Opiod Analgesics & Antagonists

Question 1

What is the mechanism of action for opioids with supraspinal analgesic effects?

Answer 1

Opioids bind the Mu-1 receptor to stimulate the periaqueductal gray and send efferent signals that block afferent nociceptive signals

Question 2

True/False. Opioids are rarely used in acute or emergency situations for pain management.

Answer 2

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.

Question 3

What opioid antagonist may be used for treatment of alcoholism?

Answer 3

Naltrexone

Question 4

True/False. Tolerance develops to hypotension and bradycardia with opioid use?

Answer 4

False. Tolerance only develops to headache, dizziness, sedation, nausea, vomiting, respiratory depression

Question 5

What opioid receptor is most analogous with endorphins?

Answer 5

Delta

Question 6

What opioid is known to cause interactions with SSRIs?

Answer 6

Tramadol

Question 7

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?

Answer 7

The dose will need to be increased since there is a greater first pass effect with PO vs. IV.

Question 8

What opioid is commonly used to treat opioid use disorders?

Answer 8

Methadone

Question 9

What opioid receptor is associated with cardiac stimulation?

Answer 9

Sigma

Question 10

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?

Answer 10

These OD symptoms can only be treated with an anti-convulsant. Naloxone would be ineffective in treatment of these specific symptoms

Question 11

Doses should be below what morphine mg equivalent to prevent OD?

Answer 11

50 MME/day - above this, risk of OD increases x2

Question 12

True/False. Fentanyl patches should NOT be used with acute pain.

Answer 12

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.

Question 13

What is the mechanism of action for opioids with spinal analgesic effects?

Answer 13

Opioids bind the Mu-2 receptor and decrease the release of substance P. This is most often by preventing Ca2+ influx

Question 14

What is the most effective dosage schedule when using opioids to treat chronic pain?

Answer 14

Fixed dosing schedule (same time every day/set intervals)

Question 15

True/False. Higher opioid doses always lead to greater pain reduction.

Answer 15

False. In some cases, higher doses lead to hyperalgesia and increased pain.

Question 16

What is the primary cause of death due to opioid OD?

Answer 16

Respiratory Depression

Question 17

True/False. Opioids are rarely used in acute or emergency situations for pain management.

Answer 17

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.

Question 18

Many ADRs are associated with opioid use. With which ADRs does tolerance eventually develop?

Answer 18

Headache, dizziness, sedation, nausea, vomiting, respiratory depression

Question 19

Seizures associated with high dose morphine use is due to production of what metabolite?

Answer 19

Morphine-3-glucuronide

Question 20

What opioid receptors are responsible for causing constipation?

Answer 20

Mu-2

Question 21

What is the first metabolite of morphine following the first pass effect?

Answer 21

Morphine-6-glucuronide

Question 22

How long after the last dose do symptoms of opioid withdrawal begin to emerge?

Answer 22

12 hours

Question 23

How long do withdrawal symptoms from opioid use last?

Answer 23

3 to 5 days

Question 24

Naloxone may be mixed with opioids. What is the purpose?

Answer 24

Mixing a small amount of naloxone with opioids can prevent misuse and abuse of the drug

Question 25

What side effect must also be treated with chronic opioid usage?

Answer 25

Constipation due to hypomotility

Question 26

What opioid is used to treat gastric hypermobility?

Answer 26

Loperamide (Immodium)