Module 5: Unit D Opioids Flashcards
What are the effects of opioid use in the preconceptual period?
Opioid use in the periconceptional period appears to be associated with a 2.2-fold increased risk of neural tube defects
Opioids-Strong agonist example
Morphine
Hydromorphone
Demerol
Fentanyl
Indication strong-agonist (morphine, etc.)
Moderate to severe pain (post-op pain, labor and delivery pain, chronic cancer pain).
MOA Morphine, etc.
Activate Mu and Kappa receptors. Produce analgesia, resp depression, and euphoria.
Safety in morphine (strong agonist)
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.
BBW morphine, hydromorphone, etc.
Resp depression in both opioid naïve and opioid-tolerant patients. Monitor for resp depression, especially after new-onset therapy or escalation in does.
Indication Methadone
Medicated assisted treatment
MOA methadone
Activate Mu and Kappa receptors. Produce analgesia, resp depression, and euphoria.
Safety methadone:
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.
Opioids-Moderate agonist example
Codeine
Hydrocodone
oxycodone
indication opiod-moderate (codeine)
Mild to moderate pain
Effective cough suppressant
MOA Codeine
bind to mu-opioid receptors in the brain. This produces endorphins and gives pain relief.
Safety codeine
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.
BBW codeine
CYP2D6 ultrarapid metabolizers have led to death in children and breastfeeding infants
Opioids Partial agonist example
Buprenorphine (Subutex)
MOA subutex
Partial agonist at mu-opioid receptors and a full antagonist at kappa receptors
Safety subutex
When used in the treatment of addiction, do not begin the partial agonist until withdrawal from the opioid has begun
Opioids Mixed agonist-antagonist example
Butorphanol (Stadol), nalbuphine (Nubain)
indication stadol
Moderate to severe pain
MOA stadol
act weakly on the Mu receptor but strongly at the Kappa receptor
Safety stadol
Use with caution in opioid-addicted patients as they could cause withdrawal symptoms.
Narcotic like
(non-opioid centrally acting analgesic) example
Tramadol (Ultram)
INdication tramadol (ultram)
Moderate to severe pain
MOA tramadol
Analog of codeine -weak agonist of Mu receptor, blocks the reuptake of norepinephrine and serotonin.
Safety Tramadol
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.
