NEURO: OPIOIDS STRONG

Question 1

OPIOIDS STRONG: INDICATIONS

Answer 1

• Acute severe pain, Post MI
• Chronic pain when paracetamol, weak NSAIDs and opioids are insufficient
• Relief of breathless in end of life care
• Anxiety and breathlessness in acute pulmonary odema

Question 2

OPIOIDS STRONG: MOA

Answer 2

• Activation of opioid mu receptors in the CNS = reduce neuronal excitability and pain transmission
• In the medulla, blunt the reponse to hypoxian and hypercapnoea, reducing respiratory drive and breathlessness
• Reduce sympathetic nervous system => reduce cardiac workload and oxygen demand of the tissue

Question 3

OPIOIDS STRONG: ADVERSE EFFECTS

Answer 3

• Respiratory depression
• Neurological depression
• Chemoreceptor trigger zone = nausea and vomiting
• Pupillary constriction
• Constipation
• Itching
• Tolerance and dependence
• Withdrawal syndrome

Question 4

OPIOIDS STRONG: WARNINGS

Answer 4

• Avoid in Hepatic and renal failure
• Elderly
• Patients with reduced repiratory drive
• Biliary Colic patients

Question 5

OPIOIDS STRONG: INTERACTIONS

Answer 5

• Avoid when other sedating drugs are used (eg - antipsychotics, benzos, TCAs)

Question 6

OPIOIDS STRONG: EXAMPLES

Answer 6

• Morphine

- Oxycodone