Opioid Flashcards
What is an opioid
any substance, wether endogenous or synthetic, that produces morphine-like effects that are blocked by the morphine antagonist naloxone
Opiates
found in plants, derived from the poppy plant
Strong mu-agonists
morphine, fentanyl, hydromorphine, meperidine, methadone, oxycodone
- used for severe pain, BEST pain relief
- generally peach 30-60 mins after administration unless given IV
- schedule II
Mild-moderate mu-agonists
codeine
- weak opioids
- used for moderate pain
- prodrug, must be metabolized to morphine to get the effect
- cough syrup effects (antitussive)
- schedule III
Opioid agonist-antagonist
partial mixed agonists
buprenorphine
- used for mild-moderate pain or if opioid dependent
- agonist at mu receptor
- antagonist at delta and kappa receptors
- prevents withdrawal symptoms when treating opioid dependence
- schedule III
Weak mu and k-agonist
tramadol
- inhibits the repute of norepinephrine and serotonin
- moderate pain relief
- believed to be less addictive
- can cause seizures
- schedule IV
Dosing
morphine is the baseline comparer
- morphine goes through extensive first pass effect so when given PO you need much more than when given IV
Adverse Effects
Most Common: sedation and nausea
Constipation and mitosis are AEs that will not away even when you have built up a tolerance
Others: respiratory depression, cough suppression, urinary retention, and reduced GI motility (truncal rigidity), delayed gastric emptying can cause DDI
Tolerance
decrease in analgesic effect due to an extended amount of time on a drug
Physical dependence
withdrawal when the drug is stopped
- anxiety, irritability, hot flashes, chills, N/V, etc.
Addiction
deliberately seeking out drug due to compulsive cravings
Addiction treatment
- methadone or buprenorphine
- titrate until cravings are minimized
- outpatient therapy
naloxone (Narcan)
competitive antagonist against mu, k, and beta receptors
- binds to opioid receptors and reverses respiratory depression and euphoria
- IV, IM, intranasal
