Module 5: Unit D Opioids

Question 1

What are the effects of opioid use in the preconceptual period?

Answer 1

Opioid use in the periconceptional period appears to be associated with a 2.2-fold increased risk of neural tube defects

Question 2

Opioids-Strong agonist example

Answer 2

Morphine
Hydromorphone
Demerol
Fentanyl

Question 3

Indication strong-agonist (morphine, etc.)

Answer 3

Moderate to severe pain (post-op pain, labor and delivery pain, chronic cancer pain).

Question 4

MOA Morphine, etc.

Answer 4

Activate Mu and Kappa receptors. Produce analgesia, resp depression, and euphoria.

Question 5

Safety in morphine (strong agonist)

Answer 5

Respiratory depression death from overdose. Avoid in the young and old, avoid with resp disease (asthma COPD).
Causes orthostatic hypotension, urinary retention, emesis, sedation, neurotoxicity, and tolerance and dependence.
Many see textbook charts but especially CNS depressants, Benzos, and alcohol.

Question 6

BBW morphine, hydromorphone, etc.

Answer 6

Resp depression in both opioid naïve and opioid-tolerant patients. Monitor for resp depression, especially after new-onset therapy or escalation in does.

Question 7

Indication Methadone

Answer 7

Medicated assisted treatment

Question 8

MOA methadone

Answer 8

Activate Mu and Kappa receptors. Produce analgesia, resp depression, and euphoria.

Question 9

Safety methadone:

Answer 9

Respiratory depression death from overdose. Avoid in the young and old, avoid with resp disease (asthma COPD).
Causes orthostatic hypotension, urinary retention, emesis, sedation, neurotoxicity, and tolerance and dependence.
Many see text charts but esp CNS depressants, Benzos, and alcohol.
Methadone prolongs Qt interval (ECG) before starting.

Question 10

Opioids-Moderate agonist example

Answer 10

Codeine
Hydrocodone
oxycodone

Question 11

indication opiod-moderate (codeine)

Answer 11

Mild to moderate pain

Effective cough suppressant

Question 12

MOA Codeine

Answer 12

bind to mu-opioid receptors in the brain. This produces endorphins and gives pain relief.

Question 13

Safety codeine

Answer 13

Not be used to treat pain or cough, and tramadol should not be used to treat pain in children younger than 12 years.

Recommend against their use in adolescents between 12 and 18 years who are obese or have conditions such as obstructive sleep apnea or severe lung disease, which may increase the risk of serious breathing problems.
Not recommended when taking codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants. These can include excess sleepiness, difficulty breastfeeding, or serious breathing problems that could result in death.

Question 14

BBW codeine

Answer 14

CYP2D6 ultrarapid metabolizers have led to death in children and breastfeeding infants

Question 15

Opioids Partial agonist example

Answer 15

Buprenorphine (Subutex)

Question 16

MOA subutex

Answer 16

Partial agonist at mu-opioid receptors and a full antagonist at kappa receptors

Question 17

Safety subutex

Answer 17

When used in the treatment of addiction, do not begin the partial agonist until withdrawal from the opioid has begun

Question 18

Opioids Mixed agonist-antagonist example

Answer 18

Butorphanol (Stadol), nalbuphine (Nubain)

Question 19

indication stadol

Answer 19

Moderate to severe pain

Question 20

MOA stadol

Answer 20

act weakly on the Mu receptor but strongly at the Kappa receptor

Question 21

Safety stadol

Answer 21

Use with caution in opioid-addicted patients as they could cause withdrawal symptoms.

Question 22

Narcotic like

(non-opioid centrally acting analgesic) example

Answer 22

Tramadol (Ultram)

Question 23

INdication tramadol (ultram)

Answer 23

Moderate to severe pain

Question 24

MOA tramadol

Answer 24

Analog of codeine -weak agonist of Mu receptor, blocks the reuptake of norepinephrine and serotonin.

Question 25

Safety Tramadol

Answer 25

Minimal resp depression
Sedation
Intensify other CNS depressants.
Not for use with MAOIs,
Can cause serotonin syndrome if used with SSRIs

Contraindicated in children younger than 18 years to treat pain after surgery to remove the tonsils and/or adenoids.