Opiods

Question 1

Mu endogenous ligands

Answer 1

B-endorphin
endomorphin
Enkephalin
Dynorphin A>B

Question 2

Mu agonists

Answer 2

Morphine and other pure agonists

Question 3

Mu1 effects

Answer 3

Supraspinal analgesia
Sedation
Hypothermia
Euphoria
Physical dependance

Question 4

Mu2 effects

Answer 4

Spinal analgesia
sedation
respiratory depression
GI transit decrease
brady cardia

Question 5

Delta endogenous Ligands

Answer 5

Met and leu enkephalin, B-endorphin

Question 6

Delta agonists

Answer 6

Sufentanil (weak)

Question 7

Delta Effects

Answer 7

analgesia
Antidepressant

Less: GI decrease/
Physical dependence/
respiratory depression than Mu

Question 8

Kappa endogenous ligands

Answer 8

Dynorphin A&B

Question 9

Kappa agonists

Answer 9

Butophanol > other partial agonists/antagonists

Question 10

Kappa Effects

Answer 10

K1 - Spinal analgesia
K3 - supraspinal analgesia
Miosis
physical dependence
GI tract decrease
Averse behavioral effects (psychotomimesis/dysphoria, sedation, diuresis)

Question 11

Respiratory depression mechanisms

Answer 11

1) depress neurogenic drive in medula

2) Decrease response to CO2 increases (medulla chemoreceptors and aortic body chemoreceptors)

Question 12

What are D isomers of opioids used for?

Answer 12

Cough suppression.

Lack respiratory depression, analgesia, tolerance, drowsiness

Question 13

Opioid CNS ADRs

Answer 13

N/V via stimulation then blockade of chemoreceptor trigger zone

Question 14

Opioid allergies

Answer 14

Very few people have a true allergy to opioids

Question 15

Opioids and constipation

Answer 15

Inhibits peristaltic action but not mixing action. Churn that shit

Question 16

Opioids and the gall bladder

Answer 16

Increased tone -> decreased secretion -> build up of pressure –> pain

Question 17

Common request for opioids. Should it be accepted?

Answer 17

Low back pain.

Not idea, try NSAIDs, APAP, muscle relaxants

Question 18

WHO 3 step ladder

Answer 18

1) Non-opioid +/- adjuvant
2) short acting opioid as required +/- non-opioid +/- adjuvant
3) sustained release/long acting opioid ATC + short acting as required +/- non opioid +/- adjuvant

Question 19

Is it better to give schedule or prn? Why

Answer 19

Schedule, less likely to become dependent

Question 20

Kappa agonist/mu antagonist drugs

Answer 20

Respiratory depression plateaus
Less smooth muscle contraction
Less dependence
However, less max efficacy