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PHARM 2 SUMMER > Narcotics!!!!!! > Flashcards

Narcotics!!!!!! Flashcards

1
Q

which receptors do narcotics work on?

A

mu

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2
Q

what type of pain are narctoics used for?

A

severe or chronic malignant pain

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3
Q

what are the three types of opioids?

A

1) full agonist
2) Partial Agonist
3) mixed agonist/antagonist

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4
Q

MOA of narcotics

A

bind to opiate receptors in brain and spinal column and inhibit ascending paths

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5
Q

what two ways to opiate receptors relieve pain? (two ways)

A

1) increased activation of neurons that inhibit pain transmission
2) increase of endogenous opiods

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6
Q

FULL AGONISTS

A
  • bind to mu, produce endorphins - pain relief, euphoria

- the larger the dose the larger the effect

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7
Q

is there a celling for analgesic effects of full agonists?

A

no

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8
Q

What type of pain do you use a full agonist for?

A

moderate to severe acute or chronic pain

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9
Q

Morphine

A
  • prototype
  • extensive first pass
  • caution in renal insuficiency pts. bc toxic metabolite
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10
Q

Oxycondone

A
  • oral only
  • Semi-synthetic derivative of MSO4- morphine
  • 9.5 times more potent than oral codeine
  • 1.5 times more potent than morphine
  • extended release available
  • tamper deterent available
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11
Q

Roxanol

A

concentrated morphine liquid

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12
Q

MSIR

A

imediate release morphine

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13
Q

MSContin

A

extended release morphine

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14
Q

Oxymorphone

A
  • metabolite of oxycodone
  • IV and PO
  • 3x more potent than morphine
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15
Q

Hydromorphone

A
  • IV. Rectal, PO
  • semi-synthetic
  • safer choice for renal compromised
  • once daily
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16
Q

Fentanyl

A
  • IV, intrathecal, epidural, transdermal, intranasal and oral transmucosal formulations
  • 100 times more powerful than MSO4
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17
Q

Fentanyl starting tritration

A

initial titration with a short-acting opioid until they reach steady state ~72 hrs

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18
Q

heating pad and fentanyl

A

increased exertion, or high fever could increase release of drug and risk for respiratory depression

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19
Q

Methadone

A
  • LONG 1/2 life
  • Dose-related QT prolongation, torsades & death have been reported
  • 1st line in CA
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20
Q

1st line treatment of CA includes ___

A

-methadone

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21
Q

frequency of dosing for methadone is…

A
  • every 8 hrs for pain

- once/day for addiciton

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22
Q

Meperidine

A
  • only use for less than 48 hours

- 30 hour 1/2 life

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23
Q

What adverse effects are cause by meperidine?

A

dysphoria, irritability, tremors, seizure, antimuscaneric effect

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24
Q

scary thing about meperidine…

A

If recent use of MAOI, meperidine can cause severe encephalopathy and death

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25
Q

What is Codeine converted to?

A

morphine

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26
Q

What is the issue with codeine and rapid metabolizers?

A

rapidly metabilize codine to morphine which produces a higher level of toxins

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27
Q

When is codeine contraindicated?

A

it is contraindicated in children undergoing tonsilectomy and/or adenoidectomy

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28
Q

Is hydrocodone a synthetic or natural opiod?

A

synthetic

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29
Q

what is hydrocodone metabolized into?

A

hydromorphine

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30
Q

what is hydrocodone often combined with?

A

acetaminophen or ibuprofen

31
Q

zohydro

A

pure hydrocodone

32
Q

vicodin

A

hydrocodone + 300 mg acetominiphen

33
Q

Norco

A

hydrocodone and 326 acetominophin

34
Q

Is Tapentadol a full agonist , partial agonist, or combination?

A

Full agonist and a NE reuptake inhibitor

35
Q

Absolute contraindication of Tapentadol is what?

A

DO NOT USE WITH AN MAOI. Wait 14 days

36
Q

Tramadol what type of narcotic and what is the MAOI?

A
  • centrally-acting agonist
    -blocks reuptake of norepinephrine and serotonin
    binds to a narcotic receptor too but weakly
37
Q

What are the adverse reactions of tramadol?

A
  • lowers seizures threshold
  • TCAs SSRI, MAOI, and other opiods and antipsychotics can increase lowered seizure threshold
  • nausea and dizziness
38
Q

When is tramadol contraindicated?

A
  • Hx of seizure, on another med that causes seizures

- increased risk of suicide

39
Q

What is the MOA of partial agonists?

A

bind primarily to mu opioid receptors and cause them to produce endorphins

40
Q

Name 3 partial agonists

A

Buprenorphine (Butrans)
Buprenorphine & naloxone (Suboxone)
Buprenorphine ER (Subutex

41
Q

What happens as the dosage of partial agonists increases?

A

-When the dosage of a partial agonist is increased, there is only a small increase, if any, in the production of endorphins

42
Q

Mixed agonist/ antagonist list

A
  • stimulate and antagonize the narcotic receptor
  • analgesic effect

Butorphanol (Stadol)- only one used

43
Q

What is morphine and hydromorphine metabolized to?

A

M3G

44
Q

what can M3G cause?

A

it is a neurotoxin and can cause seizures

-produces ADRs in patients with Renal failure

45
Q

What does Meperidine become? wha can it cause?

A

Normerperidine

- It is toxic and cause seizures in patients with renal failure , elderly or on a high dose for a long time

46
Q

what are the 3 main effects of Narcotic Receptor stimulation?

A
  • Euphoria
  • Sedation
  • Respiratory depression
47
Q

What narcotic is often used for cough supression?

A

codeine

48
Q

Miosis

A

caused by narcotic

constriction of puols

49
Q

Nausea and Vomiting

A

caused by narcotics

50
Q

List the peripheral effects of narcotics

A 
CVS
GI & biliary tract
GU
Uterus
Pruritus
Miscellaneous
51
Q

If a pt. has CVS dz or is hypovolemic what may narcotics cause?

A

-they will casue blood vessel dilatation and hypotension

52
Q

What narcotic has anticholinergic effects and what can it cause?

A

Meperidine can cuase tachycardia

53
Q

GI effects of Narcotics

A
  • constipation that does not diminish with continued use

- Nillary contraction- pain if gallstones

54
Q

what are two ways to alive narcotic pt. constipation?

A

docyate sodium- stool softener

-novanta- specific for pain med pts.

55
Q

GU side effects

A

urinary retention

56
Q

Uterine side effects of narcotics are..

A

decrease uterine contraction-> prolong labor

57
Q

Why do narcotics cause pruritis and what can you take as profylaxis?

A
  • histamine release

- profylaxis: diphenhydramine

58
Q

When does tolerance to narcotics start?

A
  • 2-3 weeks

- the only thing that doesnt decrease with tolerance is miosis, constipation and seizures

59
Q

Opioid rotation

A

change drugs, you change receptor types and therefore get greater affect from the new receptors, receptor upregulation and down regulation

60
Q

Symptoms of withdrawl

A

nausea, vomiting, lacrimation, rhinorrhea, mydriasis, piloerection, sweating, diarrhea) & CNS arousal (irritability & dysphoria

61
Q

contraindication to narcotics

A

1) Head injury- bc increase blood flow to head
2) pregnancy- fdetus becomes dependent
3) impaired respiratory fcn
4) impaired renal fxn

62
Q

what happens when benzos/sleeping aids are combined with narcotics?

A

increased CNS depression

63
Q

what happens when antipsychotics are combined with narcotics?

A

increased sedation

64
Q

what happens when MAOIs are combined with narcotics?

A

HTN

65
Q

Use of narcotics for analgesia

A

Using narcotics at fixed intervals (scheduled) is more effective for pain relief than on demand use (using just when pain is really bad)

66
Q

Narcotics and Pulmonary Edema

A

IV morphine decreases SOB by decreasing anxiety, preload and afterload

67
Q

Dextromethorphan

A

no euphoric effect but supresses cough

68
Q

diphenoxylate

A

used for diarrhea

69
Q

Use of narcotics in anesthesia

A

-sedate and decrease pain and axiety before enter OR-used more in cardiovascular surgery

70
Q

Naloxone (Narcan)

A

Bind to but do not stimulate the narcotic receptor and end up blocking effects of other agonists

-short 1/2 life, reinject every 2 hours

71
Q

Naltrexone (ReVia)

Nalmefene (Revex)

A

Used in maintenance programs and can block heroin effects for up to 48 hours

72
Q

Naltrexone (ReVia)

A

oral, long 1/2 life, lasts for 48 hours

-also given to addicts every other day to prevent ppl in recovery from getting hgih

73
Q

Nalmefene (Revex)

A

newest long 1/2 life, injectable

PHARM 2 SUMMER (3 decks)

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