Opioid Analgesics and Drug Abuse Flashcards
I-STOP/PMP
Internet System for Tracking Over-Prescribing/Prescription Monitoring Program
T/F: Ibuprofen-APAP (which are NSAIDs) combined may be more effective analgesic than many currently available opioid-containing formulations.
True
Ibuprofen-APAP combined provided greater pain relief than did Ibuprofen or APAP alone after third molar extractions.
True
The third most commonly prescribed drug in 2015.
Hydrocodone/APAP (97m)
What is a schedule II drug?
One that may lead to abuse and dependence.
Any drug containing Hydrocodone is what schedule?
II
Prescriptions for which Schedule drugs CANNOT be refilled?
II
An addictive narcotic drug consisting of the dried juice of the opium poppy.
Opium
Any natural preparation or derivative of opium
Opiate
Opioid
Any narcotic analgesic
Raw dried opium contains _____% morphine and ___% codeine.
12 ; 1
The poppy seed has _________ and _________.
Morphine; Codeine
This opioid receptor is the principal mediator of opioid-induced:
Analgesia Resp depression Miosis Reduced GI motility Physical dependence
Mu Receptor
This substance is released as part of the pleasure center or the reward process.
Dopamine
This NT is inhibited when opioids bind to the mu receptor.
GABA
What happens when opioids binding to the mu receptor inhibit GABA?
More Dopamine is released.
Tendency of the body to adapt to the presence of opioids, making it necessary to use ever-increasing doses to achieve the same effects.
Tolerance
Tolerance develops to these things, but not to these things.
Analgesia, euphoria, respiratory depression;
Constipation and miosis
The psychological attachment to the euphoric effects of opioids.
Addiction
The body has an unpleasant withdrawal syndrome if opioids are abruptly discontinued.
Dependence
2-4h: sense of intense fear
8-16h: Increased SNS activity: nervousness, sweating, increased anxiety and fear, mydriasis
36h: skeletal muscle fasciculation, cramps, gooseflesh, increased respiration, blood sugar, metabolic rate.
48-72h: peaks and subsides over 10 days.
Opioid Withdrawal Syndrome
The inability to feel pain.
Caused by activation of mu receptors.
Analgesia
What are the respiratory depressant effects of opioids?
Carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure.
The most dangerous side effect of opioids.
Respiratory depression.
Characteristic sign of morphine use as well as other opioid drugs: heroin, methadone, and fentanyl (but not meperidine/Demerol).
Miosis - pinpoint pupils
Miosis
pinpoint pupils
A narcotic analgesic agonist of opiate receptors that causes the following:
- Inhibits ascending pain pathways
- Alters brain response to pain, producing analgesia.
- Products sedation and respiratory depression.
Morphine
Adverse effects of Morphine.
Respiratory depression, hypotension, sedation, temperature decrease, constipation, strong potential for addiction.
Advantages of IV administration of Morphine.
- Effect is more immediate.
- Analgesia can be titrated to the pain.
This opioid is broken down to morphine and is less potent than morphine.
Codeine
Tylenol #3 contains:
30 mg Codeine
300 mg Acetaminophen
Used for oral conscious sedation in pediatric dentistry.
Meperidine
Tramadol MOA
1) Centrally acting weak opioid mu agonist
2) Weakly inhibits the reuptake of Serotonin and NE.
This drug is used as an alternative when NSAIDs and codeine-acetaminophen combos are contraindicated.
Tramadol
This opioid is a Schedule 4 controlled substance.
Tramadol
Combo of Hydrocodone and Acetaminophen
Lortab
Vicodin
Hydrocodone + Ibuprofen
Vicoprofen
How many hydrocodone-only products are FDA-approved?
Two: Zohydro and Hysingla
Oxycontin
Oxycodone alone
Percodan
Oxycodone + Aspirin
Percocet
Oxycodone + Acetaminophen
Used for serious pain caused by surgery, broken bones, or cancer.
Hydromorphone
This drug is highly lipid soluble, allowing for significant penetration into the brain, creating a more exaggerated euphoria.
Heroin
Why is Heroin a schedule I drug?
BC it has no medical use.
What is heroin a form of?
Morphine
Used in the controlled withdrawal of dependent abusers from heroin and morphine.
Methadone
Orally-active liquid concentrate whose elimination half-life is 24 hours.
Methadone
T/F: Methadone and other opioids suppress salivary secretion through disordered peripheral signaling at parasympathetic muscarinic receptors and centrally at primary salivary centers.
True
Has 80 to 100-fold the analgesic potency of morphine.
Fentanyl
Suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioid-dependent patient, and blocks the effects of other opioids for 24 hrs.
Buprenorphine
Buprenorphine + Naloxone
Suboxone
A competitive antagonist at opioid receptors and reverses the depressive actions, including the respiratory depression and hypotension of opioid overdose.
Naloxone
Tmax of Naloxone
20-30 mins
Half-life of Naloxone
60-90 mins
