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Pharmacology 3 > Opiods/Narcotics > Flashcards

Opiods/Narcotics Flashcards

1
Q

What is opium?

A

dried juice from the seed-head of the opium poppy

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2
Q

what are the 3 properties of opium?

A

Analgesia
Anti-tussive
Constipating

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3
Q

What was the first opium derivative?

A

Morphine- named from Morpheus greek god of dreams

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4
Q

What is another opium derivative?

A

codeine

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5
Q

define Opioid

A

generic term for natural and synthetic substances which bind opiod receptors

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6
Q

what are the 3 types of opiod receptors?

A

Delta
Mu
Kappa

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7
Q

How do opioids work?

A

receptor agonism leads to reduction in the secretion of pain inducing NTs

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8
Q

Name the a/e of opioids (7)

A 
Sedation
Reduced peristalsis
Pruritus (histamine release)
Respiratory depression
Nausea/vomiting
Miosis
Peripheral vasodilation
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9
Q

What should you remember to monitor for a patient on opioids?

A

hypotension

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10
Q

What else does an opioid do?

A

contract sphincter of Oddi, increases biliary tree pressure and worsens pancreatic pain

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11
Q

what opioid does not contract the sphincter of oddi?

A

Meperidine

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12
Q

What is the antidote for opioids?

A

Naloxone (acute, overdose)

Naltrexone (longer acting, for detox)

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13
Q

What does Naloxone do to addicts?

A

precipitates severe withdrawal

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14
Q

How do the opioid antidotes work?

A

Reverse respiratory depression

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15
Q

What can the pharmacy in KY dispense?

A

naloxone injections/nasal sprays

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16
Q

Why is methadone good for opioid detox? Why bad?

A

you can control it, and it has a large Vd and long T 1/2

most resistant opioid against naloxone

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17
Q

What forms do opioids come in?

A

IV, SQ, TD, IT (intrathecal, epidural), PCA (patient controlled analgesia)

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18
Q

What is the gold standard opioid? Why is it unique? Used for what? Significant what?

A

Morphine
Highly hydrophilic (unlike most opioids)
Chest pain alerts- reduces sympathetic tone & little reflex tachycardia

Significant first-pass effect

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19
Q

What is first pass effect?

A

With oral ingestion, first go through the liver the drug is metabolized a lot, so PO to IV ration 6:1 for morphine

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20
Q

Meperidine-
structure
potency
metabolism

A

Structure dissimilar to MS (morphine)
75-100mg meperidine, unline MS 10 mg (less potent than MS)
hepatically metabolized to normeperidine, excreted by kidney

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21
Q

What is the ADME precaution with meperidine?

A

Normeperidine accumulation in renal failure, lowers seizure threshold

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22
Q

How long do you use meperidine?

A

72 hours or less

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23
Q

Black clouds with meperidine?

A

seizures

increased serotonin levels, so if combined with SSRI may get serotonin syndrome

24
Q

what is serotonin syndrome?

A

life threatening seizures, tremors, hallucinations, death. stop the drug and treat symptoms

25
Heroin is what? what schedule? what philicity?
semi-synthetic agent derived from MS C1 Lipophilic (highly) Rapidly crosses BBB
26
Meperidine has a role in what? (3 things total)
Obstetrics, it will not prolong labor like MS does anticholenergic properties weak antitussive
27
Avoid meperidine in what?
chest pain alert, may cause reflex tachycardia
28
How is codeine made? Analgesic effects derived from what?
Natural or via methylation of MS Analgesic effects derived from metabolism to morphine (10% of dose)
29
Indications for codeine? Where specifically??
mild to moderate pain Persistent cough ABOVE THE SHOULDERS (dental)
30
What is a popular form of codeine?
Codeine #3-- 300mg APAP with 30mg codeine this is equal to 3mg of morphine!
31
Oxycodone- made how? potency what forms?
semi-synthetic 2x the potency of morphine Immediate release and continuous release
32
Oxycodone comes in combination with what?
ASA and APAP
33
Oxycodone bioavailability?
High systemic bioavailability even following oral administration, so LOW first pass
34
Benefit of oxycodone vs morphine?
Less pruritus and mental status change (less histamine release)
35
Issues with oxycodone?
high abuse potential
36
Hydrocodone- class, made in combination with what, and for pain where?
C2, was C4 made with APAP (Vicodin, Lortab) pain below the shoulders
37
Hydromorphone comes how? potency?
IV and PO, 5x the potency of MS (PO), 8x the potency of MS (IV)
38
Methadone acts how?
reduces cravings and the euphoric effects of other opiods
39
Why is methadone good for drug addicts?
Long duration of action, large Vd
40
Is methadone hydro or lipophilic?
HIGHLY lipophilic
41
Recent concerns with methadone?
QT complex prolongation (torsades) also difficult to reverse in overdose
42
What is backloading?
use own blood to mix drug, makes it isotonic so your veins don't collapse
43
Percocet vs percodan?
oxycodone with APAP (percocet) and with ASA (percodan)
44
Fentanyl- T1/2, potency, __philic
Short half life, so short-acting 100x more potent than morphine (highest) High lipophilicity
45
Fentanyl is an ideal ____ agent
transdermal, lasts 72 hours
46
How do you get the most of a transdermal agent?
run it under hot water
47
What are the fentanyl analogous? Potency compared to fentanyl?
Alfentanil (less potent) Remifentanil (as potent, good peri-anesthetic agent) shorter half lives than fentanyl
48
Tramadol- what is it? How does it work? Class
Centrally acting analgesic with weak opioid activity Inhibits reuptake of NE and enhances 5-HT release From C VI to C IV
49
Tramadol benefits and risks?
less respiratory depression. BUT reduces seizure threshold
50
What were we wrong about with tramadol?
higher addictive potential than we originally thought
51
Tramadol is between what two drugs?
Toradol and true narcotic
52
Bupenorphine should be used for what?
instead of methodone for opioid dependence and moderate-severe pain.
53
How does bupenorphine work?
opioid agonist/antagonist (pain/dependence)
54
What class is bupenorphine?
CIII
55
What is a 6th cousin to narcotics?
dextromethorphan (DM) antitussive

Pharmacology 3 (10 decks)

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