Opiod Analgesics & Antagonists Flashcards
What is the mechanism of action for opioids with supraspinal analgesic effects?
Opioids bind the Mu-1 receptor to stimulate the periaqueductal gray and send efferent signals that block afferent nociceptive signals
True/False. Opioids are rarely used in acute or emergency situations for pain management.
True. Pain can be used as a diagnostic tool to locate the source of a problem. Suppressing pain in emergency situations can delay the identification of the issue.
What opioid antagonist may be used for treatment of alcoholism?
Naltrexone
True/False. Tolerance develops to hypotension and bradycardia with opioid use?
False. Tolerance only develops to headache, dizziness, sedation, nausea, vomiting, respiratory depression
What opioid receptor is most analogous with endorphins?
Delta
What opioid is known to cause interactions with SSRIs?
Tramadol
A patient is prescribed morphine via IV during an inpatient stay. Upon discharge, the patient is switched to morphine PO. What action will need to be taken by the provider with regard to doasge?
The dose will need to be increased since there is a greater first pass effect with PO vs. IV.
What opioid is commonly used to treat opioid use disorders?
Methadone
What opioid receptor is associated with cardiac stimulation?
Sigma
Demerol is a powerful opioid stimulant. Chronic administration can lead to tremors, muscle twitches, and seizures. How would an OD causing these symptoms be treated?
These OD symptoms can only be treated with an anti-convulsant. Naloxone would be ineffective in treatment of these specific symptoms
Doses should be below what morphine mg equivalent to prevent OD?
50 MME/day - above this, risk of OD increases x2
True/False. Fentanyl patches should NOT be used with acute pain.
True. Drugs administered via patch take time to enter the bloodstream and begin working. For this reason, fentanyl patches are contraindicated for acute and post-op pain.
What is the mechanism of action for opioids with spinal analgesic effects?
Opioids bind the Mu-2 receptor and decrease the release of substance P. This is most often by preventing Ca2+ influx
What is the most effective dosage schedule when using opioids to treat chronic pain?
Fixed dosing schedule (same time every day/set intervals)
True/False. Higher opioid doses always lead to greater pain reduction.
False. In some cases, higher doses lead to hyperalgesia and increased pain.
What is the primary cause of death due to opioid OD?
Respiratory Depression
True/False. Opioids are rarely used in acute or emergency situations for pain management.
True. Pain can be used as a diagnostic tool to locate the source of a problem. Suppressing pain in emergency situations can delay the identification of the issue.
Many ADRs are associated with opioid use. With which ADRs does tolerance eventually develop?
Headache, dizziness, sedation, nausea, vomiting, respiratory depression
Seizures associated with high dose morphine use is due to production of what metabolite?
Morphine-3-glucuronide
What opioid receptors are responsible for causing constipation?
Mu-2
What is the first metabolite of morphine following the first pass effect?
Morphine-6-glucuronide
How long after the last dose do symptoms of opioid withdrawal begin to emerge?
12 hours
How long do withdrawal symptoms from opioid use last?
3 to 5 days
Naloxone may be mixed with opioids. What is the purpose?
Mixing a small amount of naloxone with opioids can prevent misuse and abuse of the drug
What side effect must also be treated with chronic opioid usage?
Constipation due to hypomotility
What opioid is used to treat gastric hypermobility?
Loperamide (Immodium)
