Narcotic Analgesics

Question 1

What are the common side effects of opioids?

Answer 1

Miosis, constipation, respiratory depression
Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

Question 2

At what receptor do opioids work at? What is the mechanism of action?

Answer 2

Mu-opioid receptor agonist–>

inhibit release of substance P; inhibit ascending transmission from dorsal horn

Question 3

Which 2 opioids are used for moderate analgesia?

Answer 3

Codeine and tramadol

Question 4

Which opioid is given in patch form?

Answer 4

Fentanyl (long half life)

Question 5

Which 2 opioid agents are used to treat diarrhea? Mechanism?

Answer 5

Loperamide (Imodium)
Diphenoxylate (Lomotil)
Slows peristalsis via opioid receptors in intestine, and possibly decreased GI secretion

Question 6

Which opioid agent is rarely used for <48hrs analgesia and its congeners are used to treat diarrhea?

Answer 6

merperidine

Question 7

What are 2 opioid antagonists? Therapeutic use of each?

Answer 7

Naloxone- Acute opioid toxicity (depressed RR best predicts reponse)
Naltrexone- Alcoholism

Question 8

What is used for a breakthrough dose?

Answer 8

10% of total 24hr dose

Question 9

What are the mechanisms of opioid tolerance?

Answer 9

internalization of receptors

Question 10

What needs to be given with opioid use?

Answer 10

stimulant laxative with stool softener