NEURO: OPIOIDS, WEAK

Question 1

OPIOIDS, WEAK: INDICATIONS

Answer 1

• Mild to moderate pain (post op, when other options do not work)

Question 2

OPIOIDS, WEAK: MOA

Answer 2

• Opioid mu receptors agonists, stronger
• 10% of caucasian population - CYTOCHROME P450 2D6 = find codeine and dihydrocodeine ineffective
• Tramadol = and its active metabolite are u-receptor agonists -> serotenergic and adrenergic pathways, seretonergic and noradrenaline reuptake inhibitor

Question 3

OPIOIDS, WEAK: ADVERSE EFFECTS

Answer 3

• Nausea
• Constipation
• Dizziness and Drowsiness
• Neurological and respiratory depression
• TRAMADOL - less constipation and resp depression than other opioids
• Codeine and dihydrocodeine = never give IV (causes a similar reaction to ANAPHYLAXIS)

Question 4

OPIOIDS, WEAK: WARNINGS

Answer 4

• Significant respiratory dx
• Reduce doses in renal and hepatic impairment
• Elderly
• Tramadol lowers seizure threshold and is best avoided in patients with epilepsy, and should not be used in patients with uncontrolled epilepsy

Question 5

OPIOIDS, WEAK: INTERACTIONS

Answer 5

• Other sedating drugs (eg antipsychs, benzos, TCAs)

- Tramadol => not used with other drugs that reduce seizure threshold (SSRIs and TCAs)

Question 6

OPIOIDS, WEAK: EXAMPLES

Answer 6

• Tramadol
• Codeine
• Dihydrocodeine