opioid analgesia

Question 1

side effects of opioids

Answer 1

1. nausea
2. pruritis/flushing/ sweating
3. respiratory depression

Question 2

opioid analgesics MOA

Answer 2

agonist to Mu, kappa and delta receptors which mediate main effects of endorphins

Question 3

central pharmacodynamic effects with opioid analgesics (5)

Answer 3

1. analgesia
2. sedation
3. mood alterations
4. miosis
5. seizures
6. respiratory depression
7. N/V (direct stim. of CTZ)
8. cough suppression

Question 4

do opioids have antipyretic or anti-inflammatory effects?

Answer 4

Nope, they might even raise the core temp

Question 5

peripheral pharmacodynamic effects of opioid analgesics

Answer 5

1. delayed gastric emptying and slowed intestinal transit

2. vasodilation (due to histamine release)

Question 6

more lipohilic the opioid agent is ….

Answer 6

the more likely it will have an effect on the reward pathway

Question 7

peripheral tolerance for SE of opioids?

Answer 7

yep except constipation

Question 8

more recent potential concerns of opioid analgesics

Answer 8

1. serotonin syndrome
2. adrenal insufficiency
3. androgen deficiency

Question 9

diacetylmorphine

Answer 9

heroine- derived from morphine

Question 10

codeine is a prodrug for

Answer 10

morphine

• needs to be converted to have analgesic effect

Question 11

codeine duration of action

Answer 11

short: 4-6 hr

Question 12

oxycodone short or long acting?

Answer 12

shortduration but there are formulas with extended release like oxycontin

Question 13

methadone

Answer 13

long acting my receptor agonist used as a opioid withdrawal maintenance.

Question 14

underlying risk of methadone

Answer 14

QT prolongation

Question 15

meperidine

Answer 15

short acting otherwise it will accumulate as nor-meperidine which causes tremors and seizures and there is the potential for serotonin syndrome

Question 16

diphenoxylate and loperamice

Answer 16

have activity in the bowel and thus is used to slow transit time and treat diarrhea

***** diphenoxylate has the potential if in high doses to produce analgesia effect but no penetration in CNS

Question 17

loperamide has what possibility to happen in excess

Answer 17

cardiotoxicity

Question 18

fentanyl

Answer 18

approx. 80-100x as potent as morphine, incredible dangerous. In a clinical setting it is either used as parenteral or transdermal

***it does not get absorbed orally

Question 19

naloxone

Answer 19

binds to the mu- receptor with high affinity with quick onset but short duration (to minimize the effect of withdrawal)

Question 20

opioid withdrawal

Answer 20

1. diaphoresis
2. abdominal cramping, diarrhea
3. nausea and vomiting
4. tachycardia
5. agitation

Question 21

Mixed Agonist-Antagonist Agents

Answer 21

Bind to mu & kappa receptors, acting as either agonists or antagonists
Can block activity of other opioids at mu- receptors

Adverse effects:
Sedation, dizziness, nausea
May induce acute w/drawal from other opioids

Question 22

PAMORAs (peripheral opioid receptor antagonist)

Answer 22

used when another opioid is causing constipation

Question 23

buprenorphine (suboxone)

Answer 23

withdrawal maintenance partial agonist

Question 24

Weak mu-opioid receptor agonist

Also inhibits re-uptake of serotonin & norepinephrine

Answer 24

tramadol

Question 25

full or partial agonist or antagonist of the opioid receptor:

methadone

Answer 25

full agonist

Question 26

full or partial agonist or antagonist of the opioid receptor:

sublaxone

Answer 26

partial agonist

Question 27

full or partial agonist or antagonist of the opioid receptor:

naloxone

Answer 27

antagonist