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Fall Pharm Block 3 > Narcotics > Flashcards

Narcotics Flashcards

1
Q

Name the three main properties of opioids.

A

Analgesia, Antitussive, Constipation

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2
Q

Define opioid.

A

Generic term for natural and synthetic substances that bind opioid receptors.

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3
Q

Name the three types of opioid receptors.

A

Delta, Mu, Kappa

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4
Q

What results from opioid receptor agonism?

A

Reduction is secretion of pain inducing neurotransmitters.

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5
Q

What is the dose limiting adverse effect of narcotics?

A

Respiratory depression

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6
Q

List additional adverse effects of narcotics other than the dose limiting A/E.

A

Sedation, reduced peristalsis, pruritis (HST), N/V, miosis, peripheral vasodilation (causing HypoTN)

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7
Q

Why might narcotics cause worsening pain in patients with pancreatic disease?

A

Narcotics cause contraction of the sphincter of Oddi increasing pressure on the biliary tree.

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8
Q

Which narcotic is the best option for pain in patients with pancreatic disease?

A

Meperidine

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9
Q

What is the antidote for narcotics and what is the potential adverse effect?

A

Naloxone - may cause acute withdrawal

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10
Q

How is naloxone distributed to EMTs and lay people in Kentucky?

A

injection and inhaled forms

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11
Q

What two factors primarily affect the kinetics of different narcotic agents?

A

half life and volume of distribution

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12
Q

What narcotic binds to plasma esterases and how does this affect its kinetics?

A

Remifentanil - causes the drug to have a very short half life

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13
Q

T/F: The effects of narcotics are consistent from one person to the next for a given dose.

A

False - wide variability

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14
Q

List 5 routes of administration for narcotics mentioned in class.

A

IV, SC, TD (transdermal - patch), IT (intrathecal - in the spine), PCA (patient conroled - pump)

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15
Q

What pharmacokinetic characteristic differentiates morphine from most other opioids?

A

Morphine is highly water soluble

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16
Q

Why is morphine the preferred narcotic in chest pain?

A

Reduces sympathetic tone and causes less reflex tachycardia compared to other narcotics.

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17
Q

Differentiate PO morphine from IV morphine and explain why?

A

PO morphine requires 6 times the IV dose to have the same effect because PO morphine is significantly impacted by first pass effect in the liver.

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18
Q

Describe the potency of meperidine relative to morphine.

A

Much less potent –> 75-100 mg meperidine = 10mg morphine

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19
Q

Describe the pharmacokinetcs of meperidine relative to the liver and kidneys.

A

Meperidine is metabolized to normeperidine in the liver. Normeperidine accumulates in renal failure patients resulting in a decreased seizure threshold.

20
Q

Why does meperidine have more of a role in obstetrics than other narcotics?

A

Most narcotics decrease uterine contractions and prolong labor. Meperidine does not have this effect.

21
Q

Why is meperidine avoided in chest pain?

A

reflex tachycardia

22
Q

T/F: Meperidine is a weak antitussive and has anticholinergic properties.

A

True

23
Q

List and describe the three drugs used to ween addicts off of narcotics.

A
  1. Naltrexone: Long acting form of naloxone that reduces euphoria in stable addicts.
  2. Methadone: Very long acting narcotic with large Vd.
  3. Bupenorphine: Opioid agonist/antagonist
24
Q

What is the injectable form of naltrexone?

A

Vivitrol

25
Q

What is the common name for diamorphine and what is special about its distribution?

A

Diamorphine = heroin. It is morphine bound to fat allowing it to easily cross the blood brain barrier.

26
Q

What is the primary use of codeine?

A

Pain above the shoulders (dental pain)

27
Q

What NSAID is codeine combined with to make Codeine #3?

A

Acetaminophen - APAP

28
Q

Compare the potency of oxycodone with morphine.

A

Oxycodone is 2x more potent than morphine.

29
Q

With what NSAIDs is oxycodone combined and in what distribution forms?

A

Combined with aspirin and acetaminophen in immediate release and controlled release forms.

30
Q

Name the drug combinations that form percocet and percodan.

A 
Percocet = Oxycodone + APAP
Percodan = Oxycodone + ASA
31
Q

How is hydrocodone most commonly available?

A

In several co-formulations

32
Q

Name two coformulations of hydrocodone and APAP.

A

Vicodin and Lortab

33
Q

What are the two narcotics most commonly used to treat outpatient pain?

A

Oxycodone and hydrocodone

34
Q

Describe the potency of hydromorphone compared to morphine.

A

PO is 5 x more potent and IV 8 x more potent.

35
Q

What is the caution with methadone and why is it a concern?

A

Prolongs QT interval –> can cause torsades

36
Q

What is true about the half life of fentanyl?

A

Very short half life (short acting) but the half life increases at higher doses.

37
Q

Describe the potency of fentanyl.

A

Most potent narcotic –> 100x potency of morphine

38
Q

Why is fentanyl often used as a TD patch and how often should the patch be replaced?

A

Fentanyl has high lipophilicity and the patch should be replaced every 72 hours.

39
Q

By what factors do fentanyl analogues differ from each other.

A

Differ in potency and half life

40
Q

How is dextromethorphan related to other narcotics and how is it used?

A

4th cousin to narcotics - used as an antitussive

41
Q

What is the initial dose of naloxone for opioid OD and what is the dose if given via ET tube?

A

2mg - double the dose via ETT

42
Q

Which narcotics require a significantly increased amount of naloxone to reverse an overdose?

A

Pentazocine, propoxyphene, codeine, methadone

43
Q

What is true about the half life of naloxone compared to opioids and how is this managed?

A

Opioids have a longer half life than naloxone. After initial naloxone bolus, infuse at an hourly rate that is 2/3 the amount required to reverse the OD.

44
Q

In addition to opioid use, what other substance is PO naltrexone used for?

A

Alcohol dependence

45
Q

How often is vivitrol redosed.

A

Injected q month

46
Q

What drug, related to naltrexone, is used for opioid induced constipation?

A

Methylnaltrexone

Fall Pharm Block 3 (8 decks)

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