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Neuro - Week 2 > Opiates & Analgesics > Flashcards

Opiates & Analgesics Flashcards

1
Q

the point the individual perceives the response as pain

A

pain threshold

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2
Q

The ability of the individual to experience pain without initiation of pain responses

A

Pain tolerance

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3
Q

Painful stimuli are sensed by peripheral nociceptive of these types of neurons via ion channels that convert stimuli to membrane potential changes

A

C or Aδ

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4
Q

Mu receptor that functions in analgesia and euphoria

A

Mu1

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5
Q

Mu receptor that functions in bradycardia and respiratory depression

A

Mu2

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6
Q

Component of G protein that modulates ion channels in opioids

A

Beta and gamma

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7
Q

What effect do opioids have on BP?

A

Causes hypotension
(at moderate to high doses)

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8
Q

What effect do opioids have on heart rate?

A

Causes bradycardia
(at moderate to high doses)

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9
Q

What effect do opioids have on repiration?

A

Depress respiration

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10
Q

Opioids can cause respiratory depression and cerebral vessel dilation, so they are contraindicated in this

A

Head trauma or severe brain injury

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11
Q

Opioid use is cautioned in patients with asthma or COPD due to the release of this

A

Histamine

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12
Q

Opioids chronically suppresse hypothalamic-pituitary-gonadal axis to trigger this

A

Opioid-induce androgen deficiency (OPIAD)

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13
Q

Opioids chronically suppress this to trigger opioid-induced androgen deficiency (OPIAD)

A

Hypothalamic-pituitary-gonadal axis

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14
Q

No opioid tolerance develops to either of these effects

A

Miosis and constipation

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15
Q

Peripheral opioid antagonist that is administered orally

A

Naloxegol

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16
Q

Peripheral opioid antagonist that is a subcutaneous injectable

A

Methylnaltrexone

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17
Q

Naloxegol and Methylnaltrexone are antagonists to this

A

Peripheral opioid antagonists

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18
Q

Benzodiazepines should not be used with these drugs due to profound sedation, respiratory depression, coma and risk of death

A

Opiates

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19
Q

This type of drug should not be used with opiates due to profound sedation, respiratory depression, coma and risk of death

A

Benzodiazepines

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20
Q

Is dependence likely when morphine is used for pain?

A

Rare

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21
Q

Does meperidine have a short or long duration of action?

A

Short

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22
Q

Meperidine is converted to this product that is not conjugated, non-analgesic, proconvulsant, and hallucinogenic

A

Normeperidine

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23
Q

Normeperidine is a product of biotransformation of this drug

A

Meperidine

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24
Q

Is Normepederidine (a product of biotransformation of meperidine) analgesic?

A

No

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25
Q

Normepederidine (a product of biotransformation of meperidine) has these two effects

A

Proconvulsant
Hallucinogen

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26
Q

Opiate that has anticholinergic activity, and may cause seizures

A

Meperidine

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27
Q

Opiate that has anticholinergic activity, and has potential for serotonin syndrome if combined with serotonin reuptake inhibitors

A

Meperidine

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28
Q

Opiate that is contraindicated in epilepsy, cardiac disease, and use with MAOI (due to malignant hyperthermia)

A

Meperidine

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29
Q

Why is Meperidine contraindicated in patients with epilepsy?

A

It has anticholinergic activity and cause cause seizures

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30
Q

Meperidine use is contraindication with MAOI’s because concurrent use can cause this

A

Malignant hyperthermia

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31
Q

Meperidine use is contraindicated with this type of drug due to malignant hyperthermia

A

MAOIs

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32
Q

What is the main issue with use of Fentanyl, Alfentanil, Sufentanil, Remifentanil?

A

Potency

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33
Q

Fentanyl, Alfentanil, Sufentanil, Remifentanil are contraindicated in this

A

Pregnancy
(respiratory depression of mother and newborns; increased sudden infant deaths)

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34
Q

Opiates where potency is an issue

A

Fentanyl et al.
(Alfentanil, Sufentanil, Remifentanil)

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35
Q

Opiates that may cause respiratory depression of mother and newborns; increased sudden infant deaths

A

Fentanyl et al.
(Alfentanil, Sufentanil, Remifentanil)

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36
Q

Synthetic opioid that also is an antagonist at (NMDA) receptor and weak inhibitor of norepinephrine and serotonin uptake

A

Methadone

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37
Q

Methadone is a synthetic opioid that also is an antagonist at this receptor

38
Q

Methadone is a synthetic opioid that also is an antagonist at (NMDA) receptor and weak inhibitor of uptake of these 2 compounds

A

Norepinephrine and serotonin

39
Q

Opioid that may be used in nociceptive pain (mu) and neuropathic pain (NMDA and uptake inhibition)

40
Q

Is Methadone short or long lasting?

A

Long
orally active

41
Q

Does Methadone cause euphoria?

42
Q

Opioid that is often combined with aspirin or acetaminophen

43
Q

Opioid that has a high degree of histamine release and vasodilation

44
Q

Codeine has a high degree of release of this

45
Q

What effect does Codeine have on vessels?

A

High degree of vasodilation

46
Q

2 opioids that are weak inhibitors of norepinephrine and serotonin reuptake

A

Tramadol and Tapentadol

47
Q

Tramadol and Tapentadol are weak inhibitors of reuptake of these two compounds

A

Norepinephrine and Serotonin

48
Q

With use of Tramadol and Tapentadol, why is respiratory depression less than predicted by analgesic action?

A

Because they are weak inhibitors of norepinephrine and serotonin reuptake

49
Q

Tramadol and Tapentadol may interact with this type of agent

A

Monoaminergic agents
(especially MAO uptake inhibitors and other reuptake inhibitors)

50
Q

Opiate that has a convulsant metabolite that restricts use to short term

A

Meperidine

51
Q

This opiate and related compounds are very potent so be careful as small doses are powerful (cannot be used during pregnancy or after surgery)

52
Q

Opiate that has a long duration of action and allows once daily dosing

53
Q

Opiate that has a very high profile of histamine release

54
Q

2 opiates that enhance norepinephrine and serotonin activity that may reduce opiate-induced respiratory depression

A

Tramadol and Tapentadol

55
Q

Yawning is characteristic of this stage of opiate withdrawal syndrome

A

Stage 1
(also involves anxiety and drug craving)

56
Q

Piloerection (“cold turkey skin”) is characteristic of this stage of opiate withdrawal syndrome

A

Stage 3
(also involves tachycardia, nausea and vomiting, hypertension, tremors, spasms, seizures)

57
Q

Do mixed agonists/antagonists have physical dependence potential?

58
Q

Is withdrawal a problem with mixed agonists/antagonists?

A

Potential to induce withdrawal in opioid-dependent
Is milder (like meperidine/Demerol)

59
Q

Opioid that is both a partial agonist and mixed agonist/antagonist:
Low antagonist action (less risk of triggering withdrawal in dependent patient)
Low abuse potential

A

Buprenorphine

60
Q

Does Buprenorphine have abuse potential?

61
Q

Buprenorphine has low action of this; leading to less risk of triggering withdrawal in dependent patient

A

Low antagonist action

62
Q

Opioid that is both a partial agonist and mixed agonist/antagonist:
Respiratory depression that does occur is not easily or fully reversed by naloxone

A

Buprenorphine

63
Q

QT prolongation has been noted in this opioid that is both a partial agonist and mixed agonist/antagonist

A

Buprenorphine

64
Q

Opioid that is both a partial agonist and mixed agonist/antagonist:
Contraindicated in heart patients or epileptics
(contraindications similar to morphine)

A

Pentazocine

65
Q

Pentazocine is contraindicated in patients with either of these 2 conditions

A

Heart patients
Epileptics

66
Q

Butorphanol, Buprenorphine, Nalbuphine and Pentazocine are opioids that are both partial agonists and this

A

Mixed agonists/antagonists

67
Q

Butorphanol, Buprenorphine, Nalbuphine and Pentazocine are opioids that are both mixed agonists/antagonists and this

A

Partial agonists

68
Q

Opioid receptor antagonist that blocks craving and subjective effects of opioids and alcohol

A

Naltrexone

69
Q

Combining this opioid receptor antagonist with ketoconazole (CYP 3A4 inhibitor) may trigger withdrawal, as levels may increase nearly 13 fold

70
Q

Combining Naloxegol with this drug may trigger withdrawal, as levels may increase nearly 13 fold

A

Ketoconazole (CYP 3A4 inhibitor)

71
Q

Are Naloxegol or Methylnaltrexone centrally or peripherally acting for opioid-induced constipation?

A

Peripherally

72
Q

Opioid receptor antagonist that may be used for alcohol dependence

A

Naltrexone

73
Q

Naloxone and Naltrexone are this type of drug

A

Opioid receptor antagonists

74
Q

Naloxegol and Methylnaltrexone are this type of drug

A

Opioid receptor antagonists
(peripherally acting for opioid-induced constipation)

75
Q

Only this isomer of opiates causes most of the action

76
Q

Both D or L forms of opiates can have this effect

A

Antitussive

77
Q

Pinpoint pupils and depressed respiration are highly suggestive of overdose of this

78
Q

These 2 effects are highly suggestive of opiate overdose

A

Pinpoint pupils
Decreased respiration

79
Q

What are opioid receptor antagonists used for?

A

Opiate overdosage and reversal
(Naltrexone also used for alcohol dependence)

80
Q

Narcan nasal spray uses this opioid

81
Q

Use of this opiate is associated with increased risk of QT prolongation (sudden cardiac death)

82
Q

Codeine is converted to this

83
Q

This type of opioid has lower abuse potential and may trigger withdrawal if used in a patient dependent on a different opiate

A

Mixed agonists/antagonists

84
Q

Opioid that has very low antagonist activity noted, reported to have low levels of euphoria making it less likely to be abused, may be difficult to reverse using naloxone (requires very large doses at times)

A

Buprenorphine

85
Q

Is withdrawal from opioids usually life-threatening or dangerous?

86
Q

Piloerection, mydriasis, diarrhea and yawning are important signs of this

A

Opioid withdrawal

87
Q

This drug (NOT an opiate) is a selective allosteric inhibitor of voltage-gated sodium channel NaV1.8 that functions peripherally

A

Suzetrigine

88
Q

This opiate may be difficult to reverse using naloxone (requires very large doses at times)

A

Buprenorphine

89
Q

Which mixed opioid agonist/antagonist has the lowest risk of abuse?

A

Buprenorphine

90
Q

What antagonist can reverse the respiratory depression of opiates?

Neuro - Week 2 (10 decks)

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