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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
What is the opiate that is not scheduled by the DEA?
tramadol
26
What does tramadol do?
* 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
What is a brand name for tramadol?
Ultram
28
What is Ultracet?
acetaminophen and tramadol
29
What NSAID provides analgesia at the opioid level?
ketorolac (Toradol)
30
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 \_\_\_\_\_\_\_\_?
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
Limit use of opiates to what?
3-5 days for acute pain only
32
What is the most widely used opiate agent for the management of dental pain?
hydrocodone with acetaminophen Vicodin or Lorcet
33
Of the codeine preparations, what is the most widely prescribed opioid in dentistry?
Tylenol #3
34
What is useful for patients with a history of codeine allergy?
meperidine (Demerol)
35
What are not indicated as analgesics in any dental situation?
morphine and hydromorphone (Dilaudid)
36
Rank these opiates by potency (highest to lowest): * meperidine * codeine * dihydrocodeine * fentanyl * morphine * hydrocodone
1. fentanyl 2. morphine 3. meperidine 4. hydrocodone 5. codeine 6. dihydrocodeine

Pharmacology (25 decks)

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