Opioid Analgesics and Antagonists

Question 1

Opioid with the shortest half life

Answer 1

Remifentanil (3-4 mins)

Question 2

Opioid with the longest half life

Answer 2

Buprenorphine (4-8 hours)

Question 3

Receptor that inhibits respiration

Answer 3

Mu (Mabagal Huminga)

Question 4

Receptor involved in development of tolerance

Answer 4

Delta (Tolerance)

Question 5

Receptor involved in slowed GI transit

Answer 5

Kappa (Konstipation)

Question 6

Analgesic of choice for MI due to reduction in preload Full Opioid Agonist, nonselective Acts on Mu receptors SE: Pruritus Exerts hemodynamic effects on pulmonary circulation

Answer 6

Morphine

Question 7

Full Opioid Agonist Acts on Mu receptors Drug for chronic pain, breakthrough cancer pain May be given transdermally or via lollipop

Answer 7

Fentanyl

Question 8

Most potent opioid (18000x)

Answer 8

Ohmefentanyl

Question 9

Full Opioid Agonist Acts on Mu and Kappa receptors Muscarinic blocking actions Drug for moderate to sever pain, spasmodic pain (biliary, renal), preop sedation, antiemetic Does NOT CAUSE MIOSIS or biliary spasm Serotonin syndrome when used with SSRIs or MAOIs

Answer 9

Meperidine

Question 10

Opioid of choice for pain relief in pancreatitis and biliary colic

Answer 10

Meperidine

Question 11

Metabolite of Meperidine that decreases seizure threshold

Answer 11

Normeperidine

Question 12

Full Opioid Agonist Acts on Mu receptors Drug for moderate to severe pain, Opioid dependence, opioid withdrawal Used in methadone Maintenance Therapy (MMT) for dependence Investigated as novel tx for Leukemia Drug?

Answer 12

Methadone

Question 13

Partial Opioid Agonist Acts on Mu and Kappa receptors Drug for Mod to Severe pain, Cancer pain, Neuropathic pain, Chronic pain SE: Hypogonadism, hearing loss Drug?

Answer 13

Hydrocodone

Question 14

Partial Opioid Agonist Decreases sensitivity of cough receptors through sigma receptor stimulation Drug for cough SE: Addiction liability Serotonin syndrome when used with SSRIs or MAOI

Answer 14

Dextrometorphan

Question 15

Weak Opioid Agonist Acts on Mu receptors Drug for mild to moderate pain, restless legs syndrome, opioid withdrawal SE: Seizures, pulmo edema, fatal arrhythmia WITHDRAWN due to fatal cardiotoxicity Used in suicides

Answer 15

Propoxyphene

Question 16

Mixed Opioid Agonist - Antagonist Strong Kappa agonist Weak Mu antagonist Drug for Moderate to severe pain, opioid dependence, alcohol dependence, balanced anesthesia SE: Sedation, dizziness Resistant to naloxone reversal

Answer 16

Nalbuphine (Buprenorphine, Butorphanol, Pentazocine)

Question 17

Opioids that can reduce craving in alcohol dependence

Answer 17

Buprenorphine Naloxone

Question 18

Systemic opioid antagonist Blocks, mu, kappa and delta Drug for opioid overdose Precipitates abstinence syndrome in pxs with opioid dependence

Answer 18

Naloxone

Question 19

Dual acting opioid analgesic Weak agonist at mu receptor, inhibits neuronal reuptake of serotonin and NE Drug for mod pain, chronic pain syndromes, neuropathic pain, fibromyalgia SE: Seizures Lowers seizure threshold Contraindicated in pxs with epilepsy Serotonin syndrome when used with SSRIs

Answer 19

Tramadol (Tapentadol)

Question 20

Triad of Opioid Overdose

Answer 20

PCR Pupilary Constriction Comatose State Respiratory Depression

Question 21

How do you confirm opioid overdose pharmacologically?

Answer 21

IV injection of Naloxone results in recovery