if already on full agonist: displaces full-agonist and has less effect
buprenorphine uses
sublingual tablets: opioid dependence tx.
- alone or combined with naloxone
Heroin
3x more potent than morphine due to greater lipid solubility
- metabolized to morphine
- crosses BBB quickly
3-methylfentanyl (china white)
1000x more potent than morphine
metabolites can accumulate
opioid AE
most common: - sedation - dizzy - N/V - itching - sweating - constipation Most serious: - resp. depression
tolerance to AE of opioids
tolerance to sedative and emetic effects
no tolerance to constipation
opioid dosage
no min. or max. dose except limitation by the dose of APAP or ASA
- use dose to maintain optimum pain relief with tolerable AE
Sustained release use
chronic pain
immediate release use
breakthrough pain
PCA use (IV, SQ)
when oral route not feasible
tramadol administration
PO
metabolite 200x greater affinity for mu Rc
tramadol MOA
blocks reuptake of Norepi and serotonin
tramadol use
moderate to severe pain
tramadol AE
seizures possible w/ MAOI or antipsychotic use
only partially reversible with naloxone
