opiates Flashcards
what is the gold standard opioid analgesic
morphine
note: In addition to relief of pain, morphine also confers a state of euphoria and mental detachment
what is the opioid of choice for severe pain in palliative care
morphine
which opioids may cause withdrawal symptoms, including pain, in patients dependent on other opioids.
buprenorphine, Pentazocine
note: this is because they have both agonist and antagonist properties
which opioid has a longer duration of action than morphine
buprenorphine
which opioid, has its effects only partially reversed by naloxone hydrochloride
buprenorphine
which opioid is equivalent to heroin
diamorphine
why can diamorphine be injected in smaller volumes
because it has a greater solubility than other opioids. this is important in emaciated (abnormally thin or weak) patients
why should methadone not be administered more often than twice daily
to avoid the risk of accumulation and opioid overdosage
what is the alternative for patients who experience excitation (or exacerbation of pain) with morphine
methadone
which opioid is commonly used as a second-line drug if morphine is not tolerated or does not control the pain
oxycodone
which opioid should be avoided after myocardial infarction
Pentazocine
this is because it may increase pulmonary and aortic blood pressure as well as cardiac work
what are the benefits associated with tramadol
It has fewer of the typical opioid side-effects (notably, less respiratory depression, less constipation and less addiction potential);
name some examples of weak opioids
codeine phosphate, dihydrocodeine, Meptazinol
which opioids are used during labour
- Pethidine
- morphine or diamorphine hydrochloride (often preferred)
what is the advantage of Tapentadol
Nausea, vomiting, and constipation are less likely to occur with tapentadol than with other strong opioid analgesics
why must you avoid co-prescribing all opioids with benzodiazepines
because prescribing both of them together increases the risk of sedation, respiratory depression, coma, and death
note: if there are no alternatives + you must prescribe both together, the lowest possible doses should be given for the shortest duration
what are the contra-indications for all opioids
- acute respiratory depression
- head injury
- raised intracranial pressure
- risk of paralytic ileus (when the muscle contractions that move food through your intestines are temporarily paralyzed)
note: opioids are contraindicated in head injury + raised intracranial pressure because opioid analgesics interfere with pupillary responses vital for neurological assessment
what are the common side effects of opioids
- arrhythmias
- dry mouth
- constipation
- nausea + vomiting
- euphoric mood
- hallucinations
- urinary retention
- skin reactions
how do you treat respiratory depression caused by opioids
it may be treated by artificial ventilation or be reversed by naloxone
what can happen if opioids are given during pregnancy
Respiratory depression and withdrawal symptoms can occur in the neonate
