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Pharmacology > Opioid Analgesics 3 > Flashcards

Opioid Analgesics 3 Flashcards

1
Q

What is the most widely used route of administration for morphine?

A

IM

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2
Q

What is the structure of morphine and why is it important?

A

Piperidine ring structure - 6 sided

Needed to bind to opiate mu receptor

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3
Q

What is the most widely abused drug by hospital personnel?

A

meperidine (Demerol)

No miosis - unlike morphine

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4
Q

How is meperidine (Demerol) used in dentistry?

A

IV sedation (conscious sedation)

Orally for moderate to severe pain

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5
Q

What is one of the most frequently prescribed opioids in dentistry, and how is it used?

A

codeine - used in combination products with acetaminophen or aspirin because of the many GI side effects

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6
Q

What is the optimum dose of codeine?

A

60 mg - if exceed 60 mg, no greater analgesic effect but more side effects

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7
Q

How does codeine compare to morphine?

A

1/6th its potency

10mg morphine = 60 mg of codeine

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8
Q

Oral morphine is poorly absorbed, so instead we use?

A

codeine given orally

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9
Q

In dentistry we use codeine in combination preparations with?

A

aspirin, acetaminophen

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10
Q

What is codeine indicated for?

A

Moderate to moderately severe pain

Not good for severe pain (use oxycodone)

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11
Q

What is the drug of choice for cough suppression?

A

codeine

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12
Q

How does the codeine dosing work?

A

codeine containing preparations are identified by numbers that reflect the mg concentration:

  1. # 1 - 8 mg (not sold in US)
  2. # 2 - 15 mg
  3. # 3 - 30 mg
  4. # 4 - 60 mg
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13
Q

What is the most widely prescribed codeine product by dentists?

A

Tylenol #3

codeine (30mg)/ acetaminophen (300mg)

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14
Q

What opioid is 3 times more powerful than codeine?

A

hydrocodone

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15
Q

Hydrocodone is prepared with acetaminophen, what are examples of these drugs?

A
  • Vicodin
  • Lorcet/Lortab
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16
Q

What drug uses acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage and combines it with 10 mg hydrocodone?

A

Norco - stronger opiate dose, baseline acetaminophen dose

17
Q

Is hydrocodone prepared with ibuprofen?

A

Yes

  • Vicoprofen, Ibudone, Reprexain
  • Constant ibuprofen dose - 200mg
18
Q

What opioid has the same efficacy/potency as codeine?

A

dihydrocodiene (Synalgos DC)

no more effective than Tylenol #3

19
Q

Which drug is highly addictive, as potent as morphine and used in dentistry in combo products for severe pain?

A

oxycodone (schedule II)

20
Q

What are the drug examples of oxycodone?

A
  • Percocet - 5/325 (acetaminophen)
  • Tylox - 5/325 (same as Percocet, diff name)
  • Percodan
  • Roxicet
21
Q

Which drug should you be cautious about patients asking specifically for by name?

A

Roxicet - extended release tablet, with concentrated core that people would get high on

22
Q

What is oxycodone 5mg with ibuprofen 400 mg called?

A

Combunox - a short term management of acute, moderate-to-severe dental pain

23
Q

What drug is 100 times more potent than morphine? And what is it used for?

A

fentanyl - in dentistry used for conscious sedation only (IV, transdermal, lollipop)

24
Q

What is the most potent opiate used in dentistry?

A

fentanyl - conscious sedation

25
Q

What is the opiate that is not scheduled by the DEA?

A

tramadol

26
Q

What does tramadol do?

A
  • binds to mu opiate receptors in CNS, which inhibit ascending pathways
  • Inhibits the reuptake of norepinephrine and serotonin
  • Also associated with seizures
  • Only use for up to 5 days
27
Q

What is a brand name for tramadol?

A

Ultram

28
Q

What is Ultracet?

A

acetaminophen and tramadol

29
Q

What NSAID provides analgesia at the opioid level?

A

ketorolac (Toradol)

30
Q

RULES

  1. Most patients are better managed with ____?
  2. Start with _______ preparations?
  3. Only prescribe stronger opioids for ______ periods of time, then switch.
  4. Prescribe _______ quantities without ______.
  5. Prescribe only if the patients has _______.
  6. If pain persists, ________?
  7. If patient demands more drugs?
  8. Chronic pain is managed ________?
A
  1. NSAIDS
  2. combination
  3. short
  4. small, refills
  5. received dental treatment
  6. bring patient back for evaluation and local treatment
  7. refer to pain clinic
  8. differently
31
Q

Limit use of opiates to what?

A

3-5 days for acute pain only

32
Q

What is the most widely used opiate agent for the management of dental pain?

A

hydrocodone with acetaminophen

Vicodin or Lorcet

33
Q

Of the codeine preparations, what is the most widely prescribed opioid in dentistry?

A

Tylenol #3

34
Q

What is useful for patients with a history of codeine allergy?

A

meperidine (Demerol)

35
Q

What are not indicated as analgesics in any dental situation?

A

morphine and hydromorphone (Dilaudid)

36
Q

Rank these opiates by potency (highest to lowest):

  • meperidine
  • codeine
  • dihydrocodeine
  • fentanyl
  • morphine
  • hydrocodone
A
  1. fentanyl
  2. morphine
  3. meperidine
  4. hydrocodone
  5. codeine
  6. dihydrocodeine

Pharmacology (25 decks)

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